Gopal Jayaraman

The biomechanics of lateral knee bracing Part I: Response of the valgus restraints to loading

To better understand the role of preventive knee braces in injury prevention, a biomechanical study using fresh frozen cadaveric knees (N = 18) was conducted. Liga ment tensions and joint displacements were measured at static, nondestructive valgus forces as well as low- rate destructive forces. After quantifying and establish ing individual ligament contributions to valgus restrain ing function, knees were then braced with two different laterally applied preventive braces, the McDavid Knee Guard and the Omni Anderson Knee StabIer.The effects of lateral bracing were analyzed according to valgus force, joint line opening, and ligament tensions. Valgus applied forces, with or without braces, consis tently produced medial collateral ligament (MCL) disrup tions at ligament tensions surprisingly higher than the anterior cruciate ligament (ACL) and higher than or equal to the posterior cruciate ligament (PCL). Although large joint displacements were necessary for complete ligament failure, bundle disruption in the MCL, ACL, and PCL was noted at much smaller joint openings. In Part I of this study, no significant protection could be documented with the two preventive braces used. Also, four potentially adverse effects were noted: MCL pre load, center axis shift, premature joint line contact, and brace slippage.

Osteocutaneous radial forearm free flaps. The necessity of internal fixation of the donor-site defect to prevent pathological fracture.

Background: Osteocutaneous radial forearm free flaps have fallen from favor due to pathological fractures of the radius. The purposes of this study were to propose a means to decrease the rate of pathological fracture by prophylactic fixation of the donor-site defect and to evaluate this technique biomechanically. Methods: Two groups of ten matched pairs of fresh-frozen cadaveric radii were harvested. In Group 1, an eight-centimeter length of radius comprising 50 percent of the cross-sectional area of the bone was removed to simulate an osteocutaneous radial forearm donor-site defect. This defect was created in one member of each pair, with the other bone in the pair left intact. In Group 2, both members of the ten matched pairs of radii had identical defects created as previously described. However, one radius in each pair had a twelve-hole, 3.5-millimeter dynamic compression plate placed across the segmental defect. In each group, five matched pairs were tested to failure in torsion and five matched pairs were tested to failure in four-point bending. Results: In Group 1, the intact radius was a mean of 5.7 times stronger in torsion and 4.2 times stronger in four-point bending than the radius with the segmental resection. In Group 2, the radius that was ostectomized and fixed with a plate was a mean of 4.0 times stronger in torsion and 2.7 times stronger in four-point bending than the ostectomized radius. Conclusions: Removal of an eight-centimeter segment from the radius dramatically decreased both torsion and bending strength. Application of a plate over the defect in the radius significantly restored the strength of the radius (p = 0.01). Clinical Relevance: The segmental defect created in the radius when an osteocutaneous radial forearm free flap is harvested weakens the donor bone an unacceptable amount, resulting in a high risk of pathological fracture. We believe that prophylactic internal fixation of the donor-site defect with a plate restores strength to such a level that pathological fracture may be prevented, thus increasing the utility of the osteocutaneous radial forearm free flap.

A study of external skeletal fixation systems for unstable pelvic fractures

This study was undertaken to determine the feasibility of constructing an anterior pelvic external fixator capable of resisting displacement of vertical shear fractures. Newly designed tapered thread pins for cancellous bone had better bone pin fixation and their greater 6-mm diameter provided more than twice the stiffness of Hoffmann 4-mm pins when tested in clusters. Using these pins and a more rigid anterior frame as one model, various pelvic fixators were tested to determine their resistance to vertical shear forces. These tests determined that this new fixator was 16 times stiffer than a Bonnel single anterior frame and five times stiffer than a double anterior frame (both constructed of Hoffmann components). Extrapolation from the data shows that 13 mm of posterior fracture displacement would occur with loads of one half body weight using the new fixator. Additionally it was noted that Hoffmann frames constructed with two 5-mm pins performed as well as those using three 4-mm pins.

Torsional strength of the radius after osteofasciocutaneous free flap harvest with and without primary bone plating.

