Biomedical subjects

T N Gardner

Publications and source records attributed to T N Gardner.

At least 19 recordsLinked to original sources

PubMed2004

Does the type of flooring affect the risk of hip fracture?

BACKGROUND: The number of hip fractures occurring worldwide in 1990 was estimated at 1.7 million and is predicted to rise to 6.3 million by 2050. The vast majority occur as a result of simple falls and the impact of the femoral trochanter with the floor. Previous studies have addressed the problem from the patient's side of the impact. Little research has been carried out on the other surface involved in the impact, the floor. STUDY LOCATION: 34 residential care homes. METHODS: (1) The mechanical properties of the floor were measured with force transducers. (2) The number and location of falls and fractures on the various floors were recorded prospectively for 2 years. The threshold for reporting falls in different care homes was assessed using a standardised set of scenarios. RESULTS: A total of 6,641 falls and 222 fractures were recorded. Wooden carpeted floors were associated with the lowest number of fractures per 100 falls. The risk of fracture resulting from a fall was significantly lower compared to all other floor types (odds ratio 1.78, 95% CI 1.33-2.35). The mean impact force was significantly lower on wooden carpeted floors: 11.9 kN compared to the other floor types. DISCUSSION: The possible implications of our findings are considerable. Residents of homes are typically frail and many have a propensity to falls. In designing safer environments for older people, the type of floor should be chosen to minimise the risk of fracture. This may result in a major reduction in fractures in the elderly.

Accidental Falls↗

PubMed2001

Rapid application fracture fixators - an evaluation of mechanical performance.

OBJECTIVE: This study evaluates the mechanical performance of the Pinless and Centrafix fixators for rapid application to tibial fractures in a disaster or battlefield scenario. DESIGN: Comparative study based on measurements made in the laboratory. BACKGROUND: The Pinless and Centrafix fixators may be considered for rapid application to stabilise fractures in emergency conditions without the aid of electrical equipment such as power drills for bone screw insertion or image intensifiers to facilitate bone alignment. METHODS: Stiffnesses, maximum service loads and fatigue strengths of the fixators were measured in the orientations of loading that correspond to walking and stretcher-bearing. These properties were compared with measurements on three conventional fixators, the AO, Shearer and Triax. RESULTS: The Centrafix stiffnesses were 31 N/mm (axial), 1 N/ degrees (torsional shear), 0.4 N/ degrees (coronal plane bending), 4 N/ degrees (sagittal plane bending) and 11 N/mm (transverse shear) and strengths were 95 N (axial) and 1.9 Nm (bending). Corresponding Pinless stiffnesses were 43 N/mm, 0.7 N/ degrees, 0.3 N/ degrees, 8 N/ degrees and 50 N/mm, and strength was 55 N (axial). CONCLUSIONS: The stiffness and strength of both rapid application fixators in simulated walking was judged to be low, and additionally the stiffness and strength of the Centrafix in simulated stretcher-bearing was judged to be low. RELEVANCE: The Pinless is not recommended for weight-bearing subjects with unstable fractures. The Centrafix is not recommended for stretcher-bearing or weight-bearing with unstable fractures.

Biomechanical Phenomena↗

PubMed2001

Biomechanical measurements in microscopically thin stratum comeum using acoustics.

