Timothy A. Burkhart

Finite element modeling mesh quality, energy balance and validation methods: a review with recommendations associated with the modeling of bone tissue.

The use of finite element models as research tools in biomechanics and orthopedics has grown exponentially over the last 20 years. However, the attention to mesh quality, model validation and appropriate energy balance methods and the reporting of these metrics has not kept pace with the general use of finite element modeling. Therefore, the purpose of this review was to summarize the current state of finite element modeling validation practices from the literature in biomechanics and orthopedics and to present specific methods and criteria limits that can be used as guidelines to assess mesh quality, validate simulation results and address energy balance issues. Of the finite element models reviewed from the literature, approximately 42% of them were not adequately validated, while 95% and 98% of the models did not assess the quality of the mesh or energy balance, respectively. A review of the methods that can be used to assess the quality of a mesh (e.g., aspect ratios, angle idealization and element Jacobians), measure the balance of energies (e.g., hour glass energy and mass scaling), and quantify the accuracy of the simulations (e.g., validation metrics, corridors, statistical techniques) are presented.

Manual segmentation of DXA scan images results in reliable upper and lower extremity soft and rigid tissue mass estimates

Quantification of segment soft and rigid tissue masses in living people is important for a variety of clinical and biomechanical research applications including wobbling mass modeling. Although Dual-energy X-ray Absorptiometry (DXA) is widely accepted as a valid method for this purpose, the reliability of manual segmentation from DXA scans using custom regions of interest (ROIs) has not been evaluated to date. Upper and lower extremity images of 100 healthy adults who underwent a full body DXA scan in the supine position were manually segmented by 3 measurers independently using custom ROIs. Actual tissue masses (fat mass, lean mass, bone mineral content) of the arm, arm with shoulder, forearm, forearm and hand, thigh, leg, and leg and foot segments were quantified bilaterally from the ROIs. There were significant differences between-measurers, however, percentage errors were relatively small overall (<1-5.98%). Intraclass correlation coefficients (ICCs) were very high between and within-measurers, ranging from 0.990 to 0.999 and 0.990 to 1.00 for the upper and lower extremities, respectively, suggesting excellent reliability. Between and within-measurer errors were comparable in general, and differences between the tissue types were small on average (maximum of 42 and 53g for upper and lower extremities, respectively). These results suggest that manual segmentation of DXA images using ROIs is a reliable method of estimating soft and rigid tissues in living people.

Reliability of upper and lower extremity anthropometric measurements and the effect on tissue mass predictions.

Accurate modeling of soft tissue motion effects relative to bone during impact requires knowledge of the mass of soft and rigid tissues in living people. Holmes et al., [2005. Predicting in vivo soft tissue masses of the lower extremity using segment anthropometric measures and DXA. Journal of Applied Biomechanics, 21, 371-382] developed and validated regression equations to predict the individual tissue masses of lower extremity segments of young healthy adults, based on simple anthropometric measurements. However, the reliability of these measurements and the effect on predicted tissue mass estimates from the equations has yet to be determined. In the current study, two measurers were responsible for collecting two sets of unilateral measurements (25 male and 25 female subjects) for the right upper and lower extremities. These included 6 lengths, 6 circumferences, 8 breadths, and 4 skinfold thicknesses. Significant differences were found between measurers and between sexes, but these differences were relatively small in general (75-80% of between-measurer differences were <1cm). Within-measurer measurement differences were smaller and more consistent than those between measurers in most cases. Good to excellent reliability was demonstrated for all measurement types, with intra-class correlation coefficients of 0.79, 0.86, 0.85 and 0.86 for lengths, circumferences, breadth and skinfolds, respectively. Predicted tissue mass magnitudes were moderately affected by the measurement differences. The maximum mean errors between measurers ranged from 3.2% to 24.2% for bone mineral content and fat mass, for the leg and foot, and the leg segments, respectively.

Kinematics, kinetics and muscle activation patterns of the upper extremity during simulated forward falls

The purpose of this study was to explore the effects of fall type and fall height on the kinematics, kinetics, and muscle activation of the upper extremity during simulated forward falls using a novel fall simulation method. Twenty participants were released in a prone position from a Propelled Upper Limb Fall ARrest Impact System. Impacts occurred to the hands from two fall heights (0.05m and 0.10m) and three fall types (straight-arm, bent-arm, self-selected). Muscle activation from six muscles (biceps brachii, brachioradialis, triceps brachii, anconeus, flexor carpi radialis and extensor carpi radialis) was collected and upper extremity joint kinematics were calculated. Peak Fx (medio-lateral), as well as Fx and Fz (inferior-superior) load rate increased between the 0.05m and 0.10m heights. With respect to fall type, the straight-arm falls resulted in significantly greater Fy (anterior-posterior) impulse and Fy and Fz load rates. The change in elbow flexion angle was greater during the self-selected and bent-arm falls compared to the straight-arm falls; a pattern also seen in the wrist flexion/extension angles. All muscles experienced peak % MVIC prior to the time of the peak force. The results of this study suggest that, to some extent, individuals are capable of selecting an upper extremity posture that allows them to minimize the effects of an impact and it has confirmed the presence of a preparatory muscle activation response.

