Experimental Methods in Orthopaedic Biomechanics

Visit the link below to download the full version of this book:

https://medipdf.com/product/experimental-methods-in-orthopaedic-biomechanics/

Click Download Now

Dedication

For my parents: Obrad and Ana Zdero

Ia npjf rpejtfљf: Pbrae j Aoa Hefrp
Acknowledgments

I am grateful to Fiona Geraghty, Maria Convey, and Lisa Jones of Elsevier Inc., who
were efficient and energetic in bringing this project to fruition. My sincere thanks to
all the contributing authors who took time out of their busy teaching and research
schedules to add their highly valuable chapters to this book, as well as for being
open to my editorial feedback. My appreciation also goes out to my past and present
students and colleagues who inspire me with their enthusiasm for discovery. And,
finally, I am beholden to the late great scientist and engineer Nikola Tesla, whose
world-changing insights and innovations allow the rest of us to stand on the
shoulders of a giant.

xix
What Is Orthopaedic Biomechanics?

Radovan Zdero
Western University, London, ON, Canada

WHAT IS THE MUSCULOSKELETAL SYSTEM?

To understand what this book is really about and how to best use it, some
basic background information must first be considered. The musculoskeletal sys-
tem is a complex network of hard tissues, soft tissues, and biofluids that interact
with each other to provide both form and function to the human body. Bones
bestow shape and size to the body while also being involved in performing a va-
riety of tasks. Muscles generate forces that move limbs and other body segments.
Tendons connect muscles to bones, thereby transmitting force from the former to
the latter. Ligaments connect bones to other bones, thus allowing appropriate
relative positioning and/or motion between neighboring bones. Cartilage and
meniscus are like shock absorbers, which modulate stresses transferred across
the interfaces of articulating joints. Biofluids, such as blood, marrow, and syno-
vial fluid, deliver nourishment to hard and soft tissues, as well as being involved
in lubricating joints.

WHAT IS BIOMECHANICS?
Biomechanics is the field of study that uses the engineering tools of statics, dy-
namics, and strength of materials to analyze the kinetics (i.e., loads) and kine-
matics (i.e., motions) experienced by the musculoskeletal system. These loads
and motions may be generated during a whole host of very different activities of
daily living, disease conditions, or injury events. So, biomechanics can be divided
into five or more primary subfields, although some overlap exists (Fig. 1). Occu-
pational biomechanics addresses workplace tasks, ergonomic design of tools and
workspaces, and injuries. Sports biomechanics deals with physical training, ath-
letic activities, and injuries. Transportation biomechanics focuses on passenger
comfort and safety during vehicle operation, ergonomic design of vehicle interiors,
and accidents causing injury. Rehabilitation biomechanics concerns the recovery
of musculoskeletal strength and function after disease, injury, or surgery. And,
finally, orthopaedic biomechanics, which is the focus of this book, uses engineer-
ing analysis tools in order to (1) characterize the mechanical properties of bones,
joints, and soft tissues; (2) develop new implants and biomaterials for artificial
joint replacement, bone fracture fixation, and soft tissue repair; and (3) optimize
orthopaedic surgical techniques.

xxi
xxii What Is Orthopaedic Biomechanics?

FIGURE 1
Biomechanics is a field of study dealing with loads and motions on the musculoskeletal
system. The subfield of orthopaedic biomechanics is the focus of this book.

WHAT IS ORTHOPAEDIC BIOMECHANICS?

Orthopaedic biomechanics is about discovering and potentially optimizing the
mechanical stresses experienced by normal, diseased, injured, or surgically treated
bones, joints, and soft tissues. This subfield of study is particularly influenced by
two groups of specialists, namely, orthopaedic surgeons and biomechanical engi-
neers. Orthopaedic surgeons are on the “clinical frontline,” as they treat patients
by performing procedures like total or partial joint replacement, bone fracture repair,
soft tissue repair, limb deformity correction, and bone tumor removal. Biomechan-
ical engineers are on the “technological frontline,” as they discover the basic me-
chanical properties of human tissues, design and test the structural stress limits of
 What Is Orthopaedic Biomechanics? xxiii

FIGURE 2
Experimental research activities in orthopaedic biomechanics.

orthopaedic implants, and develop new and improved biological and artificial bio-
materials. Consequently, the strategy for conducting cutting-edge experimental
research in orthopaedic biomechanics in hospitals, universities, and industry, in-
cludes a combination of orthopaedic surgery, mechanical testing, and medical imag-
ing (Fig. 2).

WHAT IS THE PURPOSE OF THIS BOOK?

