Carolyn F. Small

Development of a Three-Dimensional Finite Element Model for Carpal Load Transmission in a Static Neutral Posture

AbstractA three-dimensional developmental finite element model has been created to analyze load transmission pathways in the constrained carpus during static compressive loading. The bone geometry was extracted from an in vivo computed tomography scan using a combination of commercial and proprietary software. The complete geometry, including bone, cartilage, and ligament tissues, was compiled using a commercial finite element program. This model extends the state of biomechanical modeling by being the first to incorporate all eight carpal bones of the wrist and the related soft tissues in three dimensions. The model results indicate that cartilage material modulus and unconstrained carpal rotation have substantial impacts on the articular contact patterns and pressures.

In situ compressive properties of the glenoid labrum.

The purpose of this study was to measure the structural stiffness (load/displacement response) and elastic modulus (stress-strain response) of the glenoid labrum at different locations throughout the tissue. It was intended that the results of this work would serve to define the properties of the labrum. This in turn may permit a better understanding of labral function and of the mechanics of injury or degeneration and may ultimately contribute to improving the design of future labral reconstruction procedures. In addition, these data may allow incorporation of labral properties into a glenoid arthroplasty component. The testing procedure consisted of rapid compression of the labrum using a flat indentor. Stiffness and modulus results demonstrated differences between the superior and inferior portions of the labrum. The elastic moduli findings for the labrum were 0.18 +/- 0.17, 0.11 +/- 0.16, and 0.23 +/- 0.20 MPa for the inferior anterior, inferior, and inferior posterior sections, respectively. The superior anterior, superior, and superior posterior sections were respectively 0.19 +/- 0.09, 0. 32 +/- 0.22, and 0.41 +/- 0.32 MPa. These results are similar to those of knee menisci. The modulus findings for the substrate cartilage were 1.92 +/- 0.78, 1.99 +/- 0.70, and 2.00 +/- 1.33 MPa for the inferior anterior, inferior, and inferior posterior sections, respectively. The superior anterior, superior, and superior posterior sections were respectively 1.60 +/- 0.79, 1.29 +/- 0.75, and 1.42 +/- 0.54 MPa, which are comparable to previous cartilage findings.

Rationalization of kinematic descriptors for three-dimensional hand and finger motion

Modelling joint motion in three dimensions is often based on techniques taken from classical dynamics, each analysis resulting in a set of six parameters describing the relative motion between two body segments. The literature on joint kinematics has been difficult to compare due to use of different anatomical landmarks, axis nomenclature, and analytical methods. It is here shown that with care in sequence definition, the three alignment-based systems (Euler, Cardan, floating axis) give identical results for angular parameters. While the equivalent screw displacement axis system can be related simply to the other methods only if the functional axis of motion is aligned with a coordinate axis, the basic matrix for relating rigid body positions before and after a motion can always be reconstructed. Therefore the changes in alignment angles may be obtained from screw displacement parameters, permitting the results of different analyses to be compared. Translation parameters are most difficult to interpret in any system. Examples of the way in which simple planar motions are characterized by the various analytical methods are given.

Precision and accuracy of bone landmarks in characterizing hand and wrist position

Characterization of the motion of the hand and wrist requires reference to the underlying bones which, for three-dimensional analyses, are assumed to be rigid bodies. Stereoradiogrammetric techniques involving the identification of prominent bone landmarks have been used as the standard against which surface markers used for in vivo testing have been evaluated. The precision and accuracy with which the 3D positions of bone landmarks in the hand and wrist could be determined was evaluated in a small inter-observer and inter-cadaver study and compared to the precision and accuracy with which implanted lead markers could be located. A subset of landmarks suitable for evaluating wrist and metacarpal-phalangeal joint motion was identified; the mean precision for identifying these points was better than 1.1 mm in all hand positions with a mean inter-observer accuracy of 2.3 mm. These values show that the average uncertainty in locating bone landmarks is at best roughly twice that for implanted markers.

Validation of a 3D optoelectronic motion analysis system for the wrist joint.