Activation level of extensor carpi ulnaris affects wrist and elbow acceleration responses following simulated forward falls

The main objective of this study was to measure the acceleration response at the wrist and elbow as a function of different levels of isometric forearm muscle activation during the impact phase of a simulated forward fall. A seated human pendulum was designed to impact the hands of 28 participants while maintaining one of four levels of isometric muscle activation (12%, 24%, 36% and 48% maximal voluntary exertion (MVE)) in the extensor carpi ulnaris muscles. The acceleration responses including peak acceleration (PA), acceleration slope (AS) and time to peak acceleration (TPA) were measured at the wrist and elbow along two axes (axial and off-axis) with two low mass surface mounted accelerometers. At the wrist, significant muscle activation effects were found for PA(off), AS(axial), AS(off), such that they increased as muscle activation increased from baseline to 48% MVE. At the elbow, a similar response was noted, with the acceleration variables increasing as muscle activation level increased, except for AS(off). The results suggest that increases in muscle activation from 12% to 48% MVE stiffen the forearm complex and increase the transmissibility of the impact reaction force shock waves through the forearm.

Determining the optimal system-specific cut-off frequencies for filtering in-vitro upper extremity impact force and acceleration data by residual analysis.

The fundamental nature of impact testing requires a cautious approach to signal processing, to minimize noise while preserving important signal information. However, few recommendations exist regarding the most suitable filter frequency cut-offs to achieve these goals. Therefore, the purpose of this investigation is twofold: to illustrate how residual analysis can be utilized to quantify optimal system-specific filter cut-off frequencies for force, moment, and acceleration data resulting from in-vitro upper extremity impacts, and to show how optimal cut-off frequencies can vary based on impact condition intensity. Eight human cadaver radii specimens were impacted with a pneumatic impact testing device at impact energies that increased from 20J, in 10J increments, until fracture occurred. The optimal filter cut-off frequency for pre-fracture and fracture trials was determined with a residual analysis performed on all force and acceleration waveforms. Force and acceleration data were filtered with a dual pass, 4th order Butterworth filter at each of 14 different cut-off values ranging from 60Hz to 1500Hz. Mean (SD) pre-fracture and fracture optimal cut-off frequencies for the force variables were 605.8 (82.7)Hz and 513.9 (79.5)Hz, respectively. Differences in the optimal cut-off frequency were also found between signals (e.g. Fx (medial-lateral), Fy (superior-inferior), Fz (anterior-posterior)) within the same test. These optimal cut-off frequencies do not universally agree with the recommendations of filtering all upper extremity impact data using a cut-off frequency of 600Hz. This highlights the importance of quantifying the filter frequency cut-offs specific to the instrumentation and experimental set-up. Improper digital filtering may lead to erroneous results and a lack of standardized approaches makes it difficult to compare findings of in-vitro dynamic testing between laboratories.

Development and validation of a distal radius finite element model to simulate impact loading indicative of a forward fall

The purpose of this work was to develop and validate a finite element model of the distal radius to simulate impact loading. Eight-node hexahedral meshes of the bone and impactor components were created. Three separate impact events were simulated by altering the impact velocity assigned to the model projectile (pre-fracture, crack and fracture). Impact forces and maximum and minimum principal strains were calculated and used in the validation process by comparing with previously collected experimental data. Three measures of mesh quality (Jacobians, aspect ratios and orthogonality) and four validation methods (validation metric, error assessment, fracture comparisons and ensemble averages) assessed the model. The element Jacobians, aspect ratios and orthogonality measures ranged from 0.08 to 12, 1.1 to 26 and −70° to 80°, respectively. The force and strain validation metric ranged from 0.10 to 0.54 and 0.35 to 0.67, respectively. The estimated peak axial force was found to be a maximum of 28.5% greater than the experimental (crack) force, and all forces fell within ±2 standard deviation of the mean experimental fracture forces. The predicted strains were found to differ by a mean of 33% across all impact events, and the model was found to accurately predict the location and severity of bone damage. Overall, the model presented here is a valid representation of the distal radius subjected to impact.

