Serious head and neck injury as a predictor of occupant position in fatal rollover crashes.

Serious head and neck injuries are a common finding in fatalities associated with rollover crashes. In some fatal rollover crashes, particularly when ejection occurs, the determination of which occupant was driving at the time of the crash may be uncertain. In the present investigation, we describe the analysis of rollover crash data from the National Automotive Sampling System-Crashworthiness Data System for the years 1997 through 2007 in which we examined the relationship between a serious head and neck injury in an occupant and a specified degree of roof deformation at the occupant's seating position. We found 960 occupants who qualified for the analysis, with 142 deaths among the subjects. Using a ranked composite head and neck injury score (the HNISS) we found a strong relationship between HNISS and the degree of roof crush. As a result of the analysis, we arrived at a predictive model, in which each additional unit increase in HNISS equated to an increased odds of roof crush as follows: for ≥8 cm of roof crush compared with <8 cm by 4%, for ≥15 cm of roof crush compared to <8 cm by 6% and for ≥30 cm of roof crush compared to <8 cm by 11%. We describe two hypothetical scenarios in which the model could be applied to the real world investigation of occupant position in a rollover crash-related fatality.

The µPIVOT: an integrated particle image velocimeter and optical tweezers instrument for microenvironment investigations.

A novel instrument to manipulate and characterize the mechanical environment in and around microscale objects in a fluidic environment has been developed by integrating two laser-based techniques: micron-resolution particle image velocimetry (µPIV) and optical tweezers (OT). This instrument, the µPIVOT, enables a new realm of microscale studies, yet still maintains the individual capabilities of each optical technique. This was demonstrated with individual measurements of optical trap stiffness (∼70 pN µm(-1) for a 20 µm polystyrene sphere and a linear relationship between trap stiffness and laser power) and fluid velocities within 436 nm of a microchannel wall. The integrated device was validated by comparing computational flow predictions to the measured velocity profile around a trapped particle in either a uniform flow or an imposed, gravity-driven microchannel flow (R(2) = 0.988, RMS error = 13.04 µm s(-1)). Interaction between both techniques is shown to be negligible for 15 µm to 35 µm diameter trapped particles subjected to fluid velocities from 50 µm s(-1) to 500 µm s(-1) even at the highest laser power (1.45 W). The integrated techniques will provide a unique perspective toward understanding microscale phenomena including single-cell biomechanics, non-Newtonian fluid mechanics and single particle or particle-particle hydrodynamics.

Concentric and eccentric shoulder rehabilitation biomechanics.

The use of an impulse-momentum (IM) exercise technique was investigated for end-stage shoulder rehabilitation. The objectives of this study were to: (a) quantify the net shoulder joint forces and moments while using an IM system and (b) test the influence of gender and muscle loading type (concentric or eccentric) on kinetic and kinematic parameters. Fourteen healthy adults (eight males, six females) performed a repeated measures experiment on an instrumented device utilizing a cabled shuttle system. While maintaining 90 degrees of shoulder abduction and 90 degrees of elbow flexion, the subjects externally rotated their upper arm from 0 degrees to 90 degrees (concentric acceleration) and then internally rotated their upper arm back from 90 degrees to the 0 degrees position (eccentric deceleration). Shoulder joint forces and moments as well as rotational work and power were calculated using inverse dynamics (free-body forces and moments calculated at intersegmental joint centres). Overall concentric peak forces and moments were greater than eccentric peak forces and moments (P < 0.0001). Joint forces and moments reached a maximum during the initial phase of concentric loading (0 degrees to 45 degrees) compared with any other rotational position in the loading cycle (concentric 45 degrees to 90 degrees or eccentric 90 degrees to 0 degrees). The results also indicate that males experienced higher (P < 0.0001) average resultant peak joint forces (concentric 0 degrees to 45 degrees = 108.0 N and eccentric 90 degrees to 45 degrees = 87.2 N) than females (concentric 0 degrees to 45 degrees = 74.7 N and eccentric 45 degrees to 0 degrees = 56.0 N). In addition, males experienced higher (P < 0.0001) average resultant peak joint moments (concentric 0 degrees to 45 degrees = 30.4 N m and eccentric 45 degrees to 0 degrees = 21.0 N m) than females (concentric 0 degrees to 45 degrees = 19.7 N m and eccentric 45 degrees to 0 degrees = 12.8 N m).