BACKGROUND/AIMS: This study investigated whether a scanning acoustic microscope (SAM) could be developed to measure changes in the mechanical properties of the microscopically thin external layer of skin, the stratum corneum. The adapted microscope was used to determine the effects of various aqueous reagents, as compared with water, on the thickness, density, compression wave velocity and elastic constant, using 10 microm thin sections of human skin. METHODS: Specimens were exposed to aqueous solutions of glycerol, sodium chloride and alpha-hydroxy caprylic acid (HCA) to investigate permeation and to investigate the effect of these solutions on the above physical properties for signal transmission at a centre frequency of approximately 650 MHz in a path parallel to the epidermal layers. RESULTS: The system of measurement was found to give repeatable results and to provide a reliable indicator of the change in mechanical properties of the stratum corneum that arise from imbibition with different substances. Acoustic measurements of untreated specimen thickness and density agreed well with optical measurements and with previously published measurements, respectively. The trend in change of elastic moduli, however, was not in agreement with the results of the large-scale extensibility tests of Takahashi et al. and Hall & Hill, which used thicker specimens that contained additional epidermal or dermal layers. CONCLUSION: Disparate trends in elastic moduli were believed to be due to the strain rate dependence of the tissues and the different rates of loading applied during testing.

Acoustics↗

PubMed2001

An examination of the parameters that govern the acoustic behavior of sea bed sediments containing gas bubbles.

The acoustic properties of sea bed sediments containing occluded gas are dominated by the volume of gas contained in bubbles, the size of bubbles, and the elastic properties of the soil matrix. This study evaluated current theory developed by Anderson and Hampton to determine the sound speed and resonance frequency of gassy soils, and the models they used to determine the elastic properties of the soils. It compared calculated sound speeds, based on material properties simulated by the models, with measured sound speeds on "large bubble" laboratory soils produced in a similar manner to natural sea bed gassy soils. There was some evidence that the Anderson and Hampton equations accurately predicted sound speed at lower frequencies of bubbles resonance and below, but results were sensitive to inappropriate values for the elastic and damping properties of the soil. The bounds of sound speed based on the elastic properties of models that simulate "compressible fluid" or "suspension" behavior were grossly misleading when applied to large bubble soils. Conversely, sound speed based on models that correctly simulate the "bulk" or "matrix" properties of large bubble soils, at strain magnitudes and strain rates equivalent to acoustic signals, agreed well with measured data.

Journal Article↗

PubMed2001

Comparative two- and three-dimensional finite element modelling techniques for tibial fractures.

Often the choice of a two-dimensional modelling approach over a three-dimensional approach is made on the basis of available resources, and not on task appropriateness. In the case of simulating the mechanical behaviour of irregular anatomical structures in biomedical engineering, the authenticity of two-dimensional model behaviour and the interpretation of model solutions is of particular concern since little comparable two-dimensional and three-dimensional data have been published. As part of a research programme, a comparison was made between two-dimensional and three-dimensional finite element models (FEMs) that examine the stress-strain environment of a clinical bone fracture and callus. In comparison with the three-dimensional model, the two-dimensional model substantially underestimated peak compressive principal stresses in the callus tissue and peak equivalent strains. This was a consequence of geometrical and structural asymmetry in a plane perpendicular to the two-dimensional model. However, the two-dimensional model predicted similar patterns of stress and strain distribution to the corresponding mid-longitudinal plane of the three-dimensional model, and underestimates of peak stress and strain were much reduced. This confirmed that despite the irregular geometry and structure of the subject, the two-dimensional model provided a valid mechanical simulation in the plane of the fracture that it represented.

Biomechanical Phenomena↗

PubMed2000

Stiffness, strength and healing assessment in different bone fractures--a simple mathematical model.

External fixators can only be removed safely when fractures have healed sufficiently to restore mechanical integrity to the bone. A bending stiffness of 15 N m/ degrees has been suggested as a means of estimating mechanical integrity. To examine whether this end point stiffness value can be applied to all fractures, the present study examined the degree of variability in predicted stiffness and strength that arises from variations in bone dimensions. Results imply that there is no common value for the end-point of bending stiffness in different bones. At an end point value of 15 N m/degrees, the maturity of the fracture repair tissue (represented by its elastic modulus) can vary 500-fold between an adult femur with a 0.5-mm gap to a child's mid diaphyseal tibia with a 1.0-mm gap. Fortunately, the strength does not vary by as large an extent as the modulus. However, even though two fractures each have reached a stiffness of 15 N m/degrees, a fracture in a bone of 50 mm diameter may exhibit only 60% of the strength of repair in a bone of 30 mm diameter. Therefore, caution should be exercised when using the bending stiffness as an end point indicator for different bones.