Failure characteristics of the isolated distal radius in response to dynamic impact loading

We examined the mechanical response of the distal radius pre‐fracture and at fracture under dynamic impact loads. The distal third of eight human cadaveric radii were potted and placed in a custom designed pneumatic impact system. The distal intra‐articular surface of the radius rested against a model scaphoid and lunate, simulating 45° of wrist extension. The scaphoid and lunate were attached to a load cell that in turn was attached to an impact plate. Impulsive impacts were applied at increasing energy levels, in 10 J increments, until fracture occurred. Three 45° stacked strain gauge rosettes were affixed along the length of the radius quantifying the bone strains. The mean (SD) fracture energy was 45.5 (16) J. The mean (SD) resultant impact reaction force (IRFr) at failure was 2,142 (1,229) N, resulting in high compressive strains at the distal (2,718 (1,698) µε) and proximal radius (3,664 (1,890) µε). We successfully reproduced consistent fracture patterns in response to dynamic loads. The fracture energy and forces reported here are lower and the strains are higher than those previously reported and can likely be attributed to the controlled, incremental, dynamic nature of the applied loads.

Reliability of Impact Forces, Hip Angles and Velocities during Simulated Forward Falls Using a Novel Propelled Upper Limb Fall ARrest Impact System (PULARIS)

Previous forward fall simulation methods have provided good kinematic and kinetic data, but are limited in that they have started the falls from a stationary position and have primarily simulated uni-directional motion. Therefore, a novel Propelled Upper Limb fall ARest Impact System (PULARIS) was designed to address these issues during assessments of a variety of fall scenarios. The purpose of this study was to present PULARIS and evaluate its ability to impact the upper extremities of participants with repeatable velocities, hand forces and hip angles in postures and with vertical and horizontal motion consistent with forward fall arrest. PULARIS consists of four steel tubing crossbars in a scissor-like arrangement that ride on metal trolleys within c-channel tracks in the ceiling. Participants are suspended beneath PULARIS by the legs and torso in a prone position and propelled horizontally via a motor and chain drive until they are quick released, and then impact floor-mounted force platforms with both hands. PULARIS velocity, hip angles and velocities and impact hand forces of ten participants (five male, five female) were collected during three fall types (straight-arm, self-selected and bent-arm) and two fall heights (0.05 m and 0.10 m) to assess the reliability of the impact conditions provided by the system. PULARIS and participant hip velocities were found to be quite repeatable (mean ICC = 0.81) with small between trial errors (mean = 0.03 m/s). The ratio of horizontal to vertical hip velocity components (~0.75) agreed well with previously reported data (0.70-0.80). Peak vertical hand impact forces were also found to be relatively consistent between trials with a mean ICC of 0.73 and mean between trial error of 13.4 N. Up to 83% of the horizontal hand impact forces displayed good to excellent reliability (ICC > 0.6) with small between trial differences. Finally, the ICCs for between trial hip angles were all classified as good to excellent. Overall, PULARIS is a reliable method and is appropriate for studying the response of the distal upper extremity to impact loading during non-stationary, multi-directional movements indicative of a forward fall. This system performed well at different fall heights, and allows for a variety of upper and lower extremity, and hip postures to be tested successfully in different landing scenarios consistent with elderly and sport-related falls.

Tissue mass ratios and the reporting of distal lower extremity injuries in varsity athletes at a Canadian University

Abstract The purpose of this preliminary investigation was to determine the relative role of the distal lower extremity tissue masses of varsity athletes in predicting distal lower extremity injury sustained during a competitive season. One hundred male and female varsity athletes (basketball, volleyball, soccer, cross country) completed a questionnaire on general health, physiological, and psychosocial variables, during each sports respective training camp. A series of anthropometric measurements were used as inputs to distal lower extremity tissue mass prediction equations to calculate lean mass, fat mass, bone mineral content and wobbling mass (lean mass + fat mass) and tissue mass ratios. Athletes were monitored throughout their respective seasons and were instructed to report any distal lower extremity injuries to a certified athletic therapist who was responsible for assessing and confirming the reports. Logistic regression analyses were performed to determine which variables significantly predicted distal lower extremity injury. Mean leg fat mass:bone mass (OR = 1.6, CI = 1.0 – 2.5), and competition surface (rubber OR = 8.5, CI = 1.5 – 47.7; artificial turf OR = 4.0, CI = 0.77 – 22.9) were identified as significant predictors of injury. Overall, tibia bone injuries were significantly associated with the ratio of fat mass:bone mineral content and the surface on which the athletes compete.