Much of the valuable material published in the field of orthopaedic biome-
chanics, including textbooks, peer-reviewed journal articles, and conference pro-
ceedings, is still of limited practical use in learning about laboratory
experimentation. So, the aim of this book is to give the reader step-by-step,
hands-on, do-it-yourself, practical instructions for performing experiments in
xxiv What Is Orthopaedic Biomechanics?

orthopaedic biomechanics. This is not a book about foundational concepts in ortho-

paedic biomechanics,1e6 the principles and practice of orthopaedic surgery,7e9
highly specialized experiments for one type of tissue or material used in orthopae-
dics,10,11 or computational modeling in orthopaedic biomechanics,12e14 for which
there are some excellent recommended resources created by experienced biome-
chanical engineers and orthopaedic surgeons. Rather, the motivating question for
this work is, “After reading this book, can even an inexperienced reader go into
the lab and successfully perform a wide variety of orthopaedic biomechanics exper-
iments from start to finish?” Since practical factors limit the range of experimental
methods that can be described, the book focuses on in vitro test methods on cadav-
eric tissue or artificial material. Even so, the large variety of techniques explored
represent many of the most widely used approachesdsome of which are considered
“classic” techniques in the fielddwhile recognizing that the progress of science and
technology may eventually give way to new and improved modalities. Consequently,
several types of readers will benefit from this book: engineering students learning to
apply their analytical skills to the musculoskeletal system, orthopaedic surgeons
growing in their knowledge of biomechanical methods, young researchers establish-
ing their academic or professional careers, and experienced researchers expanding
their teaching and/or research beyond their current focus.

WHAT IS THE FORMAT OF THIS BOOK?

Part 1 provides chapters on experimental methods for bones, such as whole
bones with or without implants, bone tissues, and bone cells. Part 2 offers chapters
on experimental methods for assessing the properties of human and artificial artic-
ulating joints. Part 3 gives chapters on experimental methods applied to soft tissues
like cartilage/meniscus, ligament/tendon, and muscle. Obviously, some chapters
could easily be classified as belonging to another part of the book, but the chosen
groupings are sufficient for the aims of this volume. Each chapter presents content
in a generic and rational way in order to emphasize underlying principles that can
be easily adapted to a range of research questions. To this end, each chapter fol-
lows a standardized structure to make learning more effective and logical: Back-
ground, Research Questions, Methodology, Results, Discussion, Summary, Quiz
Questions, and References. Note that the Methodology and Results sections delib-
erately provide only “mock” graphs and/or “empty” tables in order to illustrate the
typical data trends and parameters measured during experiments; thus, the graphs
and tables do not show actual numerical data. But, representative numerical data
reported in the scientific literature are summarized in each Discussion section.
And, finally, gray boxes, which highlight special content, are scattered throughout
each chapter to make learning more memorable and enjoyable: Glossary, Safety
First, Tips and Tricks, The Gold Standard, Engineer’s Toolbox, and Alternatives
and Adaptations.
 What Is Orthopaedic Biomechanics? xxv

WHAT IS THE BEST WAY TO USE THIS BOOK?

Some science textbooks sit on shelves collecting dust, or perhaps they are read
but without making any practical difference. Other science textbooks, however,
are used for the advancement of teaching, research, and technology. And so, there
are many ways to get the most out of this book, rather than just reading it, which
can be applied to university, industry, or hospital contexts:
• Design a new university-level course, using this book as the course textbook.
• Create undergraduate student lab tasks, homework assignments, and class
projects.
• Formulate hypotheses and/or methodologies for graduate student thesis projects.
• Train lab managers, technicians, and other staff in experimental techniques.
• Expand the research programs of experienced researchers into new areas.
• Develop “gold standard” test methods that are recognized internationally.
• etc.
Another helpful idea for practical hands-on training and teaching using this book
can be summarized by the acronym S.H.O.E (Fig. 3). S stands for “show,” meaning
that the mentor performs a task, while the mentee only watches carefully. H stands
for “help,” meaning that the mentor helps the mentee perform the task themselves. O
stands for “observe,” meaning that the mentee performs the task by themselves,
while the mentor only watches and makes helpful verbal comments. E stands for
“exit,” meaning that the mentor now physically leaves the context, trusting
that the mentee will be able to carry on with the task by themselves. While
teacher-to-student transfer of theoretical information through lectures, books,
videos, etc., has a pivotal role in modern education, the mentor-to-mentee

FIGURE 3
The S.H.O.E. system of mentoring.
xxvi What Is Orthopaedic Biomechanics?

apprenticeship approach has also been used effectively and extensively over the
course of human civilization for many different endeavors. Now equipped with a
basic background, may the reader expectantly turn to the content of the book!

