Biomechanics of Fractures

and Fixation

Biomechanics

Biomechanics: Outline

Deni4on
Types of Mo4on
Measuring Mo4on
Describing the Geometry of Mo4on: Kinema4cs
Linear
Angular

Describing the Forces of Mo4on: Kine4cs

Linear
Angular

Fluid Mechanics

Biomechanics
The study of the structure and func4ons of
biological systems by means of the
methods of mechanics





Hatze, 1974
We might think of biomechanics as the
physics of human movement

Mo4on
Kinema4cs
describing movements with respect to 4me
and space

Kine4cs
examines the forces that produce the
movement and result from the movement

Why study biomechanics?

skill analysis
correc4on
pinpoin4ng errors

developing a new technique

adap4ng to new equipment
understanding complex movement
behavior

Types of mo4on
Linear (transla4on)
all parts travel the same distance in the same
4me along the same path

Type of Mo4on
Angular mo4on
parts rotate around an
axis of rota4on

General Mo4on

Most movements are

likely a combination of
both linear and
angular motion

Measuring Mo4on
Kinema4cs
High speed
cinematography
High speed Videography
Stroboscopy
Optoelectric
electrogoniometry
accelerometry

Kine4cs
Pressure and Force
transducers
Force PlaWorm
Isokine4c dynamometer

Other
Electromyography

Kinema4cs: Film Analysis

SETUP

CALIBRATION

ANALYSIS

What might we measure?

KINEMATICS: Spa.al component

Posi4on

loca4on in space rela4ve to some spa4al coordinate

system reference (e.g., center of joint, COG, COM, point
of contact)

Displacement
is the straight line distance and direc4on

Distance
the length of the path traversed

What might we measure?

Center of gravity
the point about which a bodys weight is equally
balanced in all direc4ons (Hall, 1995)

Measuring Mo4on

Kinema4cs: Film
Analysis
CALIBRATION

SETUP

ANALYSIS

(50,490)

(
(10, 570)

Example: Data

Example: Posi4on and Velocity Data

What might we measure?

Kinema.cs: Spa.al and temporal components
Speed
distance / 4me (m/s)

Velocity
displacement / 4me (m/s)

Accelera4on
velocity / 4me (m/s2)

What might we measure?

Kine4cs
Iner4a
a bodys resistance to being moved

Force
a push or pulling ac4on on the body (lbs, N)
(nb: 1 lb = 4.45N)

Mo4on, Force, and Sir Issac

First Law (Iner4a)
a body con4nues in a state of rest or uniform
mo4on un4l acted upon by an external force of
sucient magnitude to disturb its current state

Mo4on, Force, and Sir Issac

Second Law (Accelera4on or F=ma)
the accelera4on of the body is propor4onal to
the force exerted on it and inversely
propor.onal to its mass
e.g.1, a soccer ball (of xed mass) will experience greater
accelera4on when kicked with more force

e.g.2, for kick (of given force) a lighter soccer ball will experience
greater accelera.on

Mo4on, Force, and Sir Issac

Third Law (ac4on-
reac4on)
every ac4on has an
equal and opposite
reac4on (important for
conserva4on of
momentum)

GROUND REACTION FORCES

Angular Mo4on
When a force is not exerted along a line
that passes through a bodys center of
gravity (eccentric force), the body will
experience angular (rotary) mo4on

What might we measure?

Angular displacement
change in loca4on of rota4ng body

Angular distance
angle between ini4al and nal posi4ons when
measured by following the path of the body
angular mo4on consider in degrees, revolu4ons, or
radians
1 radian = 57.3 degrees
1 revolu.on = 360 degrees
1 revolu.on = 6.28 radians

What might we measure?

Angular Velocity

angular displacement /
4me (degree/s)

Angular Accelera4on
angular velocity / 4me
(degrees/s2)

What might we measure?

Angular Kine4cs
Torque
turning eect on a body measured as the product of force
and moment arm length (e.g., changing 4res)

Moment of iner4a
resistance to rotary mo4on that results from combina4on
of mass and distribu4on of the mass of an object
minimize resistance to angular rota4on must move
mass closer to axis of rota4on (e.g., choking-up
in baseball, spinning in ska4ng or gymnas4cs)

Moment of Iner4a: Rela4ve

Tuck
Pike
Full body rota4ng around center of mass
Full body rota4ng around a bar

1.

