Biomechanical Comparison of Facet Versus Laminar C2 Screws.

BACKGROUND: Transpedicular or transisthmic screws for C2 instrumentation represent the gold standard; however, the anatomy is not always compatible (hypoplastic pedicles, procidentia of the vertebral artery). Laminar screws (LS) have been proposed as a rescue technique and recently, bicortical facet screws (FS). To date, the biomechanical property of FS remains unknown. OBJECTIVE: To compare the pull-out resistance of bicortical facet (FS) vs laminar (LS) C2 screws. METHODS: Thirty-two human cadaveric C2 vertebrae were screened by CT scan imaging and dual x-ray absorptiometry before receiving both techniques and were randomized according to side and sequence (FS or LS first). Screw positioning was validated using 2-dimensional x-rays. Sixty-four mechanical tests were performed using pure tensile loading along the axis of the screws until pull-out. Mean pull-out strengths were compared using paired tests, multivariate and survival analysis (Kaplan-Meier curves). RESULTS: The morphometric data were consistent with previous studies. Over 64 tests, the mean pull-out strength of LS (707 ± 467 N) was significantly higher than that of FS (390 ± 230 N) ( P = .0004). Bone mineral density was weakly correlated with pull-out strength (r = 0.42 for FS and r = 0.3 for LS). Both techniques were mechanically equivalent for vertebrae in which intralaminar cortical grip was not achievable for LS. The mean pull-out strength for LS with laminar cortical grip (1071 ± 395 N) was significantly higher than that of LS without (423 ± 291 N) ( P < .0001). CONCLUSION: Our results suggest that bicortical FS of C2 offer less mechanical resistance than LS.

Slouched and Erect Sitting Postures Affect Upper Limb Maximum Voluntary Force Levels and Fatiguability: A Randomized Experimental Study.

OCCUPATIONAL APPLICATIONSModifying the spinal curvature is an empirical approach to treating upper limb musculoskeletal disorders, often attributed to the balance between physical stress and individual functional capacities. We completed an experimental biomechanical study to quantify the effect of seated spinal posture on upper limb functional capacities. Isometric maximum muscle voluntary forces (MVFs) were measured at participants' shoulder, elbow, and wrist. Fatiguability was also assessed during a repetitive painting task. Participants were asked to assume both slouched and erect spinal postures, in a random order. In the erect posture, participants achieved higher shoulder and elbow isometric MVF levels and took longer to reach a fatigue threshold. Thus, spinal posture tends to remotely influence upper limb functional capacities, especially at the shoulder and elbow. Ergonomists should consider spinal posture even when focusing on musculoskeletal disorders of the upper limb.

Background Musculoskeletal disorders are a major public health issue, and current treatments often remain unsatisfactory. Treatments based on spinal curvature modifications are empirically used for upper limb musculoskeletal disorders.Purpose To determine whether a slouched or erect sitting posture has an effect on upper limb functional capacities, with tests and outcomes focused on the risk of upper limb musculoskeletal disorders.Methods Randomized experimental study, crossover design. Twenty-two right-handed healthy participants from the local area were assessed in a research laboratory. Participants' spinal curvatures were increased or decreased, through verbal instructions and light touch, to place them in a slouched or an erect posture that was stable and easily maintained, in a random order. Isometric maximum muscle voluntary forces (MVFs) were measured. Participants also performed a repetitive task that simulated painting, with fatigue level assessed using the CR10 Borg scale. Upper limb positioning, task setting, and instructions to participants were standardized, and the investigator was blind to the results of MVF measurements. The main outcomes were normalized differences in MVF values and time-to-reach "7" on the CR10 scale.Results There were significantly higher MVF values in the erect posture for the shoulder and elbow, with respective mean (SD) normalized differences of 11.4 (18.2)% and 11.8 (19.2)%; differences approached significance at the wrist [7.7 (18.5)%]. The normalized difference in time-to-reach "7" on the CR10 scale was significantly higher in the erect posture (by 11.4%).Conclusions Spinal posture modified individual upper limb functional capacities and could thus influence the risk of upper limb musculoskeletal disorders.

Short isthmic versus long trans-isthmic C2 screw: anatomical and biomechanical evaluation.