REFERENCES
1. Fung YC. Biomechanics: mechanical properties of living tissues. New York, NY, USA:
Springer-Verlag; 1981.
2. Johnson KD, Tencer AF. Biomechanics in orthopedic trauma: bone fracture and fixation.
Philadelphia, PA, USA: JB Lippincott Company; 1994.
3. Poitout DG, editor. Biomechanics and biomaterials in orthopedics. London, UK:
Springer; 2004.
4. Mow VC, Huiskes R, editors. Basic orthopaedic biomechanics and mechano-biology.
3rd ed. Philadelphia, PA, USA: Lippincott, Williams, and Wilkins; 2005.
5. Bartel DL, Davy DT, Keaveny TM, editors. Orthopaedic biomechanics: mechanics and
design in musculoskeletal systems. Upper Saddle River, NJ, USA: Prentice Hall; 2006.
6. Winkelstein BA, editor. Orthopaedic biomechanics. Boca Raton, FL, USA: CRC Press;
2012.
7. Garino JP, Beredjiklian PK, editors. Adult reconstruction arthroplasty: core knowledge
in orthopaedics. Philadelphia, PA, USA: Mosby Elsevier; 2007.
8. Sanders R, editor. Trauma: core knowledge in orthopaedics. Philadelphia, PA, USA:
Mosby Elsevier; 2008.
9. Wiesel SW, editor. Operative techniques in orthopaedic surgery. Philadelphia, PA, USA:
Lippincott, Williams, and Wilkins; 2010.
10. An YH, Draughn RA, editors. Mechanical testing of bone and the bone-implant
interface. Boca Raton, FL, USA: CRC Press; 2000.
11. Saunders MM. Mechanical testing for the biomechanical engineer: a practical guide.
San Rafael, CA, USA: Morgan and Claypool Publishers; 2015.
12. Zdero R, Bougherara H. Orthopaedic biomechanics: a practical approach to combining
mechanical testing and finite element analysis. In: Moratal D, editor. Finite element
analysis. Rijeka, Croatia: InTech; 2010 [chapter 7] Available free online at, http://cdn.
intechweb.org/pdfs/11992.pdf.
13. Nedoma J, Stehlik J, Hlavacek I, Danek J, Dostalova T, Preckova P. Mathematical and
computational methods in biomechanics of human skeletal systems. Hoboken, NJ,
USA: Wiley and Sons; 2011.
14. Zhang M, Fan Y, editors. Computational biomechanics of the musculoskeletal system.
Boca Raton, FL, USA: CRC Press; 2014.
 CHAPTER

High-Speed Impact
Testing and Injury
Assessment of Whole
Bones
1
Cheryl E. Quenneville
McMaster University, Hamilton, ON, Canada

1. BACKGROUND
Human bones are vulnerable to injury from a wide range of events, such as falls,
automotive crashes, and sporting collisions, to name a few (Fig. 1.1). In order to
evaluate protective measures, the injury limits of whole bones need to be established
through impact testing, which is typically done on cadavers. This allows investiga-
tion of the factors that influence injury, and using statistical methods safety limits
can be established, which are used by industry to assess risk during various events.
Furthermore, the injury tolerance of whole bones must be identified and translated to
measures obtained using surrogates, such as anthropomorphic test devices (ATDs, or
“crash test dummies”), in order to be used outside of the research lab environment.
Lastly, an understanding of the factors that influence fracture allows development of
better protective measures, thus reducing the incidence and severity of these debil-
itating injuries. Therefore, this chapter explains high-speed impact testing of whole
bone, as well as how to analyze, present, and interpret results.

FIGURE 1.1
Typical whole bone injury mechanisms. (A) Motor vehicle accident, (B) fall from a height.
Experimental Methods in Orthopaedic Biomechanics. http://dx.doi.org/10.1016/B978-0-12-803802-4.00001-9 3
Copyright © 2017 Elsevier Inc. All rights reserved.
4 CHAPTER 1 High-Speed Impact Testing and Injury Assessment

2. RESEARCH QUESTIONS
Typical research questions might include one or more of the following:
• What is the fracture tolerance of a specific whole bone?
• How do posture, impact angle, and impact duration affect the fracture tolerance
of a bone?
• What is the most effective protective device for preventing injury of a bone?
• How can surrogates be developed to be used by industry for safety evaluations?
• etc.

