Stefan Klima

Finite element analysis of acetabular fractures—development and validation with a synthetic pelvis

Acetabular fracture presents a challenging situation to trauma surgeons today due to its complexity. Finite element (FE) models can be of great help as they can improve the surgical planning and post surgery patient management for those with acetabular fractures. We have developed a non-linear finite element model of the pelvis and validated its fracture prediction capability with synthetic polyurethane pelves. A mechanical experiment was performed with the synthetic bones and fracture loads and patterns were observed for two different loading cases. Fracture loads predicted by our FE model were within one standard deviation of the experimental fracture loads for both loading cases. The incipient fracture pattern predicted by the model also resembled the actual pattern from the experiment. Although it is not a complete validation with human cadaver bones, the good agreement between model predictions and experimental results indicate the validity of our approach in using non-linear FE formulation along with contact conditions in predicting bone fractures.

Teaching surgical exposures to undergraduate medical students: an integration concept for anatomical and surgical education

BackgroundDecreasing numbers of students are interested in starting a surgical career, posing substantial challenges to patient care in the next years. The anatomy course is one of the key subjects in medical training, especially in surgical disciplines. Innovative teaching concepts that integrate surgically relevant anatomy and manual dexterity might help boost student interest in surgery.MethodsA preclinical workshop entitled “Surgical exposures” was developed. A team of anatomists and surgeons introduced the surgical exposures, demonstrating the procedures on Thiel-fixed body donors. Following this introduction, students practiced the exposures in an operating room-like manner. A six-point Likert scale was used to evaluate the workshop and to compare it to the first-year dissection course.ResultsThe overall evaluation result for the surgical exposures was excellent, proving to be a significantly better result when compared to the first-year dissection course. The students were more satisfied with the teaching time invested by the peers and regarded the workshop as clinically highly relevant. Furthermore, they felt that questions were addressed better and that the overall atmosphere was better than in the gross anatomy course. Subject to criticism was the course size and practicing time in both cases.DiscussionThe surgical exposures workshop provides preclinical students with clinically relevant anatomy and manual dexterity. It may positively influence the decision to follow a surgical career. This course, however, requires extensive teaching resources. The given concept may help implement practical medical skills in the preclinical curriculum, strengthening the professional identity of surgeons and anatomists.

Pelvic Belt Effects on Health Outcomes and Functional Parameters of Patients with Sacroiliac Joint Pain.

Introduction The sacroiliac joint (SIJ) is a common source of low back pain. However, clinical and functional signs and symptoms correlating with SIJ pain are widely unknown. Pelvic belts are routinely applied to treat SIJ pain but without sound evidence of their pain-relieving effects. This case-control study compares clinical and functional data of SIJ patients and healthy control subjects and evaluates belt effects on SIJ pain. Methods 17 SIJ patients and 17 healthy controls were included in this prospective study. The short-form 36 survey and the numerical rating scale were used to characterize health-related quality of life in patients in a six-week follow-up and the pain-reducing effects of pelvic belts. Electromyography data were obtained from the gluteus maximus, biceps femoris, rectus femoris and medial vastus. Alterations of muscle activity, variability and gait patterns were compared in patients and controls along with the belts’ effects in a dynamic setting when walking. Results Significant improvements were observed in the short-form 36 survey of the SIJ patients, especially in the physical health subscores. Minor declines were also observed in the numerical rating scale on pain. Belt-related changes of muscle activity and variability were similar in patients and controls with one exception: the rectus femoris activity decreased significantly in patients with belt application when walking. Further belt effects include improved cadence and gait velocity in patients and controls. Conclusions Pelvic belts improve health-related quality of life and are potentially attributed to decreased SIJ-related pain. Belt effects include decreased rectus femoris activity in patients and improved postural steadiness during locomotion. Pelvic belts may therefore be considered as a cost-effective and low-risk treatment of SIJ pain. Trial Registration ClinicalTrials.gov NCT02027038

Comparison of operative time and accuracy using conventional fixed navigation cutting blocks and adjustable Pivotal cutting blocks.

Computer-assisted navigation in total knee arthroplasty has been shown to improve implant positioning and may lead to improved patient outcomes. The purpose of this study was to assess differences in time and accuracy using a navigation system with either a conventional (20 knees) or specially designed (20 knees) system of cutting blocks. The time needed for fixing and positioning the specially designed blocks averaged 2.9 minutes, compared to 6.4 minutes for the conventional blocks (p < 0.001). In the coronal plane, the mean angular difference between the instrument slot and the resected bone was smaller for the specially designed blocks than for the conventional blocks. This difference was significant for both the femoral (p = 0.007) and tibial (p = 0.028) cuts. These encouraging results show the need for further study of navigation in total knee arthroplasty.

Pelvic orthosis effects on posterior pelvis kinematics An in-vitro biomechanical study

The sacroiliac joint (SIJ) is a well-known source of low back pain, with increasing interest for both conservative and surgical treatment. Alterations in pelvis kinematics are hypothesized as a contributor to SIJ pain and pelvic orthoses one treatment option, but their effects on the pelvis are poorly understood. Alterations in movement patterns induced by the application of pelvic orthoses were determined in five human cadaveric pelvises. Deformations were obtained from the lumbosacral transition and the bilateral SIJ, using digital image correlation and a customized routine to compute the movements within the pelvis. Significant alterations were found for the movements at the SIJ, in particular a vast increase in axial (x-axis) rotation, accompanied by increased inferior (y-) translation of the sacrum relative to the ilium. Movement patterns at the lumbosacral transition changed, causing increases in axial rotation and decreased inferior translation of L5 relative to S1. Using a physiologic mode of load application gives novel insights into the potential effects of pelvic orthoses. The results of these in-vitro experiments vary markedly from previous experiments with loading limited to two or less axes. Furthermore, the influence of pelvic orthoses on the lumbosacral transition warrants further investigation.