Metal artifacts from titanium and steel screws in CT, 1.5T and 3T MR images of the tibial Pilon: A quantitative assessment in 3D

Radiographs are commonly used to assess articular reduction of the distal tibia (pilon) fractures postoperatively, but may reveal malreductions inaccurately. While Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) are potential 3D alternatives they generate metal-related artifacts. This study aims to quantify the artifact size from orthopaedic screws using CT, 1.5T and 3T MRI data. Three screws were inserted into one intact human cadaver ankle specimen proximal to and along the distal articular surface, then CT, 1.5T and 3T MRI scanned. Four types of screws were investigated: titanium alloy (TA), stainless steel (SS) (Ø = 3.5 mm), cannulated TA (CTA) and cannulated SS (CSS)(Ø = 4.0 mm, Ø empty core = 2.6 mm). 3D artifact models were reconstructed using adaptive thresholding. The artifact size was measured by calculating the perpendicular distance from the central screw axis to the boundary of the artifact in four anatomical directions with respect to the distal tibia. The artifact sizes (in the order of TA, SS, CTA and CSS) from CT were 2.0 mm, 2.6 mm, 1.6 mm and 2.0 mm; from 1.5T MRI they were 3.7 mm, 10.9 mm, 2.9 mm, and 9 mm; and 3T MRI they were 4.4 mm, 15.3 mm, 3.8 mm, and 11.6 mm respectively. Therefore, CT can be used as long as the screws are at a safe distance of about 2 mm from the articular surface. MRI can be used if the screws are at least 3 mm away from the articular surface except SS and CSS. Artifacts from steel screws were too large thus obstructed the pilon from being visualised in MRI. Significant differences (P < 0.05) were found in the size of artifacts between all imaging modalities, screw types and material types, except 1.5T versus 3T MRI for the SS screws (P = 0.063). CTA screws near the joint surface can improve postoperative assessment in CT and MRI. MRI presents a favourable non-ionising alternative when using titanium hardware. Since these factors may influence the quality of postoperative assessment, potential improvements in operative techniques should be considered.

Fire performance of LSF wall panels using numerical parametric studies

Light Gauge Steel Framing (LSF) walls made of cold-formed and thin-walled steel lipped channel studs with plasterboard linings on both sides are commonly used in commercial, industrial and residential buildings. However, there is limited data about their structural and thermal performances under fire conditions. Recent research at the Queensland University of Technology has investigated the structural and thermal behaviour of load bearing LSF wall systems. In this research a series of full scale fire tests was conducted first to evaluate the performance of LSF wall systems with eight different wall configurations under standard fire conditions. Finite element models of LSF walls were then developed, analysed under transient and steady state conditions, and validated using full scale fire tests. This paper presents the details of an investigation into the fire performance of LSF wall panels based on an extensive finite element analysis based parametric study. The LSF wall panels with eight different plasterboard-insulation configurations were considered under standard fire conditions. Effects of varying steel grades, steel thicknesses, screw spacing, plasterboard restraint, insulation materials and load ratio on the fire performance of LSF walls were investigated and the results of extensive fire performance data are presented in the form of load ratio versus time and critical hot flange (failure) temperature curves.

Profiled steel roof claddings under high wind forces

Profiled steel roof claddings in Australia and its neighbouring countries are commonly made of very thin high tensile steel and are crest-fixed intermittently with screw fasteners. The failure of the roof cladding systems was due to a local failure (dimpling of crests I pull-through) at the fasteners under wind uplift Cyclic wind uplift during cyclones causes fatigue cracking to occur at the fastener holes which leads to pull-through failures at lower load levels. At present the design of these claddings is entirely based on testing. In order to improve the understanding of the behaviour and the design and test methods of these claddings under wind uplift loading during storms and cyclones, a detailed investigation consisting of finite element analyses, static and fatigue experiments and cyclonic wind modelling was carried out on two-span roofing assemblies of three common roofing profiles. This paper presents the details of this investigation and its important results.

