Biomechanical analysis of the role of wrist guards in "splint-top" forearm fractures [skating application]

Abstract A numerical investigation is conducted on the injury-related biomechanical parameters of the human head under blunt impacts. The objective of this research is twofold; first to understand the role of the employed finite element (FE) head model — with its specific components, shape, size, material properties, and mesh size — in predicting tissue responses of the brain, and second to investigate the fidelity of pressure response in validating FE head models. Accordingly, two independently established and validated FE head models are impacted in two directions under two impact severities and their predicted responses in terms of intracranial pressure (ICP) and shear stress are compared. The coup-counter ICP peak values are less sensitive to head model, mesh size, and the brain material. In all cases, maximum ICPs occur on the outer surface, vanishing linearly toward the center of the brain. Hence, it is concluded that different head models may simply reproduce the results of ICP variations due to impact. Shear stress prediction, however, is mainly affected by the head model, direction and severity of impact, and the brain material.

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Medial migration in cephalomedullary nail fixation of pertrochanteric hip fractures

Bone and Joint Research ◽

10.1302/2046-3758.87.bjr-2018-0271.r1 ◽

2019 ◽

Vol 8 (7) ◽

pp. 313-322 ◽

Cited By ~ 3

Author(s):

G. W. Law ◽

Y. R. Wong ◽

A. K-S. Yew ◽

A. C. T. Choh ◽

J. S. B. Koh ◽

...

Keyword(s):

Cyclic Loading ◽

Hip Fractures ◽

Tensile Loading ◽

Biomechanical Analysis ◽

Cephalomedullary Nail ◽

Compression Loading ◽

Medial Migration ◽

Group 3 ◽

Group 2

Objectives The paradoxical migration of the femoral neck element (FNE) superomedially against gravity, with respect to the intramedullary component of the cephalomedullary device, is a poorly understood phenomenon increasingly seen in the management of pertrochanteric hip fractures with the intramedullary nail. The aim of this study was to investigate the role of bidirectional loading on the medial migration phenomenon, based on unique wear patterns seen on scanning electron microscopy of retrieved implants suggestive of FNE toggling. Methods A total of 18 synthetic femurs (Sawbones, Vashon Island, Washington) with comminuted pertrochanteric fractures were divided into three groups (n = 6 per group). Fracture fixation was performed using the Proximal Femoral Nail Antirotation (PFNA) implant (Synthes, Oberdorf, Switzerland; n = 6). Group 1 was subjected to unidirectional compression loading (600 N), with an elastomer (70A durometer) replacing loose fracture fragments to simulate surrounding soft-tissue tensioning. Group 2 was subjected to bidirectional loading (600 N compression loading, 120 N tensile loading), also with the elastomer replacing loose fracture fragments. Group 3 was subjected to bidirectional loading (600 N compression loading, 120 N tensile loading) without the elastomer. All constructs were tested at 2 Hz for 5000 cycles or until cut-out occurred. The medial migration distance (MMD) was recorded at the end of the testing cycles. Results The MMDs for Groups 1, 2, and 3 were 1.02 mm, 6.27 mm, and 5.44 mm respectively, with reliable reproduction of medial migration seen in all groups. Bidirectional loading groups showed significantly higher MMDs compared with the unidirectional loading group (p < 0.01). Conclusion Our results demonstrate significant contributions of bidirectional cyclic loading to the medial migration phenomenon in cephalomedullary nail fixation of pertrochanteric hip fractures. Cite this article: G. W. Law, Y. R. Wong, A. K-S. Yew, A. C. T. Choh, J. S. B. Koh, T. S. Howe. Medial migration in cephalomedullary nail fixation of pertrochanteric hip fractures: A biomechanical analysis using a novel bidirectional cyclic loading model. Bone Joint Res 2019;8:313–322. DOI: 10.1302/2046-3758.87.BJR-2018-0271.R1.

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