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Materials Today: Proceedings 5 (2018) 13267–13275 www.materialstoday.com/proceedings

ICMMM - 2017

Development of computational Tibia model to investigate stress

shielding effect at healing stages
Emon Baruaa*, Saurav Dasb, Ashish B. Deogharec
a,b,c
Mechanical Engineering Department, National Institute of Technology Silchar, Silchar - 788010, India

Abstract

A 3D CAD model of human Tibia is developed from scanned Computed Tomography (CT) images. Static analysis is carried out
using finite element analysis (FEA) to study the maximum stresses, deformation and strain induced in tibia during normal gait
cycle. A fracture of 1 mm is generated in the developed model and is bridged by a callus. Effect of growth of callus at various
healing stages is analyzed with stainless steel (SS), Titanium-alloy and stiffness graded (SG) implant material coupled to the
fractured bone. Result shows stress shielding effect is minimum in case of SG implants at every healed stage, compared to SS
and Ti-alloy implants. At 1% healed stage, SG implant shows an increase of 16% and 19% in stresses as compared to SS and Ti-
alloy implants.
© 2017 Elsevier Ltd. All rights reserved.
Selection and/or Peer-review under responsibility of International Conference on Materials Manufacturing and Modelling (ICMMM - 2017).

Keywords: Tibia; Computed Tomography; Finite Element Analysis; Callus; Implants

1. Introduction

Long bones like Tibia and femur are more susceptible to trauma under free fall or accidents due to its slender
shape. Patients with diaphyseal Tibial fracture are generally treated by internal fixation devices such as compression
bone plate, Intrameduallary rodding etc. Fracture fixation using plate and screw technique restricts mobilization of
bone and promotes suitable condition for primary bone healing. Implant holds the fractured bones in position and
avoids misalignment due to physiological movements. The conventional implant materials like stainless steel,
titanium alloy has 5-10 times higher young’s modulus than cortical bone. The difference in moduli of the metal
implant and the cortical bone lead to stress shielding effect. Maximum load is shared by the implants rather than the
underlying fractured bone delays in the healing process.

* Corresponding author. Tel.: +91-9577839402

E-mail address:imon18enator@gmail.com

2214-7853© 2017 Elsevier Ltd. All rights reserved.

Selection and/or Peer-review under responsibility of International Conference on Materials Manufacturing and Modelling (ICMMM - 2017).
13268 Emon Barua et al. / Materials Today: Proceedings 5 (2018) 13267–13275

Ganesh et al. [1] employed stiffness-graded (SG) implant material for fixing long bone fracture. The research
reveals that stress shielding effect in SG implant material is comparatively lesser than normal bone and it provides
higher compressive stresses in fracture boundaries. The analysis was performed using 2D finite element simulation
although bone being 3D in nature. Various types of low stiffness polymeric material implants were designed by
Benli et al. [2] and calculated stresses at the fractured interface. The work emphasized that implants with flexible
design are more effective in curing bone fractures. The main assumption was considering the cortical bone as
isotropic despite the orthotropic nature of bone. Kim et al. [3] investigated the healing efficiency using flexible
composite bone plates on a Tibia with diaphyseal oblique fractures. Time-dependent properties of callus were
estimated for different healing rates. The cortical bone model was approximated to be cylindrical in shape and
trabecular bone as cylindrical rod. Fan et al. [4] aims to reduce the stress shielding and resistance to blood flow by
inserting a soft bio-degradable cushion at the interface of rigid plate and the fractured bone surface. Healing rate was
evaluated at the fracture site by Kim et al. [5] using composite implants. The simplification of the bone model
minimizes the computational time and accuracy in results.
The present research work exhibits the development of the Tibia CAD model from CT scan images. The CAD
model is resourceful enough to represent the exact anatomical features of Tibia. The model is analyzed to identify
the critical zone under compressive loading. The load exerted on proximal end of Tibia is equivalent to three times
of the body weight of a person weighing 80 Kg [6]. A gap is modelled in the Tibia and an implant is engaged to
support the fractured bone. The stresses at the fractured site are evaluated with conventional material and stiffness
graded implants. The model is analyzed with two instances. Firstly by fixing the implants in direct contact to the
fractured bone surface and secondly, by maintaining a clearance of 5 mm between the surfaces.