Extended swing
around bar
2. Extended swing
around central axis
3. Pike
4. Tuck

Assuming:
md2
Where:

= mass
d = distance from
axis of rotation
M

Fluid Mechanics
Drag
Fluid force that opposes the forward mo4on of
the body and reduced the bodys velocity.

Lif
Component of air resistance that is directed at
right angles to the drag force

Drag
Fluid force that opposes the forward mo4on
of the body and reduced the bodys
velocity.

Will depend on:

uid density
frontal area of body (e.g., rowing shells)
drag coecient (dependent on shape)
movement velocity

Forms of Drag
Surface (hydrodynamic drag)
referring to interac4on between body surface and the
water
water temperature, water viscosity, body surface area,
movement velocity

Prole (Form)
refers to resis4ve forces resul4ng from poor body
posi4on

Wave

Surface Drag

Water particles attract other water particles and

will increase with roughness of skin

Prole Drag
Low pressure pocket forms
and holds back the
cyclist. As velocity doubles this
resistive force quadruples!!!!
Important factors:
Shape
smoothness
orientation (crouch can lower
resistance ~30%

Reducing Drag
Frame designs
on bikes are often
tear-shaped to
reduce drag
Drafting within 1 m
can reduce drag
accounting for 6% of
energy cost (e.g., ducks flying)

Lif
Component of air resistance that is directed
at right angles to the drag force
Lift
Resultant
Drag
Air Flow

Lif - common example

High velocity/Low Pressure

Low velocity/High Pressure

According to Bernoulli's Law, faster air has lower

air pressure, and thus the high pressure beneath the
wing pushes up to cause lift.

Lif and Formula I

The desire to further increase the 4re adhesion led the major
revolu4on in racing car design, the introduc4on of inverted
wings,which produce nega4ve lif or 'downforce'.

hip://www.npl.uiuc.edu/%7Ea-nathan/pob/index.html

Magnus Eect

Intended Direction

Force rst discovered by

Magnus. It explains the
curving of a spinning ball.
As the spinning object
pushes the air from one
side to the other, it will
create a lower pressure
zone, making the object
move faster on one side.

Flight
Path
Air Flow

Low
Pressure

Review
Kinema4cs
linear mo4on
displacement, velocity..

Angular Mo4on
angular displacement

Fluid dynamics
drag
lift

Kine4cs
linear mo4on
mass, iner4a

Angular Mo4on
torque, moment of iner4a

Basic Biomechanics
Material Properties
Elastic-Plastic
Yield point
Brittle-Ductile
Toughness

Independent of
Shape!

Structural Properties
Bending Stiffness
Torsional Stiffness
Axial Stiffness

Depends on Shape
and Material!

Basic Biomechanics
Force, Displacement & Stiffness

Force

Slope = Stiffness =
Force/Displacement

Displacement

Basic Biomechanics
Force
Area

Stress = Force/Area

Strain Change Height (L) /

Original Height(L0)

Basic Biomechanics
Stress-Strain & Elastic Modulus
Stress =
Force/Area

Slope =
Elastic Modulus =
Stress/Strain

Strain =
Change in Length/Original Length (L/ L0)

Basic Biomechanics
Common Materials in Orthopaedics
Elastic Modulus
(GPa)

Stress

Strain

Stainless Steel
Titanium
Cortical Bone
Bone Cement
Cancellous Bone
0.7-4.9
UHMW-PE

200
100
7-21
2.5-3.5

1.4-4.2

Basic Biomechanics
Elastic Deformation
Plastic Deformation
Energy

Elastic

Plastic

Force
Energy
Absorbed

Displacement

Basic Biomechanics
Elastic

Stiffness-Flexibility
Yield Point
Failure Point
Brittle-Ductile
Toughness-Weakness

Plastic
Failure

Yield
Force
Stiffness

Displacement

Stiff
Ductile
Tough
Strong

Stiff
Brittle
Strong

Stress

Ductile
Weak

Brittle
Weak

Strain

Flexible
Brittle
Strong

Stress

Flexible
Brittle
Weak

Strain

Flexible
Ductile
Weak

Flexible
Ductile
Tough
Strong

Basic Biomechanics
Load to Failure
Continuous
application of force
until the material
breaks (failure point
at the ultimate load).
Common mode of
failure of bone and
reported in the
implant literature.