Adult↗

PubMed2000

The influence of mechanical stimulus on the pattern of tissue differentiation in a long bone fracture--an FEM study.

2D, coronal plane, finite elements models (FEMs) were developed from orthogonal radiographs of a diaphyseal tibial fracture and its reparative tissue at four different time points during healing. Each callus was separated into regions of common tissue histology by computerised radiographic analysis. Starting point values of tissue material properties from the literature were refined by the model to simulate exactly the mechanical behaviour of the subject's callus and bone during loading. This was achieved by matching measured inter-fragmentary displacements with calculated inter-fragmentary forces. Stress and strain distributions in the callus and bone were calculated from peak inter-fragmentary displacements measured during natural walking activity, and were correlated with the subsequently observed pattern of tissue differentiation and maturation of the callus. The growth and stiffening of the external callus progressively reduced the inter-fragmentary gap strain. Partial maturation of the gap tissue was apparent only one week before fixator removal. Principal stresses in the callus were compared with 'yield stresses' in corresponding tissue from the literature. This indicated the presence of stress concentrations medial and lateral to the fracture gap, which probably caused tissue damage during normal activity levels. Tissue damage may also have precipitated partial structural failure of the callus, both of which were believed to have delayed healing during the middle third of the fixation period. Had the fixation device provided greater inter-fragmentary support during early healing, this may have prevented callus failure and the consequent delay in healing. A further benefit of this would have been the reduction of the initially high intra-gap tissue strains to a magnitude more conducive to earlier maturation of the bridging tissue that united the bone.

Adult↗

PubMed1999

A mathematical stiffness matrix for characterising mechanical performance of the Orthofix DAF.

This study investigates a method for characterising the 3D support to a bone fracture site that is provided by a fracture stabilising device. The method is demonstrated with the Orthofix DAF unilateral external fixator, for which a mathematical stiffness matrix is defined using experimental measurements in six degrees of freedom. Single forces or bending moments are applied to a model fracture stabilised by the fixator, and 3D inter fragmentary displacements are measured by an instrumented spatial linkage. The 6x6 stiffness matrix for the fracture site is calculated from the product of the vector of forces and moments and the inverse of the vector of displacements. A transformation matrix is used to determine the stiffness matrix for a range of anatomical angles (between the plane of the fixator frame and the sagittal plane). Comparison between measured displacements (for an angle of 30 degrees) and the corresponding calculated displacements showed agreement to within 8%. The method enables fracture site stiffness for a fixation device to be characterised comprehensively, and its properties to be identified in comparison with other devices. It also provides the means of analysing inter fragmentary motion that may arise from physiological loading, regardless of complexity.

Algorithms↗

PubMed1998

Measurement of impact force, simulation of fall and hip fracture.

It has been shown that the incidence of hip fracture in the elderly may be influenced by the type of floor covering commonly used in homes for the elderly. This study describes the development of a method for modelling a fall during a hip fracture event, to examine the influence of different floors on impact force. An impact transducer is dropped in free fall through a smooth plastic tube. The impactor nose of the transducer models the curvature of the greater trochanter, and a steel spring is used to simulate the compliance of the skeletal structure. A weight, which corresponds to one-sixteenth of average body mass, compresses the spring and applies force to the impactor nose on striking the floor. The temporal variation in the force of impact with the floor is measured by the transducer to within 0.41 percent (SD = 0.63%, n = 10). Five common floor coverings were tested over a concrete floor slab (vinyl, loop carpet and pile carpet--both with and without underpad). ANOVA analysis showed that the differences between mean forces for each floor covering were highly significant (p > 0.001), with the thicker coverings producing 7 percent lower forces. The transducer may be used to examine the correlation between impact force and fracture incidence for a variety of different floors in homes for the elderly.

