Second-Generation Orthopaedic Measurement Device for in-vivo Assessment of Bone Quality

There are two main types of bone in the human body, trabecular and cortical bone. Cortical bone is primarily found on the outer surface of most bones in the body while trabecular bone is found in vertebrae and at the end of long bones (Ross 2007). Osteoporosis is a condition that compromises the structural integrity of trabecular bone, greatly reducing the ability of the bone to absorb energy from falls. The current method for diagnosing osteoporosis and predicting fracture risk is measurement of bone mineral density. Limitations of this method include dependence on the bone density measurement device and dependence on type of test and measurement location (Rubin 2005). Each year there are approximately 250,000 hip fractures in the United States due to osteoporosis (Kleerekoper 2006). Currently, the most common method for repairing a hip fracture is a hip fixation surgery. During surgery, a temporary guide wire is inserted to guide the permanent screw into place and then removed. It is believed that directly measuring this screw pullout force may result in a better assessment of bone quality than current indirect measurement techniques (T. Bowen 2008-2010, pers. comm.). The objective of this project is to design a device that can measure the force required to extract this guide wire. It is believed that this would give the surgeon a direct, quantitative measurement of bone quality at the site of the fixation. A first generation device was designed by a Bucknell Biomedical Engineering Senior Design team during the 2008- 2009 Academic Year. The first step of this project was to examine the device, conduct a thorough design analysis, and brainstorm new concepts. The concept selected uses a translational screw to extract the guide wire. The device was fabricated and underwent validation testing to ensure that the device was functional and met the required engineering specifications. Two tests were conducted, one to test the functionality of the device by testing if the device gave repeatable results, and the other to test the sensitivity of the device to misalignment. Guide wires were extracted from 3 materials, low density polyethylene, ultra high molecular weight polyethylene, and polypropylene and the force of extraction was measured. During testing, it was discovered that the spring in the device did not have a high enough spring constant to reach the high forces necessary for extracting the wires without excessive deflection of the spring. The test procedure was modified slightly so the wires were not fully threaded into the material. The testing results indicate that there is significant variation in the screw pullout force, up to 30% of the average value. This significant variation was attributed to problems in the testing and data collection, and a revised set of tests was proposed to better evaluate the performance of the device. The fabricated device is a fully-functioning prototype and further refinements and testing of the device may lead to a 3rd generation version capable of measuring the screw pullout force during hip fixation surgery.

Correlation of Pullout Force of Kirschner (K-) Wire to Other Factors Indicative of Bone Quality

More than 250,000 hip fractures occur annually in the United States and the most common fracture location is the femoral neck, the weakest region of the femur. Hip fixation surgery is conducted to repair hip fractures by using a Kirschner (K-) wire as a temporary guide for permanent bone screws. Variation has been observed in the force required to extract the K-wire from the femoral head during surgery. It is hypothesized that a relationship exists between the K-wire pullout force and the bone quality at the site of extraction. Currently, bone mineral density (BMD) is used as a predictor for bone quality and strength. However, BMD characterizes the entire skeletal system and does not account for localized bone quality and factors such as lifestyle, nutrition, and drug use. A patient’s BMD may not accurately describe the quality of bone at the site of fracture. This study aims to investigate a correlation between the force required to extract a K-wire from femoral head specimens and the quality of bone. A procedure to measure K-wire pullout force was developed and tested with pig femoral head specimens. The procedure was implemented on 8 human osteoarthritic femoral head specimens and the average pullout force for each ranged from 563.32 ± 240.38 N to 1041.01 ± 346.84 N. The data exhibited significant variation within and between each specimen and no statistically significant relationships were determined between pullout force and patient age, weight, height, BMI, inorganic to organic matter ratio, and BMD. A new testing fixture was designed and manufactured to merge the clinical and research environments by enabling the physician to extract the K-wire from each bone specimen himself. The new device allows the physician to gather tactile feedback on the relative ease of extraction while load history is recorded similar to the previous procedure for data acquisition. Future work will include testing human bones with the new device to further investigate correlations for predicting bone quality.

The Expression Of Motor Planning In Squirrel Monkeys (Saimiri sciureus) And Brown Capuchins (Cebus apella)

Multiple recent studies provide evidence that both human and nonhuman primates possess motor planning abilities. I tested for the demonstration of motor planning in two previously untested primate species through two experiments. In the first experiment, I compared the extent to which squirrel monkeys (Saimiri sciureus) and brown capuchins (Cebus apella) plan their movements in a grasping task. Individuals were presented with an inverted cup that required being turned and held upright in order to extract a food reward from the inside of the cup. This task was most efficiently solved by using an initially awkward inverted grasp that affords a comfortable hand and arm orientation at the end of the movement (known as end-state comfort). While certain individuals from both species exhibited end-state comfort, many of the capuchins never demonstrated this type of motor planning. Furthermore, the squirrel monkeys used the efficient grasp significantly more than the capuchins. In the second experiment, I presented the capuchins with another grasping task to test if they would express motor planning abilities in a different context. Here, the capuchins were offered a dowel that was baited on either the left or right end. A radial grasp with the thumb pointing towards the baited end was considered to be the most efficient grasp because it afforded a comfortable final position. The capuchins switched hands and used an overhand radial grasp on the dowel significantly more often than not, thus demonstrating motor planning in this task. The grasps typically utilized by these two closely related species differ considerably in that capuchins are capable of exercising precision grips, whereas squirrel monkeys are limited to whole-handed power grips. Moreover, unlike capuchins, squirrel monkeys are not particularly dexterous nor are they capable of precise manipulative actions. It is therefore more beneficial for squirrel monkeys to plan their movements efficiently because they are less capable of compensating for inappropriate initial grasps. Due to the appreciable variability in the expression of motor planning skills across species, I proposed that morphological constraints might explain the observed discrepancies in movement planning among different primate species.