3. METHODOLOGY
3.1 GENERAL STRATEGY
Cadaveric isolated whole bones are obtained from the relevant population (e.g.,
gender, age range, bone density, etc.) and then tested under high-speed impacts. As
an example of how to perform such analysis, axial testing of the tibia is described
here, but the methods can be applied to any bone, or even fully intact limbs. Impact
testing is often done using a specialized impacting apparatus, such as pendulum-
based1 or pneumatic2 systems. The impact parameters must be properly selected
to replicate the relevant loading and may include impactor mass, velocity, acceler-
ation, impact duration, and/or energy. Tibias are aligned according to anatomical
landmarks to ensure consistency among tests, instrumented as required, and sub-
jected to impacts of increasing intensity until failure occurs. Statistical methods
are then used to establish injury tolerance curves and identify the factors that
contributed to tibial fracture risk.

GLOSSARY
✓ ATD (anthropomorphic test device). A surrogate to represent the natural human body in size and
mass distribution, commonly referred to as a “crash test dummy”.
✓ Biofidelity corridor. Force graphs from impact tests indicating the approximate range of response
of the majority of the population.
✓ Diaphysis. A long bone’s central shaft that is made primarily of cortical bone.
✓ Epiphysis. A long bone’s rounded end that transmits load from a joint to the diaphysis.
✓ Impulse. The mathematical integral of impact force over testing time.
✓ Momentum (linear). The mathematical product of mass and velocity.

SAFETY FIRST
✓ When working with scalpels, be careful to always cut away from oneself.
✓ Always follow standard operating procedures for the impacting device to ensure safety.
✓ Operate the device only when everyone is properly protected from the impact.
✓ Hearing protection is recommended, as impacts can cause high dB sounds.
 3. Methodology 5

3.2 MATERIALS AND TOOLS LIST

• alcohol wipes
• cement for potting
• high-speed camera (optional)
• human or animal bone
• impacting apparatus
• instrumentation (e.g., strain gage(s), accelerometer(s), etc.)
• levels (e.g., water or laser)
• PVC plastic pipe segment
• sandpaper
• scalpel
• strain gage glue

3.3 SPECIMEN PREPARATION

Step 1. Freeze the specimens. All isolated whole bones should be kept frozen
prior to testing, preferably freshefrozen within 24 h postmortem, and wrapped in
plastic. Prior to testing, thaw isolated bones at room temperature for at least 8 h.
Step 2. Prepare the specimens. Strip isolated bones of all soft tissues, with
particular attention to the end of the bone to be potted later, as well as locations
of interest for instrumentation to be used later.
Step 3. Prepare for potting. In order to hold the specimen in the appropriate
posture for impact testing, at least one end needs to be potted. The potting process
ensures a consistent orientation of all specimens in the impacting apparatus and pro-
vides a secure place at which to hold the bone without slipping. Potting typically
consists of embedding the end of a bone in a block of cement. This can be done
by placing the specimen’s end in a length of PVC plastic pipe and filling it with
some sort of cement (e.g., dental cement).
Step 4. Anatomically align specimens. The orientation of a bone has a significant
influence on the fracture tolerance and location under impact loading, and therefore it
must be controlled to be consistent for all specimens in a given study. To achieve this
alignment, support the bone in the required orientation using a frame structure. Select
anatomical landmarks that allow consistent alignment. For example, to pot the prox-
imal tibia, center the proximal epiphysis in the PVC plastic pipe segment with the
anterior ridge defining one vertical axis and the center of the lateral malleolus defining
a second vertical axis. Project laser levels along each specimen to fine-tune the orien-
tation until satisfactory alignment has been achieved (Fig. 1.2A and B).
Step 5. Pour the cement. The cement level should be of sufficient depth to main-
tain a strong hold, even under impacts that could jar the specimen loose. For the
proximal tibia, this is approximately 50 mm, but may vary depending on the bone
and orientation of impact. To enhance the hold, make sure the specimen is well
scraped of soft tissues, press the cement all around the contours of the specimen,
and embed screws in the potted end, if fixation is a concern. Leave the specimen sup-
ported in the alignment frame for a minimum of 10 min while the cement sets, and at
least 30 min further before testing (Fig. 1.2C).
6 CHAPTER 1 High-Speed Impact Testing and Injury Assessment

A B C D

FIGURE 1.2
Whole bone preparation for impact tests. (A) Bone alignment using a laser and support frame
(frontal view), (B) bone alignment using a laser and support frame (sagittal view), (C) the end
of each bone is embedded in PVC plastic pipe using cement to provide a rigid method to grip
specimens during impacts, (D) instrumentation such as strain gages can be affixed to the
surface of bones using adhesives in order to characterize the load transmission along
specimens during impact.