Dynamic matrix composition in engineered cartilage with stochastic supplementation of growth factors.

Dynamic extracellular matrix (ECM) synthesis is explored in a hypothesized engineered cartilage construct. Growth (alpha) and decay (beta) rate parameters are developed from a previous engineered cartilage model. The presented mathematical model was constructed from the parameterized experimental data using a deterministic and stochastic examination of ECM synthesis based on a negative feedback control mechanism. A growth factor supplementation is incorporated in a probabilistic mathematical approach. The growth factor component modified an initial deterministic model through a Gaussian white noise fluctuation. As the primary constituents of ECM, the mathematical tool is intended to characterize the probable steady state distribution of glycosaminoglycan (GAG) and collagen molecules as well as mean mass accumulation at homeostasis. Computer simulation of the models is applied to reported data from four similar chondrocyte-polymer construct culture systems. The range in rate ratios reflect the differing nature of GAG and collagen synthesis (alphaGAG/betaGAG = 4.2 to 148.6; alphacollagen/betacollagen = 8.1 to 2590.4). This technique reduced the influencing synthesis factors to a few key descriptive parameters. Additional anabolic and catabolic factors may further be built into the models.

Mechanical vasoconstriction for a cerebral myogenic autoregulatory model.

This work presents the design of a mechanical vasoconstriction mechanism with application for cerebral autoregulation. The relationship between the applied voltage of a DC motor and the tension within a pressurized vessel wall was utilized for constricting an arteriole segment within an intracranial vascular model. Using current proportional to the string tension, options for closed loop feedback control are considered.

Direct perfusion measurements of cancellous bone anisotropic permeability.

More extensive characterization of trabecular connectivity and intertrabecular space will be instrumental in understanding disease states and designing engineered bone. This project presents an experimental protocol to define the directional dependence of transport properties as measured from healthy cancellous bone when considered as a biologic, porous medium. In the initial design phases, mature bovine bone was harvested from the femoral neck (n=6 cylinders) and distal condyle (n=4 cubes) regions and used for "proof of concept" experimentation. A power study on those results led to the presented work on 20 cubic samples (mean volume=4.09cm(3)) harvested from a single bovine distal femur. Anisotropic intrinsic permeabilities (k(i)) were quantified along the orthogonal anatomic axes (i=medial-lateral, anterior-posterior, and superior-inferior) from each individual cubic bone sample. Using direct perfusion measurements, permeability was calculated based upon Darcy's Law describing flow through porous media. The maximum mean value was associated with the superior-inferior orientation (4.65x10(-10)m(2)) in comparison with the mean anterior-posterior (4.52x10(-10)m(2)) and medial-lateral (2.33x10(-10)m(2)) direction values. The results demonstrate the anisotropic (p=0.0143) and heterogeneous (p=0.0002) nature of the tissue and encourage the ongoing quantification of parameters within the established poroelastic models.

Chip fractures of the first metatarsal head. Primary fragment excision versus immobilization: a report of four cases.

Four cases of a distal lateral impaction fracture of the first metatarsal are presented. Two treatment schemes were implemented. In two of the patients the fracture fragment was removed early. The other two patients had either percutaneous pinning or a weightbearing cast Each case discusses the rationale for the selected treatment as well as the clinical outcome. All four patients ultimately had successful retums to full activity with a more immediate return to exercise for the two patients with excised fracture fragments (6-week difference).