2. Materials and Methods

2.1. Development of CAD model of Tibia

CT scan images of a 33 year old male is acquired from Siemens make machine. A total of 1173 slices with 0.5
mm distance between consecutive slices and resolution of 512 × 512 pixels are used for developing the CAD model
of Tibia. Image processing software MIMICS 17.0 is used to develop the exact model of the bone Fig. 1 (a). For
extracting the cortical and trabecular Tibial bone features accurately, threshold value is adjusted from 226 to 1956
HU which corresponds to the bone density interval. The model is reconstructed through the process of segmentation
and region growing. The 3D model in IGES (.igs) format is imported to the CATIA v5R18 software and it is shown
in Fig. 1 (b). The data obtained is processed in CATIA for creating NURBS surfaces, which can be easily managed
by FE based softwares like ANSYS [7]. The length of Tibia is 345 mm and cortical bone thickness varies between
2-2.5 mm.

(a) (b)

Fig. 1. (a) Development of 3D CAD model of tibia from CT slices in MIMICS; (b) CAD model of tibia imported to CATIA.
 Emon Barua et al. / Materials Today: Proceedings 5 (2018) 13267–13275 13269

The anatomical features and geometrical attributes are studied by fabricating physical model Fig. 2 (a) and (b). To
accomplish this task the CAD model is saved in .stl format and data file is imported to 3DS software for printing
with Projet 460 Plus 3D printing machine. The model is built layer by layer with ceramic powder using visijet PXL-
clear binder. The physical model developed replicates the exact anatomical features of the Tibia. The prototype
serves the purpose of communicating anatomical and helpful for pre-operative surgical planning.

Fig. 2. (a) GUI interface of 3DS system; (b) Physical model of Tibia

2.2. Integration of bone plate systems and callus

The behaviour of the stiffness graded implants is studied by comparing the mechanical properties of SG implants
with conventional implant materials. For this, a gap of 1 mm is created in the bone to represent the fracture on the
Tibia. To bridge the gap, a callus of 1 mm thickness is modelled by extracting the cracked surface as shown in Fig.
3. The percentage of healing stages is defined by variable young’s modulus assigned to the callus in the analysis.
The material of callus is considered to be isotropic in nature with young’s modulus of 0.02 GPa at 1% healing stage,
10 GPa and 15 GPa at 50% and 75% healing stages respectively [8]. Implant is modelled with a length of 120 mm,
width 10 mm and thickness 7 mm. The implant materials considered for the analysis are stainless steel, Titanium
alloy and stiffness graded material. The assembled model of Tibia, implant and callus is shown in Fig. 4. Material
properties considered for the implants are according to the work done by Ganesh et al. [1] and is presented in Table
1. The young’s modulus of stiffness graded implant is varied from 20 GPa to 110 GPa. Poisson’s ratio of 0.3 is
assigned to both the callus and the implants during the analysis. The young’s modulus of implant layer in contact
with the bone surface is 20 GPa and is increased linearly to 110 GPa at the outermost layer [9]. Surface-to-surface
contact is considered in the FE model to represent the contact interfaces between implant, fractured bone, screws
and callus. Coefficient of friction considered is 0.9. Analysis is performed with similar loading as employed for
Tibia bone analysis. Von-Mises stress is evaluated at the fracture site where compressive load is applied to study the
effect of stress shielding caused by engagement of implants.

Implant

Callus bridging
the gap

Fig. 3. CAD model of callus. Fig. 4. Assembly of fractured bone with callus and implant.
13270 Emon Barua et al. / Materials Today: Proceedings 5 (2018) 13267–13275

Table 1. Material properties of bone regions, implant and callus [1, 4, 5 and 6].
Particulars Young’s Modulus Poisson’s ratio (m)
(GPa)
Ex = 12.50 νxy = 0.376
Cortical bone Ey = 14.00 νyz = 0.235
Ez = 21.75 νzx = 0.222
Trabecular bone 17.5 0.3
Stainless steel implant 210 0.3
Titanium Alloy implant 210 0.3
Stiffness Graded Implant 20 to 110 0.3
Callus (1% healed) .02 0.3
Callus (50% healed) 10 0.3
Callus (75% healed) 15 0.3