The osteocutaneous radial forearm free flap (OCRFFF) has not gained widespread popularity in mandibular reconstruction, primarily because of concerns about pathologic fracture of the weakened radius. This study examines the effectiveness of plate fixation of the radius bone after harvest of the OCRFFF as a mechanism to minimize donor-site morbidity and increase the usefulness of the OCRFFF. Matched pairs of fresh human cadaveric radius bones were used in this study. Two study groups were designed. The first group was used to define the amount of strength lost after a typical bone graft harvest. The second group was designed to demonstrate how much torsional strength was regained by the application of an orthopedic reconstruction plate. Statistically significant results were obtained for both groups. In group 1, the strength of the cut bones compared with that of the unaltered bones was significantly decreased by 82% (P = 0.016). In group 2, the cut bones reinforced with a plate were 75% stronger (P = 0.002) than the bones that were only cut. Although the radius bone is significantly weakened by the harvest of a graft, much of this strength can be regained with plate fixation of the radius. (Otolaryngol Head Neck Surg 2000; 123:400-8.)

Effects of pretwist on biomechanical properties of canine patellar tendon

The purpose of this study was to measure the effect produced on canine patellar tendon of a 90 degree pretwist on the following mechanical properties: failure stress, failure strain, average elastic modulus, and strain energy density. Forty adult mongrel dog cadavers, killed for other studies, were used. Paired patellar tendons were isolated with patellar and tibial bone and the central 4.0-4.6 mm of tendon used for testing. Specimens were elongated to failure using a Materials Testing System (MTS). Only those paired specimens both failing in substance were analyzed. Eight paired specimens were analyzed, both with 0 degree twist, for right-left reproducibility. Thirty-two paired specimens were randomly assigned to four groups: right 0 degree/left 90 degree clockwise pretwist; right 0 degree/left 90 degree counterclockwise; left 0 degree/right 90 degree clockwise; left 0 degree/right 90 degree counterclockwise. No statistically significant differences were present between the paired untwisted specimens in any mechanical property. In the pretwisted specimens, there were statistically significant differences between the group left/clockwise and right/counterclockwise and the group left/counterclockwise and right/clockwise with respect to the mechanical properties failure stress, average elastic modulus, and strain energy density. No statistically significant differences were observed between the two groups for failure strain. For the canine patella-patellar tendon-tibia complex (PPTTC), the mechanical properties failure stress, average elastic modulus, and strain energy density are sensitive to both side (left/right) of PPTTC and direction (clockwise/counterclockwise) of pretwist. Pretwist of patellar tendon grafts in anterior cruciate ligament reconstruction may produce significant changes in their mechanical properties that vary with the direction of twist.

Biomechanical analyses of surgical correction techniques in idiopathic scoliosis: Significance of bi-planar characteristics of scoliotic spines

Biomechanical analyses of Harrington distraction, Harrington distraction-compression, Cotrel and Luque correction techniques simulated mechanically on a three-dimensional mathematical model of scoliotic spines are developed and relationships between mechanical forces and achievable corrections are derived in terms of Cobb angle, vertebral inclination from the frontal plane, and bi-plane bending stiffness of motion segments. For all four systems, nomograms between Cobb angles and corrective forces with correction factors as parameters are prepared in terms of given bi-plane characteristics of scoliotic spines. Parametric studies to show the influence of the torsion plane bending stiffness of motion segments and vertebral inclinations from the frontal plane on the mechanical effectiveness of the surgical correction techniques are presented. The mechanical effectiveness of each of the four surgical correction techniques determined with the use of this model compares reasonably well with the clinical findings.

DISTRIBUTION OF IN VIVO LATERAL BENDING STIFFNESSES IN IDIOPATHIC SCOLIOTIC SPINES

Publisher Summary This chapter discusses a biomechanical model that was developed to analyze progressive idiopathic scoliotic spines. This led to an optimization scheme for determining lateral bending stiffness, which was based upon Wolffs law. The chapter explains a study involving stiffness distributions for four adolescent patients, whose progressive idiopathic scoliosis was corrected surgically with Harrington distraction instrumentation. The mean stiffness parameters for the scoliotic spines are comparable to those reported for adolescent cadaver spinal motion segments. The chapter discusses the linkage system, which is composed of both rigid link elements and interconnecting torsional springs. The linkage boundary condition, which consists of simple support on one end and a roller support on the opposite end, allows only displacements along the axis of the distraction rod. The equilibrium equations for the corrected spinal configuration are derived from the minimum total potential energy.