Effects of mechanical and thermal fatigue on dental drill performance.

Osseous integration of dental implants depends on the use of proper surgical technique during site preparation, including the prevention of thermal injury to the surrounding bone. Heat generation during drilling has been reported to positively correlate with the production of forces at the surgical site. In this study, peak torque and axial load levels were measured during a drilling procedure into a polymeric material simulating the human mandible. Axial rotary milling was performed using 5 different twist drill designs (3i Irrigated Tri-Spade, 3i Disposable, Nobel-Biocare, Straumann, and Lifecore) of 15 to 20 mm in length and 2 to 2.3 mm in diameter, at a free-running rotational speed of 1,500 rpm and continuous feed rate of 3.5 mm/second, to a total depth of 10.5 mm. Ten drills representing each of the 5 types (n = 50) were subjected to 30 individual drill "pecks" and heat-sterilized every 3 "pecks" to determine the effects of cyclic mechanical and thermal loading on drill performance. Normal stress (sigma) and shear stress (tau) were calculated from the kinetic data and drill geometries. A drill efficiency coefficient (mu) was also calculated as the ratio of torsional resistance to translational resistance. Overall, the hypotheses of drill performance dependency on drill type as well as mechanical and thermal accumulated loading were tested and confirmed (P < .05). The 5 drill types produced a range of normal stresses (2.54 to 5.00 MPa), shear stresses (9.69 to 29.71 MPa), and efficiency (1.16 to 3.16) during repeated testing. Scanning electron microscopic images revealed minor deformations in the cutting edges of the tri-spade drills following testing.

Comparison of chondrogensis in static and perfused bioreactor culture.

As a result of the low yield of cartilage from primary patient harvests and a high demand for autologous cartilage for reconstructive surgery and structural repair, primary explant cartilage must be augmented by tissue engineering techniques. In this study, chondrocytes seeded on PLLA/PGA scaffolds in static culture and a direct perfusion bioreactor were biochemically and histologically analyzed to determine the effects of fluid flow and media pH on matrix assembly. A gradual media pH change was maintained in the bioreactor within 7.4-6.96 over 2 weeks compared to a more rapid decrease from 7.4 to 6.58 in static culture over 3 days. Seeded scaffolds subjected to 1 microm/s flow demonstrated a 118% increase (p < 0.05) in DNA content, a 184% increase (p < 0.05) in GAG content, and a 155% (p < 0.05) increase in hydroxyproline content compared to static culture. Distinct differences were noted in tissue morphology, including more intense staining for proteoglycans by safranin-O and alignment of cells in the direction of media flow. Culture of chondrocyte seeded matrices thus offers the possibility of rapid in vitro expansion of donor cartilage for the repair of structural defects, tracheal injury, and vascularized tissue damage.

A morphometric evaluation of allograft matrix combinations in the treatment of osseous defects in a baboon model.

Recent and ongoing research efforts have been made to increase the efficacy of biomaterials as structural fillers during in vivo bony reconstructions. Although the selection of the possible material choices has grown, a biomaterial that can be physically molded to the defect/void space as well as offer biomimetic tissue regeneration has yet to be made available. With the potential success of demineralized freeze-dried bone allografts (DFDBA) combined with tendonous collagen as an effective filling material, further research should help to elucidate its use. The purpose of this study was to evaluate the regenerative healing response of five allograft mixtures via the morphology of filled, periodontal defects. Critical size mandibular and maxillary osseous defects were surgically created in six adult baboons. The filling response of four combinations of DFDBA and tendon collagen was compared with an all-collagen graft after 3 months of implantation. The overall results indicate that all combinations of DFDBA and collagen provided a better fill response than the all-collagen matrix (P < 0. 05). Statistically, however, all of the combinations were similar (P > 0.05) with a 60:40 collagen to DFDBA mass ratio resulting in the largest defect fill response.

Applications of an anisotropic parameter to cortical bone.