Accidental Falls↗

PubMed1998

Temporal variation of applied inter fragmentary displacement at a bone fracture in harmony with maturation of the fracture callus.

The amplitude of inter fragmentary displacement in long bone fractures greatly influences the pattern and speed of healing. Unfortunately, the amplitude of natural cyclical displacement arising from patient activity is random because of the inherent flexibility of fixation devices under natural loading. Although fixators may be designed to control the amplitude of this displacement, the amplitudes most beneficial to healing have not been determined. Furthermore, the appropriate amplitude must vary during healing as the reparative tissue (callus) progresses histologically and stiffens during maturation. In this study on an experimental fracture, the amplitude of applied cyclical displacement is varied during healing to correspond with the inverse of the callus stiffness versus time curve. In vivo mechanical stiffness tests on the callus indicate that the end point of the fixation period is achieved more rapidly than with a constant level of applied displacement.

Animals↗

PubMed1997

Temporal changes in dynamic inter fragmentary motion and callus formation in fractures.

This study examined whether callus proliferation at long bone fractures is triggered by cyclical inter-fragmentary displacement which arises from routine activity. It also examined whether a growing callus increases the stability of a fracture, thereby reducing displacement amplitude during relative motion. Seven tibial fractures stabilised with external fixators were monitored up to and beyond fixator removal. An instrumented spatial linkage was developed which was attached to the bone screws to measure inter-fragmentary displacement at the fracture in all six degrees of freedom during routine walking. Callus index (final bone width/initial bone width) was measured at the posterior and lateral cortical surfaces from orthogonal radiographs. In all seven subjects, callus growth was initiated subsequent to a peak in displacement which occurred within the first 42 days; at nine of the 14 surfaces occurred callus initiation occurred within 14 days of the peak displacement. With the exception of two lateral surfaces, maximum callus size, subsequent to fixator removal (at up to 119 days after removal). Displacement reduced during callus growth in five out of six subjects. Since the reduction in displacement did not arise from reduced weight-bearing, increasing callus size must correlate with progressive mechanical union. This was confirmed by end point stiffness tests. Therefore, peak cyclical displacement appears to be the stimulus for callus growth, the effect of which is to reduce displacement and strain which allows the following stages of bone formation and remodelling to unite the fracture.

Adult↗

PubMed1997

A biomechanical study on five unilateral external fracture fixation devices.

OBJECTIVE: This study examines plastic, slip and fatigue failures in external fixator frames. DESIGN: Failure was examined in five commonly used unilateral external fixators using experimental models that simulated both stable and unstable diaphyseal fractures. BACKGROUND: Plastic failure arises from permanent deformation of a frame initiated by bending of frame components, while slip failure arises from slip at clamping interfaces. Such failure may lead to refracture or to malalignment of the bone (transverse or angular). Fatigue failure arises from the loosening or wear of components under long-term cyclic loading; this can lead to variable interfragmentary displacement and impairment of fracture stability. METHODS: Axial loads were measured at which plastic or slip failure occurred, as were changes in interfragmentary motion due to 10 000 load cycles simulating walking activity. RESULTS: In four fixators, plastic or slip failure initiated bone malalignment at only 50% of average adult weight bearing (650 N). Additionally, in three fixators a third screw at the clamp centre was found to reduce retention of the two adjacent screws, causing premature slip failure. Evidence of fatigue was found in all the fixators after only 10 000 load cycles. In one fixator, the amplitude of elastic interfragmentary motion increased progressively by 30% transversely, 15% angularly and 100% torsionally. In another fixator it increased by 10% in all directions while the column was locked (non-dynamizing), and it increased a further 10% while it was unlocked and able to slide telescopically (dynamizing). Clamp slip occurred at the column of a third fixator almost immediately after commencing the cyclic loading. CONCLUSION: Plastic or slip failure of frames may occur prematurely during routine weight-bearing on unstable fractures, and frame fatigue may affect long-term interfragmentary stability.