Fatigue Failure
Cyclical subthreshold loading
may result in failure
due to fatigue.
Common mode of
failure of orthopaedic
implants and fracture
fixation constructs.

Basic Biomechanics
Anisotropic
Mechanical
properties dependent
upon direction of
loading

Viscoelastic
Stress-Strain
character dependent
upon rate of applied
strain (time
dependent).

Bone Biomechanics
Bone is anisotropic - its modulus is
dependent upon the direction of
loading.
Bone is weakest in shear, then tension,
then compression.
Ultimate Stress at Failure Cortical Bone
Compression < 212 N/m2
Tension
< 146 N/m2
Shear
< 82 N/m2

Bone Biomechanics
Bone is viscoelastic: its forcedeformation characteristics are
dependent upon the rate of loading.
Trabecular bone becomes stiffer in
compression the faster it is loaded.

Bone Mechanics
Bone Density
Subtle density
changes greatly
changes strength
and elastic modulus
Density changes
Normal aging
Disease
Use
Disuse

Cortical Bone
Trabecular Bone

Figure from: Browner et al: Skeletal Trauma

2nd Ed. Saunders, 1998.

Basic Biomechanics
Bending
Axial Loading
Tension
Compression

Torsion
Bending Compression Torsion

Fracture Mechanics

Figure from: Browner et al: Skeletal Trauma 2nd Ed, Saunders, 1998.

Fracture Mechanics
Bending load:
Compression
strength greater than
tensile strength
Fails in tension

Figure from: Tencer. Biomechanics in Orthopaedic

Trauma, Lippincott, 1994.

Fracture Mechanics
Torsion
The diagonal in the direction of the applied force is in
tension cracks perpendicular to this tension diagonal
Spiral fracture 45 to the long axis

Figures from: Tencer. Biomechanics in Orthopaedic

Trauma, Lippincott, 1994.

Fracture Mechanics
Combined bending
& axial load
Oblique fracture
Butterfly fragment

Figure from: Tencer. Biomechanics in Orthopaedic

Trauma, Lippincott, 1994.

Moments of Inertia
Resistance to
bending, twisting,
compression or
tension of an object is
a function of its shape
Relationship of
applied force to
distribution of mass
(shape) with respect
to an axis.

Figure from: Browner et al, Skeletal Trauma 2nd Ed,

Saunders, 1998.

Fracture Mechanics
Fracture Callus

1.6 x stronger

Moment of inertia
proportional to r4
Increase in radius by
callus greatly
increases moment of
inertia and stiffness

Figure from: Browner et al, Skeletal Trauma

2nd Ed, Saunders, 1998.

0.5 x weaker
Figure from: Tencer et al: Biomechanics in
Orthopaedic Trauma, Lippincott, 1994.

Fracture Mechanics
Time of Healing
Callus increases
with time
Stiffness
increases with
time
Near normal
stiffness at 27
days
Does not
correspond to
radiographs

Figure from: Browner et al, Skeletal Trauma,

2nd Ed, Saunders, 1998.

IM Nails
Moment of Inertia
Stiffness
proportional to the
4th power.

Figure from: Browner et al, Skeletal Trauma, 2nd Ed,

Saunders, 1998.

IM Nail Diameter

Figure from: Tencer et al, Biomechanics in Orthopaedic Trauma, Lippincott, 1994.

Slotting
Allows more flexibility
In bending
Decreases torsional strength

Figure from Rockwood and Greens, 4th Ed

Figure from: Tencer et al, Biomechanics
in Orthopaedic Trauma, Lippincott, 1994.