Cost effectiveness of osseointegration

Individuals with limb amputation fitted with conventional socket-suspended prostheses often experience socket-related discomfort leading to a significant decrease in quality of life. Bone-anchored prostheses are increasingly acknowledged as viable alternative method of attachment of artificial limb. In this case, the prosthesis is attached directly to the residual skeleton through a percutaneous fixation. To date, a few osseointegration fixations are commercially available. Several devices are at different stages of development particularly in Europe and the US. [1-15] Clearly, surgical procedures are currently blooming worldwide. Indeed, Australia and Queensland, in particular, have one of the fastest growing populations. Previous studies involving either screw-type implants or press-fit fixations for bone-anchorage have focused on biomechanics aspects as well as the clinical benefits and safety of the procedure. [16-25] In principle, bone-anchored prostheses should eliminate lifetime expenses associated with sockets and, consequently, potentially alleviate the financial burden of amputation for governmental organizations. Sadly, publications focusing on cost-effectiveness are sparse. In fact, only one study published by Haggstrom et al (2012), reported that “despite significantly fewer visits for prosthetic service the annual mean costs for osseointegrated prostheses were comparable with socket-suspended prostheses”.[26] Consequently, governmental organizations such as Queensland Artificial Limb Services (QALS) are facing a number of challenges while adjusting financial assistance schemes that should be fair and equitable to their clients fitted with bone-anchored prostheses. Clearly, more scientific evidence extracted from governmental databases is needed to further consolidate the analyses of financial burden associated with both methods of attachment (i.e., conventional sockets prostheses, bone-anchored prostheses). The purposes of the presentation will be: 1. To outline methodological avenues to assess the cost-effectiveness of bone-anchored prostheses compared to conventional sockets prostheses, 2. To highlight the potential obstacles and limitations in cost-effectiveness analyses of bone-anchored prostheses, 3. To present preliminary results of a cost-comparison analysis focusing on the comparison of the costs expressed in dollars over QALS funding cycles for both methods of attachment.

Osseointegration internationally: Australia is playing a key role?

Individuals with limb amputation fitted with conventional socket-suspended prostheses often experience socket-related discomfort leading to a significant decrease in quality of life. Bone-anchored prostheses are increasingly acknowledged as viable alternative method of attachment of artificial limb. In this case, the prosthesis is attached directly to the residual skeleton through a percutaneous fixation. To date, a few osseointegration fixations are commercially available. Several devices are at different stages of development particularly in Europe and the US.[1-15] Clearly, surgical procedures are currently blooming worldwide. Indeed, Australia and Queensland in particular have one of the fastest growing populations. Previous studies involving either screw-type implants or press-fit fixations for bone-anchorage have focused on fragmented biomechanics aspects as well as the clinical benefits and safety of the procedure. [16-25] However, very few publications have synthetized this information and provided an overview of the current developments in bone-anchored prostheses worldwide, let alone in Australia. The purposes of the presentation will be: 1. To provide an overview of the state-of-art developments in bone-anchored prostheses with as strong emphasis on the design of fixations, treatment, benefits, risks as well as future opportunities and challenges, 2. To present the current international developments of procedures for bone-anchored prostheses in terms of numbers of centers, number of cases and typical case-mix, 3. To highlight the current role Australia is playing as a leader worldwide in terms of growing population, broadest range of case-mix, choices of fixations, development of reimbursement schemes, unique clinical outcome registry for evidence-based practice, cutting-edge research, consumer demand and general public interest.

Health-related quality of life of individuals with transfemoral amputation fitted with the Transcutaneous Bone Anchoring Prosthesis following the OGAAP

The benefits and safety transcutaneous bone anchored prosthesis relying on a screw fixation are well reported. However, most of the studies on press-fit implants and joint replacement technology have focused on surgical techniques. One European centre using this technique has reported on health-related quality of life (HRQOL) for a group of individuals with transfemoral amputation (TFA). Data from other centres are needed to assess the effectiveness of the technique in different settings. The aim of this study is to report HRQOL data at baseline and up to 2-year follow-up for a group of TFAs treated by Osseointegration Group of Australia who followed the Osseointegration Group of Australia Accelerated Protocol (OGAAP), in Sydney between 08/12/2011 and 09/04/2014.

Bone-anchored prosthesis: Update in international developments

This symposium will provide hand-on update on the current development of the load sensors measuring the inner prosthetic loading that can strongly contribute the ever increasing demand for evidence-based clinical practice. Surgical implantations of osseointegrated fixations for bone-anchored prosthesis are developing at an unprecedented pace worldwide (e.g., Australia, UK, Sweden, US). This option is becoming accessible to a wide range of individuals with limb loss. With these new developments come new potential challenges and opportunities for all the stakeholders involved in the prosthetic care of these patients. Clearly, there is a need for those stakeholders, particularly those attending the ISPO, to be informed of the current and upcoming international developments in bone-anchored prostheses. The objectives of this symposium will be: • To present an overview of the current growth of the procedures worldwide (e.g., identification of key players, centers of activities, growth trend) with a strong focus on the introduction of the framework to evaluate the availability of the procedure at national level (e.g., number of patients treated, range of the levels of implantation, number of commercial fixations accessible), • To provide first-hand updates on the latest cutting-edge scientific and clinical developments of fixations and rehabilitations programs (e.g., Innovative design of implant, cost-effectiveness, long-terms rehabilitation outcomes for screw-type fixation, current developments in US, comparative analysis for press-fit type of implant, potential moves toward single-stage surgeries).