INTRODUCTION: The Harms technique is now considered as the gold standard to stabilize C1-C2 cervical spine. It has been reported to decrease the risk of vertebral artery injury. However, the risk of vascular injury does not totally disappear, particularly due to the proximity of the trans-isthmic C2 screw with the foramen transversarium of C2. In order to decrease this risk of vertebral artery injury, it has been proposed to use a shorter screw which stops before the foramen transversarium. OBJECT: The main objective was to compare the pull-out strength of long trans-isthmic screw (LS) versus short isthmic screw (SS) C2 screw. An additional morphological study was also performed. METHOD: Thirteen fresh-frozen human cadaveric cervical spines were included in the study. Orientation, width and height of the isthmus of C2 were measured on CT scan. Then, 3.5-mm titanium screws were inserted in C2 isthmus according to the Harms technique. Each specimen received a LS and a SS. The side and the order of placement were determined with a randomization table. Pull-out strengths and stiffness were evaluated with a testing machine, and paired samples were compared using Wilcoxon signed-rank test and also the Kaplan-Meier method. RESULTS: The mean isthmus transversal orientation was 20° ± 6°. The mean width of C2 isthmus was less than 3.5 mm in 35 % of the cases. The mean pull-out strength for LS was 340 ± 85 versus 213 ± 104 N for SS (p = 0.004). The mean stiffness for the LS was 144 ± 40 and 97 ± 54 N/mm for the SS (p = 0.02). DISCUSSION: The pull-out strength of trans-isthmic C2 screws was significantly higher (60 % additional pull-out resistance) than SSs. Although associated with an inferior resistance, SSs may be used in case of narrow isthmus which contraindicates 3.5-mm screw insertion but does not represent the first option for C2 instrumentation. LEVEL OF EVIDENCE: Level V.

The biomechanics of concussion in unhelmeted football players in Australia: a case-control study.

OBJECTIVE: Concussion is a prevalent brain injury in sport and the wider community. Despite this, little research has been conducted investigating the dynamics of impacts to the unprotected human head and injury causation in vivo, in particular the roles of linear and angular head acceleration. SETTING: Professional contact football in Australia. PARTICIPANTS: Adult male professional Australian rules football players participating in 30 games randomly selected from 103 games. Cases selected based on an observable head impact, no observable symptoms (eg, loss-of-consciousness and convulsions), no on-field medical management and no injury recorded at the time. PRIMARY AND SECONDARY OUTCOME MEASURES: A data set for no-injury head impact cases comprising head impact locations and head impact dynamic parameters estimated through rigid body simulations using the MAthematical DYnamic MOdels (MADYMO) human facet model. This data set was compared to previously reported concussion case data. RESULTS: Qualitative analysis showed that the head was more vulnerable to lateral impacts. Logistic regression analyses of head acceleration and velocity components revealed that angular acceleration of the head in the coronal plane had the strongest association with concussion; tentative tolerance levels of 1747 rad/s(2) and 2296 rad/s(2) were reported for a 50% and 75% likelihood of concussion, respectively. The mean maximum resultant angular accelerations for the concussion and no-injury cases were 7951 rad/s(2) (SD 3562 rad/s(2)) and 4300 rad/s(2) (SD 3657 rad/s(2)), respectively. Linear acceleration is currently used in the assessment of helmets and padded headgear. The 50% and 75% likelihood of concussion values for resultant linear head acceleration in this study were 65.1 and 88.5 g, respectively. CONCLUSIONS: As hypothesised by Holbourn over 70 years ago, angular acceleration plays an important role in the pathomechanics of concussion, which has major ramifications in terms of helmet design and other efforts to prevent and manage concussion.

An investigation of shoulder forces in active shoulder tackles in rugby union football.

In rugby union football the tackle is the most frequently executed skill and one most associated with injury, including shoulder injury to the tackler. Despite the importance of the tackle, little is known about the magnitude of shoulder forces in the tackle and influencing factors. The objectives of the study were to measure the shoulder force in the tackle, as well as the effects of shoulder padding, skill level, side of body, player size, and experimental setting on shoulder force. Experiments were conducted in laboratory and field settings using a repeated measures design. Thirty-five participants were recruited to the laboratory and 98 to the field setting. All were male aged over 18 years with rugby experience. The maximum force applied to the shoulder in an active shoulder tackle was measured with a custom built forceplate incorporated into a 45 kg tackle bag. The overall average maximum shoulder force was 1660 N in the laboratory and 1997 N in the field. This difference was significant. The shoulder force for tackling without shoulder pads was 1684 N compared to 1635 N with shoulder pads. There was no difference between the shoulder forces on the dominant and non-dominant sides. Shoulder force reduced with tackle repetition. No relationship was observed between player skill level and size. A substantial force can be applied to the shoulder and to an opponent in the tackle. This force is within the shoulder's injury tolerance range and is unaffected by shoulder pads.