Slotting-Torsion

Figure from: Tencer et al, Biomechanics

in Orthopaedic Trauma, Lippincott, 1994.

Interlocking Screws
Controls torsion and axial
loads
Advantages
Axial and rotational stability
Angular stability

Disadvantages
Time and radiation
exposure
Stress riser in nail

Location of screws
Screws closer to the end
of the nail expand the
zone of fxs that can be
fixed at the expense of
construct stability

Biomechanics of Internal Fixation

Biomechanics of Internal Fixation

Screw Anatomy
Inner diameter
Outer diameter
Pitch

Figure from: Tencer et al, Biomechanics in

OrthopaedicTrauma, Lippincott, 1994.

Biomechanics of Screw Fixation

To increase strength
of the screw & resist
fatigue failure:
Increase the inner
root diameter

To increase pull out

strength of screw in
bone:
Increase outer
diameter
Decrease inner
diameter
Increase thread density
Increase thickness of
cortex
Use cortex with more
density.

Biomechanics of Screw Fixation

Cannulated Screws
Increased inner
diameter required
Relatively smaller
thread width results in
lower pull out strength
Screw strength
minimally affected
( r4outer core - r4inner core )
Figure from: Tencer et al, Biomechanics in
OrthopaedicTrauma, Lippincott, 1994.

Biomechanics of Plate Fixation

Plates:
Bending stiffness
proportional to the
thickness (h) of
the plate to the 3rd
power.

Base (b)

I= bh3/12

Height
(h)

Biomechanics of Plate Fixation

Functions of the plate
Compression
Neutralization
Buttress

The bone protects the

plate

Biomechanics of Plate Fixation

Unstable constructs
Severe comminution
Bone loss
Poor quality bone
Poor screw
technique

Biomechanics of Plate Fixation

Applied Load

Fracture Gap /Comminution

Allows bending of plate with
applied loads
Fatigue failure
Gap

Bone

Plate

Biomechanics of Plate Fixation

Fatigue Failure
Even stable
constructs may fail
from fatigue if the
fracture does not
heal due to biological
reasons.

Biomechanics of Plate Fixation

Applied Load

Bone-Screw-Plate
Relationship
Bone via
compression
Plate via bone-plate
friction
Screw via resistance
to bending and pull
out.

Biomechanics of Plate Fixation

The screws closest
to the fracture see
the most forces.
The construct rigidity
decreases as the
distance between
the innermost
screws increases.

Screw Axial Force

Biomechanics of Plate Fixation

Number of screws (cortices)
recommended on each side of
the fracture:
Forearm

(5-6)

Humerus

3-4

(6-8)

Tibia

(7-8)

Femur

4-5

(8)

Biomechanics of Plating
Tornkvist H. et al: JOT 10(3) 1996, p
204-208
Strength of plate fixation ~ number of
screws & spacing (1 3 5 > 123)
Torsional strength ~ number of screws
but not spacing

Biomechanics of External Fixation

Biomechanics of External Fixation

Pin Size
{Radius}4
Most significant
factor in frame
stability

Biomechanics of External Fixation

Number of Pins
Two per segment
Third pin

Biomechanics of External Fixation

Third pin (C)
out of plane of
two other pins
(A & B)
stabilizes that
segment.

Biomechanics of External Fixation

Pin Location
Avoid zone of injury or future ORIF
Pins close to fracture as possible
Pins spread far apart in each fragment
Wires
90

Biomechanics of External Fixation

Bone-Frame
Distance
Rods
Rings
Dynamization

Biomechanics of External Fixation

SUMMARY OF EXTERNAL FIXATOR STABILITY:
Increase stability by:
1] Increasing the pin diameter.
2] Increasing the number of pins.
3] Increasing the spread of the pins.
4] Multiplanar fixation.
5] Reducing the bone-frame distance.
6] Predrilling and cooling (reduces thermal necrosis).
7] Radially preload pins.
8] 90 tensioned wires.
9] Stacked frames.
**but a very rigid frame is not always good.

