Anatomic investigation of the deep posterior compartment of the leg.

The purpose of this study is to critically investigate the anatomy of the deep posterior compartment of the leg. Specifically, the relationship of the deep posterior compartment to the superficial posterior compartment and their insertion onto the posteromedial border of the tibia are assessed. Cross-sectioning of 10 fresh-frozen cadaver legs was performed at 2-cm increments. The inferior surface of each section was photographed. The photographs were visually analyzed, and the fascial separation between the posterior compartments along with their relationship to the posteromedial border of the tibia were recorded for each specimen. Magnetic resonance images in the axial plane of 10 healthy, normal volunteers' lower extremities at 2-cm increments were obtained and analyzed. All specimens and images demonstrated that the medial fascial attachment of the deep posterior compartment was along the posteromedial aspect of the tibia in the proximal third of the leg and was not superficially accessible. In the proximal third of the leg, the superficial posterior compartment fascial attachment overlapped the deep posterior compartment by inserting medial and anterior to the deep posterior compartment fascial attachment. In the middle and distal thirds of the leg, the medial fascial attachment of the deep posterior compartment shifted medially and anteriorly, making the deep posterior compartment superficially accessible. The surgeon must appreciate the change in the anatomic relationships along the medial side of the leg while performing double-incision four-compartment fasciotomy release to obtain a complete release of the muscular portion of the deep posterior compartment.

Triple arthrodesis: a biomechanical evaluation of screw versus staple fixation.

The subtalar, talonavicular, and calcaneocuboid joints were internally fixed to simulate triple arthrodesis was performed on eight matched pairs of human cadaver feet. Feet were randomly assigned such that one specimen in each pair was internally fixed with cobalt-chrome staples and one specimen with stainless steel screws. Liquid metal strain gauges were placed in a perpendicular fashion across the three joints of each specimen. Each foot was then secured to the Shore Western Materials Test System where a series of 10 increasing eversion stresses across the foot was created. Displacement was measured at each joint with every increase in eversion stress. Our results show that there is no statistical difference in fixation strength between screws and staples at the talonavicular, calcaneocuboid, or subtalar joints (P = 0.862). Although many studies determining the strength to failure of different implants have been performed, shear stress and micromotion at the joint surfaces have not been evaluated, to our knowledge, and no single implant in this study has shown superior immobilization characteristics to recommend its use as the implant of choice in triple arthrodesis.

Material and structural characterization of human saphenous vein.

Saphenous vein patch rupture after carotid endarterectomy is an infrequent but devastating complication. This study was undertaken to evaluate the material and structural properties of fresh human saphenous veins to understand the causes of this complication. Segments of saphenous veins were obtained from 22 patients from vein harvested during coronary artery bypass surgery. Ninety-three specimens, oriented in both circumferential (n = 45) and longitudinal (n = 48) directions, were prepared from the available vein segments for testing. Specimens were mounted on specially designed grips and then subjected to uniaxial tension testing. For each specimen the following material and structural parameters were determined: vessel diameter, tensile stiffness, failure and ultimate forces, and tensile modulus, failure stress, and strain. The physical properties of specimens evaluated in longitudinal orientations and thus limit the inherent strength of the vein. The physical properties of circumferentially tested vein specimens were negatively correlated to age, female gender, diabetes, and hypertension. The data obtained in this investigation suggest that age, hypertension, as well as diabetes and gender may adversely influence the circumferential tensile strength of human saphenous veins used as patch grafts.

Fatigue life improvement of nitrogen-ion-implanted pedicle screws.

An experimental study of the fatigue life of pedicle screws and their nitrogen-ion-implanted counterparts was conducted. Nitrogen-ion implantation parameters were varied in the first part of the study to obtain the best implantation characteristics. Using this optimal parameter for N(+)-implantation, the performance of two matched groups were compared at two bending moments near the "knee" of the S-N curves. At 3.96 N-m and 5.09 N-m of applied bending moments, the increase in the mean fatigue life for the former was 98% and for the latter 20%. The 98% prolongation was statistically significant at P less than 0.005; however, the 20% increase was statistically insignificant (P less than 0.1). The implantation depth is about 0.1 mu in the near surface of the screw. This appears to be thick enough to inhibit crack initiation at 3.96 N-m, but only marginally at 5.09 N-m. Increasing the implantation depth has the potential of increasing the fatigue life at the higher bending moments.

