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Orthopedic and Rehabilitation Engineering

Orthopedic and Rehabilitation Engineering - Poster Session C

Poster K13 - Investigating Fracture Risks Associated with Corticotomies in Femoral Bones​

Friday, October 25, 2024
10:00 AM - 11:00 AM EST
Location: Exhibit Hall E, F & G

Introduction:  In surgical interventions, alterations to bone structures are often necessary, including procedures like corticotomies, which are vital for accessing the inner bone canal during examinations of bone abnormalities. However, the effects of these changes on the bone's structural integrity, particularly in patients at higher risk for fractures, such as those with osteoporosis, are unknown. Despite the widespread application of these methods in orthopedic practice, standardized protocols for managing potential post-surgical complications are absent. Analytical approaches, like Finite Element Analysis (FEA) and mechanical assessments, provide avenues for investigating these potential hazards. Our investigation hypothesized that corticotomies, due to their stress-inducing properties, might weaken the femoral bone and increase the likelihood of postoperative fractures. This study aimed to evaluate the impact of various surgical factors, including the configuration, dimensions, and location of the corticotomies on the risk of fractures in cortical and osteoporotic bone and to assess the necessity of preventive measures in situations with elevated risks.

Materials and

Methods:  This investigation unfolded in two phases. Phase one employed FEA on a rendered femur model, reconstructed from a quantitative CT scan of an adult male sourced from an open-source library, and incorporating healthy bone material properties. 1000N Force vectors were applied to recreate two potential failure models: (1) axially on the femoral head to simulate loading at an upright posture, and (2) laterally on the greater trochanter to simulate a sideways fall. Diverse configurations of cortical defects were examined to gauge their effect on bone strength. Furthermore, the results of these models were compared to the same model with material properties of osteoporotic bone. Phase II will involve mechanical testing on thirty synthetic composite bone models. Surgical alterations, mirroring those performed in clinical settings, will be enacted, followed by axial compression and lateral bending tests to assess mechanical stiffness, ultimate failure strength, and failure model under loading conditions. Final benchtop loading methodology will be influenced by phase one finite element analysis results.

Results, Conclusions, and Discussions: The study examined the biomechanical effects of cortical defects and osteoporosis on femur bones using static axial and fatigue tests. Static cortical axial results supported the hypothesis, showing that the healthy femur exhibited a maximum von Mises stress of 122 MN/m². The femur with a 4mm defect had a slightly higher stress of 1.24 MN/m², indicating the defect's impact. In the fall test, the healthy sample demonstrated a lower maximum von Mises stress of 167 MN/m² compared to the osteoporotic sample, which had a stress of 172e MN/m², highlighting osteoporosis's substantial influence on stress distribution. The static osteoporotic axial test revealed a decrease in maximum von Mises stress when comparing samples with and without defects, with the no-defect sample showing a max von Mises stress of 1.40 MN/m² and the defected sample 136 MN/m².

This study aimed to provide insights into the biomechanical repercussions of corticotomies, aiding orthopedic surgeons in postoperative care decisions and contributing to standardized guidelines for preventative measures. Moving forward, research is aimed at exploring the biomechanical effects of lateral falls, anticipating similar stress distribution patterns to those observed in axial tests. This research advanced the use of FEA in orthopedic studies, paving the way for the future.

Acknowledgements (Optional):