Step 6. Instrument the bones. Specimens can be instrumented at various loca-

tions to provide further information about load transmission and to provide data for
developing finite element models. The most common types of instrumentation are
strain gages and accelerometers. To provide accurate data, these sensors must be
securely attached to the bone and, thus, should be placed above and below the ex-
pected location of fracture to provide the most useful data on stress propagation.
Clean the surface of the bone by scraping it gently with a scalpel, and then rub it
with sandpaper. Rub the surface with an alcohol pad to degrease the surface, and
allow it to dry. Apply a thin layer of glue to the location of interest, and apply finger
pressure through adhesive tape to form a smooth flat surface. After it dries, remove
the adhesive tape, and let it cure for another 5 min. Lightly smooth any irregularities
with sandpaper, apply the instrumentation (e.g., strain gage) with glue, and press
evenly until it dries. Cover the sensor and lead wire attachments with a protective
coating (e.g., clear nail polish) (Fig. 1.2D).

TIPS AND TRICKS

✓ Removing soft tissue is easier if bone is thawed for 1 h.
✓ Potting can be done before thawing of the whole bone specimen.
✓ To protect instrumentation, secure lead wires to the specimen with tape or elastic bands.
✓ Align strain gages or one element of strain gage rosettes with the long axis of the bone.
✓ Paired specimens can be used to directly compare different test conditions.
 3. Methodology 7

THE “GOLD STANDARD”

No known international standards exist specifically for performing high-speed impact tests on long
bones. Thus, researchers should consult previously published peer-reviewed journal articles that
have done experimental testing for this orthopaedic biomechanics application.

3.4 SPECIMEN TESTING

Step 1. Perform pre-test calibration. Once the relevant test parameters have
been decided in order to accurately replicate the loading scenario being examined,
the impacting apparatus must be calibrated prior to generating these impacts
(Fig. 1.3). This ensures that known impact conditions are applied to the bone test
specimen, and it allows for precise control over the increments used. This can be
done using an ATD or even a potted section of PVC plastic pipe or wood so cadav-
eric bone specimens are not wasted during this process. However, remember that the
output forces will vary depending on the stiffness of the object being struck. Select
the appropriate input parameters (e.g., pressure, mass, velocity, force) for all calibra-
tion tests, which are conducted using the same steps 2e9 (below) that are employed
for testing the whole bones. Next, generate the resulting calibration curve for the
impacting device by testing at different conditions (e.g., increasing the pressure of
a pneumatic system and then measuring the resulting projectile velocity immedi-
ately prior to impact) (Fig. 1.4).
Step 2. Mount the bone into the tester. Place an isolated whole bone into the
impacting apparatus, attaching the pot securely (Fig. 1.3). If testing in a posture
other than pure axial impacts, align one anatomical direction that was marked during
the laser alignment process with the axes of the impacting apparatus (e.g., always
place the anterior surface pointing upwards). Verify the alignment in both planes us-
ing levels typically held at the mid-diaphysis location.
Step 3. Ballast to a consistent weight. Add any required ballast weight to the
bone specimen. Often it is desired to ensure that the overall mass of the specimen
is equivalent to the segment mass in vivo, so this would be on the order of w4.5 kg
for the lower leg and foot, or w12 kg to represent the full leg. Obtain these mass
values from anthropometric tables for the population of interest. Weigh each potted
specimen and any supporting components, and attach masses to the potted specimen
until the desired mass is reached. Make sure these masses are mounted securely.
Step 4. Verify data acquisition. Connect the instrumentation (e.g., strain gages,
accelerometers, etc.) to the data acquisition system, calibrate the sensors, and verify
that all signals are collecting properly. High sampling frequencies are necessary for
these tests, as they are quite rapid; thus, aim for a minimum of 10 kHz. Position any
lights, and then adjust balance and focus of any high-speed cameras being used to
record the event, which is typically recording at >1000 fps. The velocity of the pro-
jectile can be measured using reflective sensors or a photo gate at the location imme-
diately prior to impact.
8 CHAPTER 1 High-Speed Impact Testing and Injury Assessment

B C

FIGURE 1.3
Impacting test setup. (A) Tibia loaded in axial alignment for testing, (B) artificial bone or joint
(e.g., rapid prototyped plastic talus) used to transmit load to the articular surface of the bone,
(C) metal projectile used to create the impact event.

Step 5. Position the bone for testing. Push the bone specimen up so it contacts
the load transmission component (e.g., for distal tibia impacts, an artificial talus can
be used to transfer the load evenly over the articular surface) (Fig. 1.3B). This load
transmission component should be stronger than the specimens, and it can be made
of a synthetic composite bone or a plastic (e.g., rapid prototyped plastic). Adjust this
interface so the two components fit together as naturally as possible to ensure an
even transfer of force. By mounting this load transmission component to an