An equational description of the extent of the anisotropy in cortical bone is presented from both the perspective of plane stress (two-dimensional stress state) and plane strain (three-dimensional stress state). The orthotropic elastic properties that are incorporated in these states are used to provide a more thorough and refined description of planar and volumetric anisotropy in comparison to the commonly used ratio of elastic moduli. The resulting anisotropic parametric equations (eta(sigma) and eta(epsilon)) are applied to the elastic material properties measured from cortical bone within rats, dogs, cows and humans as reported in 12 previous studies. The resulting calculated parameters reduce the typically nine independent properties down to three parameters which in turn represent the degree of anisotropy within the three orthogonal planes of symmetry as are common in cortical bone. It was found that no statistical difference existed between the plane stress versus plane strain parameter in all but two studies (p > 0.10). Planar and volumetric anisotropies were compared to the isotropic condition (eta(sigma) = eta(epsilon) = 1.0) for all of the included studies. All of the studies reported cortical bone properties that were volumetrically anisotropic (p < 0.05), however, a common plane of isotropy was noted in the radial-circumferential (1-2) plane (p > 0.05). Future use of these parametric equations will allow further illucidation of the issue of mesomechanical and micromechanical levels of anisotropy within other tissues and materials of interest.

Elastic and physicochemical relationships within cortical bone.

The purpose of this study was to examine the relationships that exist between the elastic properties and the physicochemical properties of cortical bone in two groups of experimental animals. The animal model was the immature mutant dwarf rat, and the groups consisted of rats treated and not treated with recombinant human growth hormone (rhGH). The objective was to establish and broaden the quantifiable link between the three-dimensional form and function of bone beyond the typical unidirectional measures. This study was based on previously reported work that refined the ultrasonic elasticity technique for use with small specimens (<1.0 mm) and determined that the administration of rhGH can counter the degenerative effects produced by hormone-suppressed downregulation on the elastic and physicochemical characteristics of cortical bone. Ultrasonic wave propagation and density measurements were used previously to determine the three-dimensional (orthotropic) material properties of rat femoral cortical bone. X-ray powder diffraction, microscopic, morphometric, and biochemical analysis techniques have been used to describe physicochemical properties, including mineral crystal size, cortical porosity, mineral and nonmineral content, and microstructural characteristics. In this study, mathematical relationships between the local physicochemical (independent variable) and elastic (dependent variable) properties were formulated via linear and nonlinear regression analyses. In general, apparent density was found to have the highest level of correlation with most of the longitudinal and shear moduli (R(2) = 0.300 to 0.800). Concomitantly, mineral crystal width and cortical porosity offered the best correlations with the Poisson's ratios (R(2) up to 0.600). Wilcoxon t tests verified a significant decrease in the elastic properties in dwarf rat cortical bone after rhGH treatments (p < 0.05). Physicochemical measures of bone quality (density, crystal size) generally decreased while measures of bone quantity (cortical area, moments of inertia) generally increased (p < 0.05) after rhGH treatments. Some mineral and nonmineral properties were unchanged. This study presents a quantifiable link between cortical bone elasticity and its composite construction as measured across two dramatically different experimental groups.

A device for measuring relative angular displacement.

A simple, inexpensive, and accurate way to measure relative segmental rotations resulting from torsional loadings locally is described. To measure these rotations, we fabricated a planar spatial linkage (open-loop kinematic chain) requiring only one rotational displacement transducer. This paper describes this device, defines its kinematics, and examines its accuracy.

Stability of proximal femoral grafts in canine hip arthroplasty.