Response of the ligamentous lumbar spine to cyclic bending loads.

The effect of a "pure" cyclic flexion bending moment on the three-dimensional load-displacement behavior of fresh ligamentous lumbar spine was investigated. The load-displacement behavior, for 11 L1-sacrum specimens, pre- and post-cyclic fatigue bending tests were quantified using a Selspot II system. A special fixture was designed to mount the specimen within the MTS system to administer "pure" cyclic flexion bending, under displacement control, for 5 hours. The testing was accomplished in a 100% humidity chamber at 0.5 Hz. The maximum cyclic bending moment, based on the literature dealing with loads experienced by the spine during activities involving lifting, was set at 3.0 Nm. An increase in motion of the order of 10% in the extension loading mode was observed. The increase in motion in other loading modes was not significant. In the extension loading mode, the increase in the anteroposterior displacement (retrodisplacement) in general was higher than the corresponding rotation component. The results suggest that the bending moment of low magnitude, usually experienced by the spine during activities of daily living, alone may not trigger the mechanical failure processes in the disc. The presence of high axial compressive loads on the disc seems to be the main contributing factor in this process. The presence of bending moments and axial twist along with axial compressive load may accelerate the unstable processes leading to low back pain.

Bone-particle-impregnated bone cement: an in vitro study.

Bone-particle-impregnated bone cement specimens (up to 30% by weight) were characterized by various test methods. The experimental bone cement showed decreased crack propagation rates and increased Young's modulus, while the ultimate tensile strength and impact strength were decreased. The viscosity could be adjusted by adding initiators lost when substituting the PMMA powder with bone particles. The present study warranted further in vivo experiments on the possibility of tissue ingrowth for which the new bone cement was developed.

Dynamic performance characteristics of the liquid metal strain gage.

Performance characteristics of the liquid metal strain gage (LMSG) were evaluated by both static and dynamic bench testing. Statically, the devices were found to have outputs closely proportional to engineering strains, up to strain levels of 40%. While individual gage factors varied appreciably (up to 50%), each of the gages studied showed excellent reproducibility of behavior. Dynamically, the response to sinusoidal strain inputs was frequency-independent up to 50 Hz, and there was no detectable phase shift. Similarly, the LMSG response to constant-speed displacement inputs was velocity-independent over the range of nominal strain rates from 20 s-1 to 0.02 s-1. The devices proved capable of maintaining stable outputs when held stretched to fixed lengths, even if such tests were performed immediately following stepwise displacement inputs. Thermal artifacts were found to be modest (0.185% apparent strain per degree C), and there was no appreciable sensitivity to non-axial strains. When mounted on an in vitro ligament preparation, the LMSG measured apparent ligament strain similar to that detected by a video dimension analyzer. A protocol by which an implanted LMSG could be used to infer in vivo muscle forces was demonstrated, based on recordings of tendo-Achilles strains developed by a rabbit during slow hopping.

The inertial and geometrical properties of helmets.

The center of gravity (CG) and the principal mass moments of inertia about the CG of Army aviator, American football, and bicycle helmets were experimentally determined by a variation of the classic differential weighing and torsional pendulum techniques. In the course of these experiments, an innovative method for three-dimensional (3D) digitization was found. An electronic caliper, which measured length, was used with a computer algorithm to achieve 3D digitization. The results of the above measurements show that the weight of the helmet and the distances from the CG to the orthogonal coordinate axes intercepts with the outer shell surface were highly correlated with its principal mass moments of inertia. A set of regression equations was derived on theoretical considerations and served to unify the experimentally obtained data. Our results indicate that the principal mass moments of inertia of helmets vary linearly with its mass but nonlinearly with size and shape. For a helmet, given its weight and certain geometrical distances, the regression equations estimate the principal mass moments of inertia to within 5% of its experimentally-determined values. For the helmets studied in this series, a modified linear-regression relationship between the principal mass moments of inertia and its mass was found. This result is reasonable because the mass distribution of the current generation of helmets are set primarily by the head size and secondarily by helmet size, shape, and materials.