Functionally graded 3D printed plates for rib fracture fixation.

BACKGROUND: Design freedom offered by additive manufacturing allows for the implementation of functional gradients - where mechanical stiffness is decreased along the length of the implant. It is unclear if such changes will influence failure mechanisms in the context of rib fracture repair. We hypothesized that our novel functionally graded rib implants would be less stiff than controls and decrease occurrence of secondary fracture at implant ends. METHODS: Five novel additively manufactured rib implants were tested along with a clinically used Control implant. Fracture reconstructions were modeled with custom synthetic rib bones with a transverse B1 fracture. Ribs were compressed in a cyclic two-point bend test for 360,000 cycles followed by a ramp to failure test. Differences in cyclic stiffness, 3D interfragmentary motions, ramp-to-failure stiffness, maximum load, and work to failure were determined. FINDINGS: The Control group had lower construct stiffness (0.76 ± 0.28 N/mm), compared to all novel implant designs (means: 1.35-1.61 N/mm, p < 0.05) and rotated significantly more about the bending axis (2.7° ± 1.3°) than the additively manufactured groups (means between 1.2° - 1.6°, p < 0.05). All constructs failed via bone fracture at the most posterior screw hole. Experimental implants were stiffer than Controls, and there were few significant differences between functional gradient groups. INTERPRETATION: Additively manufactured, functionally graded designs have the potential to change the form and function of trauma implants. Here, the impact of functional gradients was limited because implants had small cross-sectional areas.

A Novel Approach to Visualize Liquid Aluminum Flow to Advance Casting Science.

Turbulent filling of molten metal in sand-casting leads to bi-films, porosity and oxide inclusions which results in poor mechanical properties and high scrap rate of sand castings. Hence, it is critical to understand the metal flow in sand-molds, i.e., casting hydrodynamics to eliminate casting defects. While multiple numerical methods have been applied to simulate this phenomenon for decades, harsh foundry environments and expensive x-ray equipment have limited experimental approaches to accurately visualize metal flow in sand molds. In this paper, a novel approach to solve this challenge is proposed using Succinonitrile (SCN) as a more accurate metal analog in place of water. SCN has a long history in solidification research due to its BCC (Body-Centered-Cubic) crystal structure and dendrite-like solidification (melting temperature ~60 °C) like molten aluminum. However, this is the first reported study on applying SCN through novel casting hydrodynamics to accurately visualize melt flow for casting studies. This paper used numerical simulations and experiments using both water and SCN to identify the critical dimensionless numbers to perform accurate metal flow analog testing. Froude's number and wall roughness were identified as critical variables. Experimental results show that SCN flow testing was more accurate in recreating the flow profile of molten aluminum, thus validating its utility as a metal analog for metal flow research. Findings from this study can be used in future metal flow analysis such as: runner, in-gate and integrated filling-feeding-solidification studies.

Biomechanical behavior of PMMA 3D printed biomimetic scaffolds: Effects of physiologically relevant environment.

Functional cellular structures with controllable mechanical and morphological properties are of great interest for applications including tissue engineering, energy storage, and aerospace. Additive manufacturing (AM), also referred to as 3D printing, has enabled the potential for fabrication of functional porous scaffolds (i.e., meta-biomaterials) with controlled geometrical, morphological, and mechanical properties. Understanding the biomechanical behavior of 3D printed porous scaffolds under physiologically relevant loading and environmental conditions is crucial in accurately predicting the in vivo performance. This study was aimed to investigate the environmental dependency of the mechanical responses of 3D printed porous scaffolds of poly(methyl methacrylate) (PMMA) Class IIa biomaterial that was based on triply periodic minimal surfaces - TPMS (i.e., Primitive and Schoen-IWP). The 3D printed scaffolds (n = 5/study group) were tested under compressive loading in both ambient and fluidic (distilled water with pH = 7.4) environments according to ASTM D1621 standards. Outcomes of this study showed that compressive properties of the developed scaffolds are significantly lower in the fluidic condition than the ambient environment for the same topological and morphological group (p≤0.023). Additionally, compressive properties and flexural stiffness of the studied scaffolds were within the range of trabecular bone's properties, for both topological classes. Relationships between predicted mechanical responses and morphological properties (i.e., porosity) were evaluated for each topological class. Quantitative correlation analysis indicated that mechanical behavior of the developed 3D printed scaffolds can be controlled based on both topology and morphology.

A reactive molecular dynamics study of bi-modal particle size distribution in binder-jetting additive manufacturing using stainless-steel powders.