In a canine model, the fixation stability of a prosthesis and proximal bone graft composite were measured relative to the distal femur. One group had the prosthesis graft composite cemented into the distal femur. The second group had the prosthesis graft composite press fit into the distal femur for biologic ingrowth. Displacements of the proximal femoral grafts relative to the host bone in each group were measured after ex vivo (acute with graft) implantation and 4 months after implantation. A third group with no osteotomy (acute intact) simulated perfect graft to host bone union. Relative displacements representing 6 degrees freedom (translation and rotation) were calculated from the displacement values measured by 9 eddy current transducers. Measurements of displacement were used to test the hypothesis that distal press fit fixation equals distal cement fixation at 4 months after implantation. In all cases the measured translations and rotations of the graft to implant construct were small and of a magnitude that should encourage bone ingrowth (< 0.05 mm and < 0.1 degree, respectively). The stability of the press fit group at 4 months was not significantly different from the cemented group in axial and transverse displacement during axial and transverse loading, respectively. There was no difference in stabilities at 4 months between distal press fit and cemented fixation in hip replacements requiring a proximal femoral graft.

Ultrasonic wave velocity measurement in small polymeric and cortical bone specimens.

A system was refined for the determination of the bulk ultrasonic wave propagation velocity in small cortical bone specimens. Longitudinal and shear wave propagations were measured using ceramic, piezoelectric 20 and 5 MHz transducers, respectively. Results of the pulse transmission technique were refined via the measurement of the system delay time. The precision and accuracy of the system were quantified using small specimens of polyoxymethylene, polystyrene-butadiene, and high-density polyethylene. These polymeric materials had known acoustic properties, similarity of propagation velocities to cortical bone, and minimal sample inhomogeneity. Dependence of longitudinal and transverse specimen dimensions upon propagation times was quantified. To confirm the consistency of longitudinal wave propagation in small cortical bone specimens (< 1.0 mm), cut-down specimens were prepared from a normal rat femur. Finally, cortical samples were prepared from each of ten normal rat femora, and Young's moduli (Eii), shear moduli (Gij), and Poisson ratios (Vij) were measured. For all specimens (bone, polyoxymethylene, polystyrene-butadiene, and high-density polyethylene), strong linear correlations (R2 > 0.997) were maintained between propagation time and distance throughout the size ranges down to less than 0.4 mm. Results for polyoxymethylene, polystyrene-butadiene, and high-density polyethylene were accurate to within 5 percent of reported literature values. Measurement repeatability (precision) improved with an increase in the wave transmission distance (propagating dimension). No statistically significant effect due to the transverse dimension was detected.

Thermographic strain analysis of the proximal canine femur.

Thermographic strain analysis (TSA) was used to measure the surface strain distribution of cyclically loaded canine femora. Eleven canine femora were cyclically loaded at 20 Hz in compression at 600 N (+/-200 N). After calibration with measured local strain data, it was possible to quantify the full field patterns measured from the proximal, anterior and medial cortex. The average of each TSA signal normalized by the coincident strain data (0.996) was very near to 1.0 (p = 0.999). The thermographical scans iterate the maximum compressive strains carried by the femur within the region just distal to the femoral neck. Further understanding of the strain distribution in this region is critical in the design of components that attempt to mimic anatomical load transfer after total hip arthroplasty. TSA appears to offer a promising technology as a full field experimental strain analysis method for use with biomechanical issues.

Finite elasticity formulations for evaluation of ligamentous tissue.

The variety of techniques used to measure the cross-sectional area of soft connective tissues during mechanical testing lead to inconsistencies in elastic descriptions. This study compares the numerical differences between finite elasticity (Eularian and Lagrangian formulations) and infinitesimal elasticity when considering stress, strain and elastic modulus of ligamentous tissue. Our results found stress differences (Cauchy versus Kirchhoff) of 22.4%, strain differences (engineering versus Green versus Almansi) as large as 14% and elastic modulus differences (Eularian versus Lagrangian) of 44% from ligament tissue sampled from rats. It is therefore critical to maintain consistent (energy conjugate) elastic formulations for reporting mechanical evaluation of soft hydrated tissue.

Effect of a growth hormone treatment on bone orthotropic elasticity in dwarf rats.