2.3. Finite Element Analysis

The CAD model is imported to ANSYS 14.0 WORKBENCH for static analysis. The cortical and trabecular
region of the bone are assumed to be orthotropic [10, 11] and isotropic [12] material respectively and their
properties assigned are depicted in Table 1. The model is meshed using SOLID187 10 nodes quadratic element. The
nodes at the distal end of the bone are constrained totally. During normal gait cycle, the peak load that acts on the
human Tibia is almost three times the body weight of the person [6]. Therefore, a pressure of approximately 2.5
MPa [2] is applied at the proximal end of the Tibia. The meshing of healthy tibia is done using 13269 numbers of
nodes and 8449 numbers of elements. The element size is taken as 3.65 mm. In case of fractured tibia model with
implant, the number of nodes generated is 8700 and the number of elements used is 4771 with a minimum edge
length of 4.95 mm. The meshed models of the healthy tibia with loading conditions are shown in Fig. 5. (a) and (b)
respectively.

Fig. 5. (a) Meshed model of tibia with distal end fixed; (b) Meshed model of tibia with pressure applied on proximal end.
 Emon Barua et al. / Materials Today: Proceedings 5 (2018) 13267–13275 13271

3. Results and Discussion

3.1. Analysis of tibia bone

Static analysis is performed on the FE model developed under the conditions of normal gait. The results obtained
from the simulation for the maximum displacement, stress and strain are tabulated and presented in Table 2. Fig. 6
(a), 6 (b) and 6 (c) shows the variation of stress, strain and displacement along the length of the tibia. The
displacement is found to be maximum at the proximal end of the tibia and it gradually decreases towards the distal
end. The maximum stress and strain is found to be 47.524 MPa and .0021 respectively and maximum deformation is
found to be 2.568 mm at the proximal end. The results show close agreement with the work by Devika et al. [13].

Table 2. FEA results showing maximum stress, strain and deformation for the healthy tibia
Particulars Published Results Evaluated Results
[1]
Maximum Stress (MPa) 54.656 47.524
Maximum Strain 0.00245 0.0021
Maximum Deformation (mm) 3.012 2.568

Fig. 6. Simulation results showing (a) maximum stress; (b) maximum strain; (c) maximum displacement developed in the tibia under compressive
load.

3.2. Analysis of fractured bone with implant

To study the effect of the implant material on the fractured surface of tibia, the distribution of stresses at callus
site is determined. The fractured bone is assembled with the bone plate and a callus of thickness 1 mm is inserted at
the fracture gap as shown in Fig 6. FE analysis is performed using ANSYS WORKBENCH 14.0 considering all the
three plates at three healing stages (1%, 50% and 75%). The distribution of stress on the callus site is represented by
the contour plots (Fig. 7 and Fig. 8) for contact and clearance conditions between the implants and the bone surface
respectively. The result obtained is summarized and tabulated Table 3 and 4.
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Table 3. von-Mises stresses evaluated at the callus site under contact condition
Implant material 1% healing [MPa] 50% healing [MPa] 75% healing [MPa]
Stainless Steel 2.68 3.24 3.45
Titanium Alloy 2.9 3.35 3.55
Stiffness Graded 3.20 3.65 3.70

Table 4. von-Mises stresses evaluated at the callus site under clearance condition
Implant material 1% healing [MPa] 50% healing [MPa] 75% healing [MPa]
Stainless Steel 2.94 3.38 3.55
Titanium Alloy 3.23 3.60 3.65
Stiffness Graded 3.65 4.25 4.39

Fig. 7 Simulation results showing von-Mises stress distribution at the callus site under contact condition between the implant and the bone
surface using (a) Ti-alloy material at 1% healing stage, (b) SS material at 50% healing stage and (c) SG material at 75% healing stage
respectively.
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Fig. 8 Simulation results showing von-Mises stress distribution at the callus site under clearance (non-contact condition between the implant and
the bone surface using (a) Ti-alloy material at 1% healing stage, (b) SS material at 50% healing stage and (c) SG material at 75% healing stage
respectively.