Binder-jetting is a powder-bed-based additive manufacturing (AM) process that is uniquely different from other powder-bed "fusion" metal AM technologies because it is a binder-based consolidation process similar to powder metallurgy "green" part and offers a larger selection of materials and part design capabilities. In order to improve a final part's density and achieve desired mechanical properties, binder-jetting usually requires lengthy post-processing steps such as curing, sintering, and infiltration. The role of particle size distribution in this process has been demonstrated to have a major impact. When comparing different distributions such as mono- and bi-modal sizes, the latter, consisting of a mix between coarser and finer particles, has shown to increase packing density and decrease porosity for a printed part. In this present work, we employ ReaxFF reactive force-field-based molecular dynamics (MD) simulations to study the atomistic level mechanism of binder-jetting using a bi-modal austenitic stainless-steel powder mixture. In addition, we compare the fracture process of the bi-modal powder mixture system with that of a system with mono-modal particle size, aiming to understand how the finer particles in the bi-modal powder mixture contribute to raising rupture strength. The MD simulation results show that the energy barriers after curing and sintering in the bi-modal particle system increase by 42.9% and 40.9%, respectively than in the mono-modal particle system. Moreover, the analysis of chemical composition and microstructure shows that iron is dominantly oxidized by oxygen atoms rather than hydroxyl radicals. Besides, the finer particle is subject to internal oxidation during sintering because its iron core melts. In contrast, the iron core of the coarser particle remains crystalline. Additionally, the statistical analysis of bonding oxygen atoms for each reference iron atom indicates that both particles have a small ratio of iron oxidized to Fe(II) but only slowly oxidizes to Fe(III) in the binder-jetting process. The coarser particle has a lot of non-oxidized iron atoms, while the majority of iron atoms in the finer particle bond with one oxygen atom during the time scale of our MD simulations. Furthermore, de-hydroxylation and oxygen inward diffusion lead to the reduction of chromium cations throughout sintering. The original findings of this study provide a nanoscale explanation for the mechanical property improvement using a bi-modal powder mixture. Moreover, the study of chemical composition and microstructure also contributes to improving the chemical properties of binder-jetting products.

Current concepts in fracture healing: temporal dynamization and applications for additive manufacturing.

Objectives: Current surgical fracture treatment paradigms, which use rigid metallic constructs to heal bones, provide reasonable clinical outcomes; however, they do not leverage recent advances in our understanding of bone healing and mechanotransduction throughout bone healing. The objective of this review was to investigate the efficacy and potential clinical applicability of surgical techniques and implants that deliberately introduce interfragmentary motion throughout the healing process. Methods: The authors searched PubMed and Google Scholar databases for articles reporting on fracture repair using dynamic locking plates, dynamized surgical techniques, and reverse dynamization. Data collection also included assessment of additively manufactured (AM) implants that provide dynamic mechanical behaviors. Results: Forty articles were included for final review. It was found that accelerated rates of fracture healing can be achieved with staged 2-part surgeries or dynamic implant designs. Temporal dynamization, where static fixation of bones is followed by the introduction of micromotion and controlled loading, has been shown to improve callus volume and accelerate the healing response. Reverse dynamization, where micromotion is encouraged during early callus formation and arrested later, may represent a significant advance for the treatment of critical defect injuries. Advances in AM techniques will likely provide the ability to create high-resolution implants capable of dynamized and reverse dynamized modalities. Conclusions: There is no one-size-fits-all approach to optimization of fracture healing. However, it has been clearly demonstrated that fracture treatment can be enhanced by systematically altering the construct stiffness throughout the different phases of healing, which may be achieved with AM implant designs.

Additively manufactured patient-specific prosthesis for tumor reconstruction: Design, process, and properties.

Design and processing capabilities of additive manufacturing (AM) to fabricate complex geometries continues to drive the adoption of AM for biomedical applications. In this study, a validated design methodology is presented to evaluate AM as an effective fabrication technique for reconstruction of large bone defects after tumor resection in pediatric oncology patients. Implanting off-the-shelf components in pediatric patients is especially challenging because most standard components are sized and shaped for more common adult cases. While currently reported efforts on AM implants are focused on maxillofacial, hip and knee reconstructions, there have been no reported studies on reconstruction of proximal humerus tumors. A case study of a 9-year-old diagnosed with proximal humerus osteosarcoma was used to develop a patient-specific AM prosthesis for the humerus following tumor resection. Commonly used body-centered cubic (BCC) structures were incorporated at the surgical neck and distal interface in order to increase the effective surface area, promote osseointegration, and reduce the implant weight. A patient-specific prosthesis was fabricated using electron beam melting method from biocompatible Ti-6Al-4V. Both computational and biomechanical tests were performed on the prosthesis to evaluate its biomechanical behavior under varying loading conditions. Morphological analysis of the construct using micro-computed tomography was used to compare the as-designed and as-built prosthesis. It was found that the patient-specific prosthesis could withstand physiologically-relevant loading conditions with minimal permanent deformation (82 µm after 105 cycles) at the medial aspect of the porous surgical neck. These outcomes support potential translation of the patient-specific AM prostheses to reconstruct large bone defects following tumor resection.