OBJECTIVE: A study was undertaken to determine the experimental accuracy of a non-invasive optoelectonic 3-dimensional tracking system in assessing wrist joint motion. DESIGN: This was an in vivo experimental study involving volunteer subjects performing prescribed wrist motions. BACKGROUND: Current clinical practice does not include routine kinematic analysis for evaluating arthritic disease state, although motion disorders are common. METHODS: Surface markers were applied to 24 subjects assigned two hand postures in a test-retest factorial design for the expected range of motion. The marker positions were measured optoelectronically and using calibrated stereoradiography, to determine the positions of the surface markers and of key bone landmarks. Alignment and motion were compared for the three measurement techniques. Standard kinematic analyses were performed to extract Euler angles and equivalent screw displacement axes for paired postures. RESULTS: The three measurement techniques were highly correlated for wrist flexion-extension. Uncertainties were less than 6 degrees, similar to uncertainties from bone landmark identification errors when implanted markers cannot be used. Measures of motion exhibited higher correlations than those for alignment. Equivalent screw displacement axis orientations had poor intraclass correlations, reflecting sensitivity to coordinate system definitions. CONCLUSIONS: For motion analysis in the wrist in vivo, a non-invasive optoelectronic measurement system is as accurate as stereoradiographic analysis of bone segments.

Changes in oscillometric pulse amplitude envelope with cuff size: implications for blood pressure measurement criteria and cuff size selection

Oscillometric blood pressures are derived from the amplitude envelope of oscillometric pulses generated in an occlusive cuff during cuff inflation or deflation; one factor which will affect the characteristics of these pulses is the size of the cuff bladder. Because limiting values are stipulated in recommendations and standards for bladder sizes, there is a wide variety of acceptable cuff sizes for any particular application. An experimental and theoretical study was undertaken to show the dependence of oscillometric blood pressures on bladder size. Actual cuff-arm compliance data were obtained from two subjects for two cuffs of different bladder size. Theoretical analysis was then applied to the data to predict the effects of different bladder sizes on the characteristics of the pulses. The results show that cuff-arm compliance and bladder size interact to affect the pulse amplitude and hence oscillometric blood pressure determination. These results suggest that blood pressures obtained using the oscillometric method may vary depending on cuff size, and in particular that replacement cuffs for oscillometric non-invasive blood pressure monitors should be chosen carefully.

Three-dimensional metacarpophalangeal joint kinematics using two markers on the phalanx

Abstract A protocol for analysing three-dimensional metacarpophalangeal (MCP) joint motion in vivo using two markers on the proximal phalanx is described. The analysis uses an assumption that the rotation of the phalanx about its own long axis is zero. In an experimental study 24 volunteers had surface markers applied to the dorsal surfaces of their hands and index and long finger proximal phalanges, with three-dimensional marker positions recorded in two hand and finger postures in an incomplete box design using a test-retest protocol. Kinematic parameters from the optoelectronic system were compared with those obtained from three-dimensional reconstruction of bone landmarks and of the marker positions identified on stereoradiographs. Pronation/supination angles obtained from bone landmarks showed high test-retest variability, reflecting the difficulty in obtaining reliable pronation/supination data in small bones without the use of implanted markers. Changes in MCP joint extension and deviation angles determined using two surface markers agree with those obtained from bone landmarks. The results indicate a reproducible protocol for tracking MCP joint motion using only two phalangeal markers, suggesting that the ‘no-rotation assumption’ can be applied without affecting measures of extension and deviation motion in the normal joint.

Stereoradiogrammetric technique for estimating alignment of the joints in the hand and wrist.

A method and apparatus for quantitative measurement of the alignment and motion of the joints of the hand in three dimensions has been developed using stereoradiogrammetric principles. Alignment in planes of flexion-extension and radial-ulnar deviation can be determined to within 2.5 degrees; rotation about the long axis of the metacarpals or phalanges is more difficult to determine, and can be measured to within 7 degrees. Stereo views subtending angles in the range of 40 degrees were found to optimize the total system accuracy.