Pull-through failure tests of thin steel roof battens under wind uplift load

Thin profiled steel roof sheeting and battens are increasingly used in the construction of roofing systems of residential, commercial, industrial and farm buildings in Australia. The critical load combination of external wind suction and internal wind pressures that occur during high wind events such as thunderstorms and tropical cylcones often dislocate the roofing systems partially or even completely due to premature roof connection failures. Past wind damage investigations have shown that roof sheeting failures occured at their screw connections to battens. In most of these cases, the screw fastener head pulled through the thin roof sheeting whilst the screw fasteners also pulled out from the battens. Research studis undertaken on the roof sheeting to batten connection failures have improved this situation. However, the batten to rafter or truss connections have not been investigated adequately. Failure of these connections can cause the failure of the entire roof structure as observed during the recent high wind events. Therefore a detailed experimental study consisting of both small scale and full scale tests has been undertaken to investigate the steel roof batten pull-through failures in relation to many critical parameters such as steel batten geometry, thickness and grade, screw fastener head sizes and screw tightening. This paper presents the details of this experimental study and the pull-through failure load results obtained from them. Finally it discusses the development of suitable design rules that can be used to determine the pull-through connection capacities of thin steel roof battens under wind uplift loads.

Numerical modeling of thin steel roof battens under wind uplift loads

Extreme wind events such as tropical cyclones, tornadoes and storms are more likely to impact the Australian coastal regions due to possible climate changes. Such events can be extremely destructive to building structures, in particular, low-rise buildings with lightweight roofing systems that are commonly made of thin steel roofing sheets and battens. Large wind uplift loads that act on the roofs during high wind events often cause premature roof connection failures. Recent wind damage investigations have shown that roof failures have mostly occurred at the batten to rafter or truss screw connections. In most of these cases, the screw fastener heads pulled through the bottom flanges of thin steel roof battens. This roof connection failure is very critical as both roofing sheets and battens will be lost during the high wind events. Hence, a research study was conducted to investigate this critical pull-through failure using both experimental and numerical methods. This paper presents the details of numerical modeling and the results.

Design of steel roof and wall cladding systems for pull-out failures

When thin steel roof and wall cladding systems are subjected to wind uplift/suction forces, local pull-through or pull-out failures occur prematurely at their screwed connections. During high wind events such as stom1s and cyclones, these localized failures then lead to severe damage to buildings and their contents. In recent times, the use of thin steel battens, purlins and girts has increased considerably, which has made the pull-out failures more critical in the design of steel cladding systems. An experimental investigation was therefore carried out to study the pull-out failure using both static and cyclic tests for a range of commonly used screw fasteners and steel battens, purlins and girts. This paper presents the details ofthis experimental investigation and its results.

Pull-through strength of high tensile steel cladding systems

The profiled steel roof and wall cladding systems in Australia are commonly made of very thin high tensile steels, and are crest-fixed with screw fasteners. A review of current literature and design standards indicated the need to improve the understanding of the behaviour of crest-fixed steel cladding systems under wind uplift/suction loading, in particular, the local failures. Therefore a detailed experimental study using a series of small scale tests and some two-span cladding tests was conducted to investigate the local pull-through and dimpling failures in the commonly used steel cladding systems. The applicability of the current design formulae for the pull-through strength of crest-fixed steel classing systems was investigated first. An improved design formula was then developed in terms of the thickness and ultimate tensile strenth of steel cladding material and diameter of screw head or washer. This paper presents the details of this investigation and its results. A review of current design and test methods is also included.

Web crippling tests of rivet fastened rectangular hollow flange channel beams under two flange load cases

Recent research on hollow flange beams has led to the development of an innovative rectangular hollow flange channel beam (RHFCB) for use in floor systems. The new RHFCB is a mono-symmetric structural section made by intermittently rivet fastening two torsionally rigid closed rectangular hollow flanges to a web plate element, which allows section optimisation by selecting appropriate combinations of web and flange widths and thicknesses. However, the current design rules for cold-formed steel sections are not directly applicable to rivet fastened RHFCBs. To date, no investigation has been conducted on their web crippling behaviour and strengths. Hence an experimental study was conducted to investigate the web crippling behaviour and capacities of rivet fastened RHFCBs under End Two Flange (ETF) and Interior Two Flange (ITF) load cases. It showed that RHFCBs failed by web crippling, flange crushing and their combinations. Comparison of ultimate web crippling capacities with the predictions from the design equations in AS/NZS 4600 and AISI S100 showed that the current design equations are unconservative for rivet fastened RHFCB sections under ETF and ITF load cases. Hence new equations were proposed to determine the web crippling capacities of rivet fastened RHFCBs. These equations can also be used to predict the capacities of RHFCBs subject to combined web crippling and flange crushing conservatively. However, new capacity equations were proposed in the case of flange crushing failures that occurred in thinner flanges with smaller bearing lengths. This paper presents the details of this web crippling experimental study of RHFCB sections and the results.