It can be seen from Fig. 7, 8 and Table 3, 4 that at initial stage of healing, maximum load is beared by the
implants. This is because the callus remains immature. At 1% healed stage, the stresses obtained are 2.68 MPa and
2.94 MPa in contact and non-contact condition with stainless steel implant respectively. However, with engagement
of Titanium alloy implant, stresses at the callus site increases by 0.22 MPa and 0.29 MPa in both the contact as well
as non-contact condition. With the engagement of stiffness graded implant, maximum stresses obtained are 3.2 MPa
and 3.65 MPa at the callus site. There is an increase in stress value by 16% and 19% due to engagement of SG
implant in comparision to SS implant for contact and clearance condition respectively. The increase in stresses at the
fracture site indicates that the stress shielding effect decreases with the use of stiffness graded implant. At 50%
healing the callus is stronger (10 GPa) and is able to bear high compressive load. Using SG implant at 75% healed
stage; the stress rises from 3.45 MPa to 3.7 MPa for contact condition and from 3.55 MPa to 4.39 MPa for clearance
condition compared SS implant. Therefore to utilize the advantage of the clearance, iterative analysis needs to be
executed. The results indicate that presence of clearance increases the stresses at the callus site. The increase in the
stress is due to bending of the implants due to presence of clearance. The process has an advantage in rapid healing
of callus as stated by Wolff’s law in the theory of bone healing process [14]. The increase in stress indicates
reduction of stress shielding effect. But on the contrary, clearance between the surfaces may lead to frequent
loosening of screws of the implant. The maximum stress at the callus location is useful for understanding the stress
shielding effect.
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Fig. 9. (a) Variation of von-Mises stress with healing percentage for three different implant materials without gap; Fig. 9. Variation of von-Mises
stress with healing percentage for (b) stainless steel; (c) titanium alloy and (d) stiffness graded implant material.

The variation of von-Mises stress with healing percentage of different implant materials under contact and non-
contact condition are plotted in graphs. Fig. 9 (a) shows the variation of Von-Mises stress with healing percentage
for different bone-plate systems without contact at the fracture site. For all the types of bone-plates, stresses at the
fracture site increases with healing time. This implies stress shielding effect reduces and the fracture zone becomes
stronger. At initial stages (1% healing), the fracture zone is weak and therefore the load carrying member is the bone
plate only without the support of the callus. The fracture site has low stress value with maximum stress shielding
effect. At 50% healing level, the von-Mises stress value is found to increase which implies that the callus is matured
and the bone and the plate together behave as a composite material. The modulus of callus is assumed to be 10 GPa
[13]. At 75% healing level, the stress further increases. The callus is able to take more compressive load due to
reduction of stress shielding effect and formation of additional callus at the fracture zone with a higher Young’s
modulus (15 GPa). Similar observations were made by Benli et al. [2] with contact low stiffness implant material. A
comparision of von-Mises stress at fracture site with SS, SG and Ti-alloy implant materials reveals that SG plate
exhibits maximum stress and therefore minimum stress shielding effect under compressive load. This variation in
stress is due to the flexibility of the material under load. The inferences drawn are in good agreement with the study
done by Ganesh et al. [1].
Fig. 9 (b), (c) and (d) shows the effect of a clearance between different bone-plate systems on the von-Mises
stresses at the fracture interface for stainless steel, Titanium alloy and stiffness graded implants respectively. It is
clear from the graphs that for all the three different types of bone-plate systems, existence of a clearance at the
fracture increases the stresses at all healing stages. This occurs due to rise in bending moment in the fracture site.
 Emon Barua et al. / Materials Today: Proceedings 5 (2018) 13267–13275 13275

The presence of a gap has minimal effect on the stress state at later stages of healing. The present observation is in
good agreement with the ones made by Fan et al. [4]. Therefore it can be concluded that stress shielding effect
decreases at the fracture site for both contact and non-contact when using SG bone-plates instead of Ti alloy or SS
bone-plate systems at different healing stages.

4. Conclusions
The procedure employed for the development of the 3D CAD model of tibia using CT data enables analysis of
patient specific geometry. The analysis with the change in callus properties at every healed stage using different
implant materials reveals that the use of stiffness graded implants is reduces the stress shielding effect. Using SG
implant, an increase in 16% and 19% of stress value is found at the callus site for contact and clearance condition
respectively. This variation of stress values are with respect to stainless steel implant. The contact and clearance
positioning of the implants also shows significant effect on the stress shielding. Use of stiffness graded implants
under clearance condition is found to be most suitable to enhance the bone healing rate. It can also be concluded that
bone plate with low-stiffness material is recommendable for treating long bone fractures.

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