Finite Element-Predicted Effects of Screw Configuration in Proximal Humerus Fracture Fixation.

Internal fixation with the use of locking plates is the standard surgical treatment for proximal humerus fractures, one of the most common fractures in the elderly. Screw cut-out through weak cancellous bone of the humeral head, which ultimately results in collapse of the fixed fracture, is the leading cause of failure and revision surgery. In an attempt to address this problem, surgeons often attach the plate with as many locking screws as possible into the proximal fragment. It is not thoroughly understood which screws and screw combinations play the most critical roles in fixation stability. This study conducted a detailed finite element analysis to evaluate critical parameters associated with screw cut-out failure. Several clinically relevant screw configurations and fracture gap sizes were modeled. Findings demonstrate that in perfectly reduced fracture cases, variation of the screw configurations had minor influence on mechanical stability of the fixation. The effects of screw configurations became substantial with the existence of a fracture gap. Interestingly, the use of a single anterior calcar screw was as effective as utilizing two screws to support the calcar. On the other hand, the variation in calcar screw configuration had minor influence on the fixation stability when all the proximal screws (A-D level) were filled. This study evaluates different screw configurations to further understand the influence of combined screw configurations and the individual screws on the fixation stability. Findings from this study may help decrease the risk for screw cut-out with proximal humerus varus collapse and the associated economic costs.

Biomechanical Testing of Additive Manufactured Proximal Humerus Fracture Fixation Plates.

Achieving satisfactory fracture fixation in osteoporotic patients with unstable proximal humerus fractures remains a major clinical challenge. Varus collapse is one of the more prominent complications that may lead to screw cutout. This aim of this study was to compare the fixation provided by conventional locking plates with novel design concepts that are only feasible through additive manufacturing (AM) techniques. In addition to reversed engineered implants, two novel implant designs with integrated struts were included in the study to provide medial support to humeral head. The medial strut was either solid or included a porous lattice structure intended to promote bone ingrowth. Biomechanical tests were performed using low density synthetic bones with simulated 3-part comminuted fractures. Nondestructive torsion and compression were performed, followed by increasing cyclic loading. The relative displacements between the bone fragments were determined using a 3D motion capture system. The AM manufactured implants with medial strut showed significant reduction of varus displacement during the increasing cyclic loading when compared to conventional designs. AM reversed-engineered locking plates showed similar mechanical behavior to conventional plates with identical geometry. This study demonstrates the feasibility and potential of employing alternative design via AM for fixation of unstable comminuted proximal humerus fractures to reduce fragment displacement.

A ReaxFF molecular dynamics study of molecular-level interactions during binder jetting 3D-printing.

In the present work, we study one of the major additive manufacturing processes, i.e., the binder jetting printing (BJP) process, at the molecular level through atomistic-scale level representations of powders and binder solutions with chromium-oxide (Cr-oxide) nanoparticles and water-based diethylene glycol solutions, respectively. The results show that both diethylene glycol and water contribute to the bonding of Cr-oxide particles during the print and curing stages by forming a hydrogen bond network. Heating the system to the burn-out temperature results in the oxidation of diethylene glycol and the decomposition of the hydrogen bond network. Subsequently, Cr-oxide particles are partially sintered by forming Cr-O bonds. The final sintering facilitates further Cr-O bond formation. Additionally, the influence of the chemical composition of the binder solution is investigated by performing ReaxFF molecular dynamics simulations on two sets of systems, which control the number of water and diethylene glycol molecules, respectively. Our results demonstrate that adding both diethylene glycol and water to the binder solution can raise the number of "useful" hydrogen bonds, resulting in a higher breaking strength at the print and curing stages. During the burn-out and sintering stages, the influence of water on the breaking strength is not obvious. In contrast, an optimal quantity of binder species exists for the breaking strength after sintering. A comparison of the ReaxFF molecular dynamics simulations using 2-ethoxyethanol, diethylene glycol and 1-(2,2,2-trihydroxyethoxy)ethane-2,2,2-triol as the binder phase indicates that an increasing number of hydroxyl groups leads to higher breaking strength at the print and curing stages. The findings from this study can be extended to identify the optimal binder chemistry, curing and sintering conditions for different material systems.