Journal Article↗

PubMed1997

A method of examining the magnitude and origin of "soft" and "hard" tissue forces resisting limb lengthening.

Complications arising from limb-lengthening procedures such as muscle contracture, axial malalignment of the bone and traction injuries to the nerves and vessels, are often severe. Often complications arise from the build-up of forces in the biological tissues which are resisting lengthening. Little is known about the origin and magnitude of these forces, although three studies have identified the regenerate (new bone tissue) as the dominant resisting tissue. This study describes the development of a method to examine these forces. It employs load measurement devices in the structural columns of Ilizarov fixators which measure the compressive load on the frame exerted by the biological tissues. The distribution of this load between the columns of the frame, in conjunction with a transverse radiograph of the limb at the regenerate site, is used to examine the origin of the resisting force. Accuracy was determined by a laboratory simulation which found the predicted position of the force to be within 5 mm of the actual position in all four cases tested. Mean error in the total measured force was 2 N (SD, 1 N). A pilot study on a patient undergoing a 60 mm femoral lengthening revealed a peak force of 717 N originating in the Vastus Lateralis or the illiotibial tract. Negligible contribution to resistance was provided by the regenerate, contrary to that found with other studies.

Adult↗

PubMed1997

Dynamic interfragmentary motion in fractures during routine patient activity.

Natural interfragmentary motion was measured in tibial fractures during normal patient activity, and the results were interpreted using correlations from the literature to examine the influence of natural motion on healing. Ten patients were selected with reduced, diaphyseal tibial fractures stabilized with Orthofix external fixators. Three-dimensional motion was monitored with an instrumented spatial linkage during walking, standing, and muscle activities at 2 and 4 weeks postfixation. Fracture motion arising from dorsal to plantar flexion while supine produced peak cyclic displacements of the same order of magnitude as that seen during weightbearing activity. Thus, therapeutic exercise may be used to provide a stimulus to osteogenic repair processes in patients who are unable to bear weight. In 3 patients, maximum amplitudes of axial motion during walking were 1 mm or greater. This implied regular gap closure and high tissue strains within the 1 mm +/- 0.5 mm gaps. In 3 patients, axial motion was less than 0.25 mm. These 2 extremes may indicate a range of displacement relative to gap size that embraces inhibitive and stimulative influences on healing. Transverse shear displacements also varied greatly from between 0.6 and 0.75 mm in 3 patients to less than 0.2 mm in 5 patients.

Adult↗

PubMed1997

Prevention of deformity during limb lengthening.

Deformity occurs frequently at the site of distraction during leg lengthening and can add to disability. The elastic and nonelastic displacements have been measured in a model that simulates leg lengthening in the laboratory. Measurements have been made for different fixator systems. The angulation in the vertical plane that occurs during leg lengthening is minimized if the distance between the bone and the fixator bar is kept as small as possible, if three screws are inserted in the proximal and distal bone fragments, and if the peak loads on the fixator are reduced by adjusting the rhythm of distraction. However, even if these precautions are taken, the results show that some fixators designed for leg lengthening will fail and lead to deformity at the osteotomy site. This may occur under the repeated cycles of high loads associated with the rises in soft tissue tension that are known to occur in certain groups of patients. This study suggests that deformity can be prevented by the proper selection of a suitable frame and the adjustment of its configuration to meet the loading requirements.

Bone Lengthening↗

PubMed1996

The influence of external fixators on fracture motion during simulated walking.