Ideal Construct
Far/Near - Near/Far on either side of fx
Third pin in middle to increase stability
Construct stability compromised with
spanning ext fix avoid zone of injury (far/
near far/far)

Biomechanics of Locked
Plating

Courtesy of Synthes- Robi Frigg

Conventional Plate Fixation

Patient Load

Patient Load

<
Patient Load

Friction Force

Courtesy of Synthes- Robi Frigg

Locked Plate and Screw Fixation

<
Patient Load

Compressive
Strength of the
Bone

Courtesy of Synthes- Robi Frigg

Stress in the Bone

Patient Load

Preload

Courtesy of Synthes- Robi Frigg

Standard versus Locked Loading

Courtesy of Synthes- Robi Frigg

Pullout of regular screws

by bending load

Higher resistant LHS

against bending load

Courtesy of Synthes- Robi Frigg

Larger resistant area

Biomechanical Advantages of
Locked Plate Fixation
Purchase of screws to bone not critical
(osteoporotic bone)
Preservation of periosteal blood supply
Strength of fixation rely on the fixed angle
construct of screws to plate
Acts as internal external fixator

Preservation of Blood Supply

Plate Design

DCP

LCDCP

Courtesy of Synthes- Robi Frigg

Preservation of Blood Supply

Less bone pre-stress

Conventional Plating
Bone is pre-stressed
Periosteum strangled

Locked Plating
Plate (not bone) is
pre-stressed
Periosteum preserved

Courtesy of Synthes- Robi Frigg

Angular Stability of Screws

Nonlocked

Locked

Courtesy of Synthes- Robi Frigg

Biomechanical principles
similar to those of external fixators

Stress distribution

Courtesy of Synthes- Robi Frigg

Surgical Technique
Compression Plating

The contoured plate maintains anatomical

reduction as compression between plate and bone
is generated.
A well contoured plate can then be used to help reduce
the fracture.
Traditional Plating

Courtesy of Synthes- Robi Frigg

Surgical Technique
Reduction

If the same technique is attempted with a locked

plate and locking screws, an anatomical reduction
will not be achieved.
Locked Plating

Courtesy of Synthes- Robi Frigg

Surgical Technique
Reduction

Instead, the fracture is first reduced and then the

plate is applied.
Locked Plating

Surgical Technique
Precontoured Plates
Conventional Plating

Locked Plating

1. Contour of plate is important

to maintain anatomic
reduction.

1. Reduce fracture prior to

applying locking screws.

Unlocked vs Locked Screws

Biomechanical Advantage
1.
2.
3.
4.
5.

Force distribution
Prevent primary reduction loss
Prevent secondary reduction loss
Ignores opposite cortex integrity
Improved purchase on osteoporotic bone

Sequential Screw Pullout

Larger area of resistance

Courtesy of Synthes- Robi Frigg

Surgical Technique

Reduction with Combination Plate

Lag screws can be used to help reduce fragments

and construct stability improved w/ locking screws
Locked Plating

Courtesy of Synthes- Robi Frigg

Surgical Technique

Reduction with Combination Hole Plate

Lag screw must be placed 1st if locking screw in

same fragment is to be used.
Locked Plating

Hybrid Fixation
Combine benefits of both standard &
locked screws
Precontoured plate
Reduce bone to plate, compress & lag
through plate
Increase fixation with locked screws at
end of construct

Length of Construct
Longer spread with less screws
Every other rule (3 screws / 5 holes)

< 50% of screw holes filled

Avoid too rigid construct

Further Reading

Tencer, A.F. & Johnson, K.D., Biomechanics in Orthopaedic Trauma,

Lippincott.
Orthopaedic Basic Science, AAOS.
Browner, B.D., et al, Skeletal Trauma, Saunders.
Radin, E.L., et al, Practical Biomechanics for the Orthopaedic Surgeon,
Churchill-Livingstone.
Tornkvist H et al, The Strength of Plate Fixation in Relation to the Number
and Spacing of Bone Screws, JOT 10(3), 204-208
Egol K.A. et al, Biomechanics of Locked Plates and Screws, JOT 18(8),
488-493
Haidukewych GJ & Ricci W, Locked Plating in Orthopaedic Trauma: A
Clinical Update, JAAOS 16(6),347-355

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