Biomechanics In Orthopedics

Presenter: Dr.Aragaw kibret (OSR1)

Moderator- Dr.Abiy(COTS)
Outline
 Objectives
 Introduction
• History of biomechanics
• Definition of Biomechanics
 Importance of biomechanics
 Basic of biomechanics properties
 Biomechanics of joints and bones
Biomechanics of fractures
 Biomechanics of Orthopedics Implants
Objective
 To understand some basic biomechanical properties
of biologic tissue.
 To understand how an injury occur to MSS and

how to best treat the injury.

 To understand and modify basic biomechanical

properties and to restore the function of injured

orthopedic tissue
History of Biomechanics

 Hippocrates (460-370 BC) promoted the application

of mechanics (force and motion) to reduce
dislocated knees and straighten spinal deformities.
 Galileo Galilei and Giovanni Alfonso Borelli studied

on the forces imposed on human and animal bodies

by the activities and functions of life.
 Dr. YC Fung, referred to as the Father of Modern

Biomechanics,contributed to a crescendo of
biomechanics
Importance of Biomechanics
 The improvement of performance
 The basis of all implants and devices we use
 The basis for most trauma we see
 The basis for most of our interventions
 To prevent occurrence of injury during performance.
 To evaluate posture exercises based on individual needs and the
efficient methods of using the body in daily living
Basics of biomechanics
 Biomechanics is:
Bio-Life
Mechanics-deals with effects of force
and energy on the motion
of bodies.
 examines force acting on the body and its effects
Basics of biomechanics …cont’d
 Biomechanics is science that deals with action of
force on living body.
 Study on effects of forces and energy on biologic

systems.
 deals the effects (motion and deformation) of forces

and moments acting on tissue such as tendon ,

ligament and bone.
Basics of biomechanics …cont’d
Force
 A force is something that causes acceleration of a
moving body or when it is blocked, which cause its
deformation.
 Mechanical forces can be visualized easily as ‘push

or pull’ applied to an object, or in the language of

mechanics, to a ‘body’ or a ‘particle.’
Force..cont

A. Cause a body at rest to move

B. Cause a moving body to change

direction, accelerate or decelerate

C. Change an object’s shape.

Force..cont..

 A normal force- tension or compression applied

perpendicular to a surface or a plane within an object.
 Shear(tangential)force-indicates a force parallel to a
surface or a plane within an object and tends to cause
relative displacement of two parallel objects or of
parallel planes within an object.
 Axial force - ‘along an axis’. It applied to a body at a
point on or along a central axis tends to cause its
linear displacement.
 Force in human body
 Internal

 External
 JRF
 Wt. of body segment
 Muscle
 Ext.load
Laws of Motion

 Sir Isaac Newton

3 Laws of Motion :

1 INERTIA
2 ACCELERATION
3 ACTION & REACTION
Basics of biomechanics …cont’d
Newton’ s laws
First law- Inertia
If a zero net external force acts on a body, the body will
remain at rest or move uniformly.
Second law-acceleration
Acceleration of an object of mass m is directly proportional
to the force applied to the object, F= ma.
Third law-reactions
For every action there is an equal and opposite reaction.
Moment/Torque

 -Turning,twisting and rotational effect of

force.
- The effect of a force perpendicular to the
long axis of a body,causing rotation.

M=F*d
Types of machines found in the body
 Mechanical advantage
◦ Load/effort or load divided by effort
◦ Ideally using a relatively small force, or effort to move a
much greater resistance
 Musculoskeletal system may be thought of as a
series of simple machines
◦ Machines - used to increase mechanical advantage
◦ Consider mechanical aspect of each component in
analysis with respect to components’ machine-like
function
Types of machines found in the body
 Machines function in four ways
◦ balance multiple forces
◦ enhance force in an attempt to reduce total force needed to
overcome a resistance
◦ enhance range of motion & speed of movement so that
resistance may be moved further or faster than applied
force
◦ alter resulting direction of the applied force
Human musculoskeletal arrangement provide 3 type
of machine in producing movement
 Levers
 Wheel-axles
 Pulley
1.Levers
Components of levers
 Lever: Rigid bar
 Fulcrum: Axis of rotation/fixed point
 Force:
◦ Applied force (F)
◦ Resistance force (R)
 Moment arm: d
◦ Applied force
◦ Resistance
Levers…cont’d
 Humans moves through system of levers
 Component of levers are bars (bone) , axis or

fulcrum ( joint) and force applied ( muscle

contraction)
 Three type of levers
 1st lever
 2nd lever
 3rd lever
1st class levers