A Kinematic Technique for Describing Wrist Joint Motion: Analysis of Configuration Space Plots

This paper describes an experimental method for determining the minimum number of degrees of freedom of a human joint. Application of this technique to the wrist suggests that the normal, intact wrist joint uses only two degrees of freedom to move in a plane that is not aligned with the anatomic planes. The technique may be useful in identifying emerging joint pathologies and in simplifying kinematic models of joint function.

Detection of interruptions in the breathing gas of ventilated anaesthetized patients

Interruption of the breathing gas to a ventilated anaesthetized patient due to accidental disconnection or anaesthesia system malfunction may have serious consequences if not detected quickly. A series of tests which covers the range of foreseeable mechanical problems was developed and used to test the performance of three breathing gas interruption monitors, two commercially available and one developed at Vancouver General Hospital. The tests were designed to evaluate the performance of monitors as installed on anaesthesia systems under a variety of failure conditions, including endotracheal tube disconnection with and without occlusion of the opening, kinks in the inspiratory and fresh gas hoses, disconnection of the fresh gas hose, leaks in the breathing circuit, excessive high or low pressure in the scavenging circuit, continuing high breathing circuit pressure, and kinks in the circuit pressure sensing hose. Ability to detect both significant changes in ventilation variables and faults existing at initiation of ventilation were also tested over a representative range of ventilator and patient variables using circle, coaxial and paediatric circuits.Only complete endotracheal tube disconnections with no obstruction of the opening were reliably detected by all three monitors. A commercial monitor with a single fixed-threshold alarm level also detected fresh gas interruptions in circle and adult coaxial circuits, but failed to alarm in response to any other fault condition. A monitor with selectable pressure thresholds and high, low, and continuing pressure limits detected just under half of the fault conditions. A microprocessorbased monitor developed at Vancouver General Hospital detected and correctly identified roughly 80 per cent of the faults.The series of tests forms the basis for a Canadian Standards Association Preliminary Standard (Z168.10) and will allow hospitals to test the performance of breathing gas interruption monitors in use in their institutions. Comments on the test series are solicited.RésuméChez un patient ventilé ľinterruption de ľapport des gaz par déconnection accidentelle ou un malfonctionnement du circuit anesthésique peut avoir des conséquences sérieuses si elle n’est pas détectée rapidement. Une série de lests qui couvre les problèmes mécaniques possibles a été développée et utilisée afin ďétudier la performance de trois moniteurs de détection de débit de gaz dont deux sont commercialement disponibles et un développé à ľHôpital Général de Vancouver. Les lests ont été planifiés afin ďévaluer la performance de ces moniteurs installés sur les machines ďanesthésie dans différentes conditions de bris de circuits incluant la déconnection du tube endotracheal avec ou sans occlusion de ľouverture, une coudure des tubulures de gaz frais et inspiré, une déconnection de la tubulure de gas frais, une fuite dans le circuit, une pression excessivement haute ou basse dans le circuit de scavenging, une pression élevée dans le circuit inspiratoire, et une coudure dans le tuyau détectant les variations de pression du circuit. La possibilité de détecter des changements significatifs dans les paramètres de ventilation et des erreurs à ľinitiation de la ventilation était aussi étudiée utilisant des circuits pédiatriques, coaxiaux et systèmes circulaires.Seulement une déconnection du tube endotrachéal sans obstruction de ľouverture était détectée avec fiabilité par tous les moniteurs. Un moniteur commercial avec un seuil fixe du niveau ďalarme à détecté ľinterruption du débit de gaz frais dans le circuii circulaire et coaxial adulte, mais n’a pu déclencher ľalarme en réponse à ďautres bris du circuit. Un moniteur avec des seuils de pression variable a détecté un peu moins que la moitié des conditions du bris de circuit. Un moniteur basé sur un système de microprocesseur développé à ľHôpital Général de Vancouver a détecté et correctement identifié approximativement 80 pour cent des bris du circuit.Cette série de tests constitue la base pour ľAssociation Canadienne des Normes (Z168.10) et permet aux hôpitaux de tester la performance des moniteurs utilisés dans leurs institutions. Des commentaires sur la série de tests sont sollicités.