Shear strength and stiffness of crest-fixed steel claddings

Diaphragm action of crest-fixed profiled steel claddings is present in low-rise buildings whether the designer acknowledges it or not. For the designers to take advantage of the diaphragm strength of the crest-fixed steel claddings in the design of low-rise buildings in a similar manner to valley-fixed claddings, and to design the buildings based on the true behaviour rather than the assumed behaviour, shear/racking behaviour of the three trapezoidal and corrugated steel claddings commonly used at present was investigated using large scale experiments. Crest-fixed claddings (up to a maximum size of 6 x 6.2m) with different aspect ratio and fastening systems were tested to failure, based on which suitable shear strength and stiffness values have been proposed for these claddings as they are used at present. A simple analytical model combined with basic connection data from small scale experiments was used to predict the shear strength of tested panels. Currently attempts are being made to develop general design formulae to determine shear strength and stiffness of crest-fixed steel claddings...

Rehabilitation of individuals with bone-anchored prosthesis: State-of-the-art and challenges

Individuals with limb amputation fitted with conventional socket-suspended prostheses often experience socket-related discomfort leading to a significant decrease in quality of life. Bone-anchored prostheses are increasingly acknowledged as viable alternative method of attachment of artificial limb. In this case, the prosthesis is attached directly to the residual skeleton through a percutaneous fixation. To date, a few osseointegration fixations are commercially available. Several devices are at different stages of development particularly in Europe and the US.[1-15] Clearly, surgical procedures are currently blooming worldwide. Indeed, Australia and Queensland in particular have one of the fastest growing populations. Previous studies involving either screw-type implants or press-fit fixations for bone-anchorage have focused on fragmented biomechanics aspects as well as the clinical benefits and safety of the procedure. However, very few publications have synthetized this information and provided an overview of the current developments in bone-anchored prostheses worldwide, let alone in Australia. The purposes of the presentation will be: 1. To provide an overview of the state-of-art developments in bone-anchored prostheses with as strong emphasis on the design of fixations, treatment, benefits, risks as well as future opportunities and challenges, 2. To present the current international developments of procedures for bone-anchored prostheses in terms of numbers of centers, number of cases and typical case-mix, 3. To highlight the current role Australia is playing as a leader worldwide in terms of growing population, broadest range of case-mix, choices of fixations, development of reimbursement schemes, unique clinical outcome registry for evidence-based practice, cutting-edge research, consumer demand and general public interest.

Cost-effectiveness of bone-anchored prosthesis: the Queensland experience

Individuals with limb amputation fitted with conventional socket-suspended prostheses often experience socket-related discomfort leading to a significant decrease in quality of life. Bone-anchored prostheses are increasingly acknowledged as viable alternative method of attachment of artificial limb. In this case, the prosthesis is attached directly to the residual skeleton through a percutaneous fixation. To date, a few osseointegration fixations are commercially available. Several devices are at different stages of development particularly in Europe and the US. [1-15] Clearly, surgical procedures are currently blooming worldwide. Indeed, Australia and Queensland, in particular, have one of the fastest growing populations. Previous studies involving either screw-type implants or press-fit fixations for bone-anchorage have focused on biomechanics aspects as well as the clinical benefits and safety of the procedure. In principle, bone-anchored prostheses should eliminate lifetime expenses associated with sockets and, consequently, potentially alleviate the financial burden of amputation for governmental organizations. Unfortunately, publications focusing on cost-effectiveness are sparse. In fact, only one study published by Haggstrom et al (2012), reported that “despite significantly fewer visits for prosthetic service the annual mean costs for osseointegrated prostheses were comparable with socket-suspended prostheses”. Consequently, governmental organizations such as Queensland Artificial Limb Services (QALS) are facing a number of challenges while adjusting financial assistance schemes that should be fair and equitable to their clients fitted with bone-anchored prostheses. Clearly, more scientific evidence extracted from governmental databases is needed to further consolidate the analyses of financial burden associated with both methods of attachment (i.e., conventional sockets prostheses, bone-anchored prostheses). The purpose of the presentation will be to share the current outcomes of a cost-analysis study lead by QALS. The specific objectives will be: • To outline methodological avenues to assess the cost-effectiveness of bone-anchored prostheses compared to conventional sockets prostheses, • To highlight the potential obstacles and limitations in cost-effectiveness analyses of bone-anchored prostheses, • To present cohort results of a cost-effectiveness (QALY vs cost) including the determination of fair Incremental cost-effectiveness Ratios (ICER) as well as cost-benefit analysis focusing on the comparing costs and key outcome indicators (e.g., QTFA, TUG, 6MWT, activities of daily living) over QALS funding cycles for both methods of attachment.