This experimental study examines the relative influence of five unilateral external fixators on tibial fracture stability during simulated walking. Stability during routine patient activity is important, because cyclic inter fragmentary motion, or strain, has been shown to affect fracture healing. In model stable fractures simulating early healing (six weeks), it was found that fixators do little to constrain against axial inter fragmentary strains as great as 100% at only nominal weight-bearing (6.0 kg). These strains may occur repeatably at peak amplitudes of motion during walking. Similarly, peak angular movements may lead to additional axial strains of up to 25% at the external cortex and shear movements may lead to shear strains of up to 100%. Such strains are great enough to yield and possibly refracture the intra gap fracture tissue that may be composed of a combination of granulation tissue, fibrous cartilage, cartilage and bone. It was also shown that the procedure of releasing the fixator column to telescope (dynamize) has little influence on peak cyclic axial motion and on loading at the fracture, although increases occurred in peak transverse and torsional shear strains of up to 100%. Since permanent inter fragmentary translation also arises from the consequent compaction of the intra gap tissue, it may be permanent displacement rather than any change in the amplitude of motion that is responsible for the beneficial effect on healing claimed for the dynamizing procedure. In unstable fractures that are unable to support tibial load at the fracture, the peak amplitudes of cyclic movement were as great as those reported for fractures stabilized by plaster casts, and were approximately twice the movement of the stable fractures simulating early healing. Therefore, patients with unstable fractures supported by external fixators, may be expected to have similar patterns of healing to plaster-casted patients with similar fractures.

Biomechanical Phenomena↗

PubMed1996

The static and dynamic behaviour of tibial fractures due to unlocking external fixators.

OBJECTIVE: To determine how the mechanical environment of a tibial fracture is influenced by unlocking an external fixator frame. DESIGN: A clinical study examined 10 consecutive patients fixed with the Orthofix DAF. BACKGROUND: It has been claimed that the healing of diaphyseal tibial fractures is assisted by unlocking external fixators to allow free axial movement, but the influence on the mechanical environment at the fracture has not been established. METHODS: A transducer attached to bone screws measured dynamic interfragmentary displacement during walking both before and immediately after unlocking the fixator at 6 weeks in 10 subjects. Four subjects were monitored over the first hour after unlocking to measure interfragmentary gap shortening. RESULTS: Mean peak amplitudes of cyclical axial and angular displacement before unlocking were 0.46 mm (SD 0.27) and 0.37 degrees (SD 0.30), and after were 0.42 mm (SD 0.19) and 0.34 degrees (SD 0.28). Mean peak torsional and transverse shear displacements were 0.21 degrees (SD 0.11) and 0.30 mm (SD 0.17) before unlocking, and after were 0.42 degrees (SD 0.39) and 0.51 mm (SD 0.60). Gaps shortened permanently by unrecoverable axial translations of between 0.2 and 1.4 mm; the mean was 0.69 mm. CONCLUSIONS: Unlocking was found more often to reduce both axial and angular motion, but to increase shear. Overall, this may reduce maximum longitudinal strains in the external callus. The reduced motion may arise from gap shortening.

Journal Article↗

PubMed1996

An instrumented spacial linkage for monitoring relative three-dimensional motion between fracture fragments.

A mechanical linkage with electro-magnetic sensors (a displacement transducer) is described, which may be used to measure accurately the relative motion at a bony junction such as a fracture. The linkage may be fixed to bone screws of externally-fixated fractures during routine patient activity, to measure three-dimensional inter fragmentary displacements arising from dynamic loading. Movements of the linkage are monitored by six Hall Effect devices for the six degrees of freedom (three orthogonal translations and three rotations about the translating axes). Measurements are made within error bounds of +/- 0.025 mm and +/- 0.025 deg over a range of 5 mm for the two orthogonal transverse translations, 8 mm for axial translation and 8 deg for the three rotations. Movements at the linkage, remote from the fracture, are then translated mathematically to the fracture site, assuming rigid screw contact with the bone. Displacements of the distal fragment in relation to the proximal, at the fracture center, can then be expressed anatomically through anterior, medial, and distal translations, and rotations in the sagittal, coronal, or transverse planes.

Biomechanical Phenomena↗