Tackle characteristics and injury in a cross section of rugby union football.

BACKGROUND: The tackle is the game event in rugby union most associated with injury. This study's main aims were to measure tackle characteristics from video using a qualitative protocol, to assess whether the characteristics differed by level of play, and to measure the associations between tackle characteristics and injury. METHODS: A cohort study was undertaken. The cohort comprised male rugby players in the following levels: younger than 15 yr, 18 yr, and 20 yr, grade, and elite (Super 12 and Wallabies). All tackle events and technique characteristics were coded in 77 game halves using a standardized qualitative protocol. Game injuries and missed-game injuries were identified and correlated with tackle events. RESULTS: A total of 6618 tackle events, including 81 resulting in a game injury, were observed and coded in the 77 game halves fully analyzed (145 tackle events per hour). An increase in the proportion of active shoulder tackles was observed from younger than 15 yr (13%) to elite (31%). Younger players engaged in more passive tackles and tended to stay on their feet more than experienced players. Younger than 15 yr rugby players had a significantly lower risk of tackle game injury compared with elite players. No specific tackle technique was observed to be associated with a significantly increased risk of game injury. There was a greater risk of game injury associated with two or more tacklers involved in the tackle event, and the greatest risk was associated with simultaneous contact by tacklers, after adjusting for level of play. CONCLUSIONS: Tackle characteristics differed between levels of play. The number of tacklers and the sequence of tackler contact with the ball carrier require consideration from an injury prevention perspective.

Numerical reconstruction of real-life concussive football impacts.

PURPOSE: To present a protocol of numerical reconstructions of concussive events in football using MADYMO. To refine the knowledge of the dynamics associated with these events. METHODS: Twenty-seven cases of concussive head impacts involving unhelmeted Australian football and rugby players were simulated using MADYMO. The cases had been previously analyzed using a video analysis protocol and were fully reconstructed for the purpose of this study. The reliability of these reconstructions had been previously assessed using a sensitivity analysis of the influence of several independent variables on the dynamical outputs. The use of a complete human model enabled consideration for morphometry, initial movements of the players, and an accurate estimate of the effective masses involved in the impacts. RESULTS: Mean peak values for concussion were found to be 103 g for the head center of gravity linear acceleration, 8022 rad s(-2) for the head angular acceleration, and 359 for the head impact criterion. An estimate of the average effective energy transferred to the head was 47 J. With the severity grading used in this study, the head impact power was found to be the best predictor of concussion severity. CONCLUSIONS: These biomechanical results compare well with other studies. They should contribute to the identification of the energy levels at which concussive impacts occur in football for the purpose of a better evaluation of protective devices in these sports.

Neck injury tolerance under inertial loads in side impacts.

Neck injury remains a major issue in road safety. Current side impact dummies and side impact crashworthiness assessments do not assess the risk of neck injury. These assessments are limited by biofidelity and knowledge regarding neck injury criteria and tolerance levels in side impacts. Side impact tests with PMHS were performed at the Heidelberg University in the 1980s and 1990s to improve primarily the understanding of trunk dynamics, injury mechanisms and criteria. In order to contribute to the definition of human tolerances at neck level, this study presents an analysis of the head/neck biomechanical parameters that were measured in these tests and their relationship to neck injury severity. Data from 15 impact tests were analysed. Head accelerations, and neck forces and moments were calculated from 9-accelerometer array head data, X-rays and anthropometric data. Statistically significant relationships were observed between resultant head acceleration and neck force and neck injury severity. The average resultant head acceleration for AIS 2 neck injuries was 112 g, while resultant neck force was 4925 N and moment 241 Nm. The data compared well to other test data on cadavers and volunteers. It is hoped that the paper will assist in the understanding of neck injuries and the development of tolerance criteria.