A refinement of the current ultrasonic elasticity technique was used to measure the orthotropic elastic properties of rat cortical bone as well as to quantify changes in elastic properties, density, and porosity of the dwarf rat cortex after a treatment with recombinant human growth hormone (rhGH). The ultrasonic elasticity technique was refined via optimized signal management of high-frequency wave propagation through cubic cortical specimens. Twenty dwarf rats (37 days old) were randomly assigned to two groups (10 rats each). The dwarf rat model (5-10% of normal GH) was given subcutaneous injections of either rhGH or saline over a 14-day treatment period. Density was measured using Archimedes technique. Porosity and other microstructural characteristics were also explored via scanning electron microscopy and image analysis. Statistical tests verified significant decreases in cortical orthotropic Young's (-26.7%) and shear (-16.7%) moduli and density (-2.42%) concomitant with an increase in porosity (+125%) after rhGH treatments to the dwarf model (p < 0.05). A change in material symmetry from orthotropy toward planar isotropy within the radial-circumferential plane after GH treatments was also noted. These results demonstrate some alteration in bone properties at this time interval. Structural implications of these changes throughout physiological loading regimens should be explored.

Interstitial fluid flow in tendons or ligaments: a porous medium finite element simulation.

The purpose of this study is to describe interstitial fluid flow in axisymmetric soft connective tissue (ligaments or tendons) when they are loaded in tension. Soft hydrated tissue was modelled as a porous medium (using Darcy's Law), and the finite element method was used to solve the resulting equations governing fluid flow. A commercially available computer program (FiDAP) was used to create an axisymmetric model of a biomechanically tested rat ligament. The unknown variables at element nodes were pressure and velocity of the interstitial fluid (Newtonian and incompressible). The effect of variations in fluid viscosity and permeability of the solid matrix was parametrically explored. A transient loading state mimicking a rat ligament mechanical experiment was used in all simulations. The magnitude and distribution of pressure, stream lines, shear (stress) rate, vorticity and velocity showed regular patterns consistent with extension flow. Parametric changes of permeability and viscosity strongly affected fluid flow behaviour. When the radial permeability was 1000 times less than the axial permeability, shear rate and vorticity increased (approximately 5-fold). These effects (especially shear stress and pressure) suggested a strong interaction with the solid matrix. Computed levels of fluid flow suggested a possible load transduction mechanism for cells in the tissue.

Effect of a hypergravity environment on cortical bone elasticity in rats.

There is considerable interest in determining whether hypergravity can be used as a countermeasure for microgravity-induced bone loss. This study was conducted on 20 immature male rats in order to investigate possible elastic adaptations of cortical bone in rapidly growing rats exposed to chronic hypergravity. Ten rats were continuously centrifuged for 14 days at twice gravitational acceleration (2G) on a 12.75 foot radius centrifuge and 10 rats concurrently acted as stationary controls. The effect of hypergravity on the elastic characteristics of cortical bone was quantified via ultrasonic wave propagation. Propagation velocities of longitudinal and shear waves were measured through cubic cortical specimens from the posterior femoral diaphyses. Density was measured with an Archimedes' technique. The orthotropic elastic properties were calculated and used to compare the difference between groups. Results showed an average increase in both the Young's moduli (Eii, + 2.2%) and shear moduli (Gij, + 4.3%) with a statistically significant increase only in G12 (+15.7%, P = 0.046). The ratio of transverse to axial strain (Poisson's ratio, nuij) demonstrated statistically significant changes in nu12, nu21, nu13, and nu31 (P < 0.05). These findings suggest that although slight elastic changes were incurred via a hypergravity environment, the treatment level or duration in this study do not dramatically perturb the normal elastic behavior of cortical bone and that dramatic biomechanical differences noted in previous studies were due more to structural changes than material elasticity changes. Hypergravity applied post facto to a microgravity environment would offer further illucidation of this method as treatment for a degenerative spaceflight experience.