 Produced balanced movement if axis is midway

between force and resistance e.g seesaw
 Produce speed and range of motion if axis is close to

force e.g triceps in elbow extension

 Produce force motion if axis is close to resistance e.g

crowbar
1st class levers…

Load Effort

Fulcrum

First Class
Lever
2nd class levers
 Resistance is between force and axis e.g
wheelbarrow and raising up the body on the toes.
 Few 2nd class in our body
3rd class levers

 Produce speed and range of motion movement

 Most common in human body
 Require large amount of force for even small

resistance
 e.g paddling a boat and shoveling
 Biceps brachii in elbow flexion
2. Wheels and axles

 Primarily used to enhance range of motion and

speed of movement in musculoskeletal system.
 Example: shoulder joint
 Mechanical advantage

= radius of wheels/radius of axels

3.Pulley
 Fixed pulley is one attached to a beam. It acts like a
first class lever, it is used to change directions of
force application.
 Medial malleolus

Acts as a pulley for the

Tendon of peroneus
longus
3.Pulley…
Basic biomechanical properties
 Material properties : describes the fundamental
behavior of substance independent to geometry.
 Describes relationship between stress and strain
 Structural properties : it is the function of its shape

and distribution of material around cross section

area.
 Describes relationship between force and ability of

elongation.
Basic biomechanical properties
 Material Properties  Structural Properties
◦ Elastic-Plastic ◦ Bending Stiffness
◦ Stess and strain ◦ Torsional Stiffness
◦ Yield point ◦ Axial Stiffness
◦ Brittle-Ductile ◦ Depends on
◦ Toughness
Shape of Material!
◦ Independent of
Shape!
Basic biomechanical properties

LOAD-A force that acts on a body.

 Stress-Intensity of an internal force

-Force /Area
-Units - Pascal's (Pa) or N/m2

Strain- Relative measure of the deformation of an object
 - Change in length / original length
 - Units—none
►Strain rate = strain / time
Basic biomechanical properties
Basic biomechanical properties
 Deformation : change in configuration ( change in
size and/ or shape) of an object .
 Two types
 Elastic deformation : the object will return to its

resting state if force is removed.

 Plastic deformation : the object will not return to its

resting state even if the force is removed

Basic biomechanical properties
 Toe region : applies to ligaments stress/strain
curve.Represents the straightening or stretching of
crimped ligament fibrils
 Yield point : the transition point between elastic

region and plastic region.

 Elastic zone : is zone where material return to its

original shape
 Plastic zone: zone where material will not return to

its original shape.

 Yield strength : is the amount of stress necessary to
produce a specific amount permanent deformation.
 Breakpoint/failure point : is point where an object

undergo failure or break

Young’s modulus of elasticity
-Measure of material stiffness.
-Also a measure of the material’s ability to resist
deformation in tension.
E = stress/strain
E is the slope in the elastic range of the
stress-straincurve.
 Toughness : is the amount of energy a material
absorbs prior to failure.The area under stress-strain
curve.
 Ductile: are material with large plastic deformation

region before it fails.

 Brittle : material having little plastic deformation

before it fails.Undergo elastic deformation only.

stiff and brittle

flexible and ductile

 Mechanical failure : two types
 Load to failure : material break or failure following

continuous application of force

 Common mode of failure in bone.
 Fatigue failure: failure due to continuous cyclical sub

threshold load or force.

 It is common mode of failure in orthopaedics

implants and fracture fixation constructs.

 Depends on endurance limit and fatigue life.
 Fatigue failure depends on:
1)Endurance limit- The stress level below which a
material does not fail (usually must last greater than
10 million cycles)
 Depends on biomechanical property of the material

2)Fatigue life- The number of cycles that a material can

withstand at a given stress level
 Depends on given level of stress
Viscoelastic properties
 It is characteristic of material properties on which
the stress-strain is dependent on time and rate of
load applied.
 Properties of viscoelastic materials

 creep
Stress relaxation
hysteresis
 Creep- Progressive deformation of materials in
response to a constant force applied over an
extended period of time. If sudden stress followed
by constant loading causes material to continue to
deform over time, it demonstrates a creep.

 Creep - Increase in strain over time in response to

constant tensile stress
 Stress relaxation : decrease in stress over time in
response to a constant strain over period of time.
Hysteresis (energy dissipation)
 loading and unloading curves do not overlap,
forming a closed loop; area b/n them is hysteresis.
 loading curve - strain energy stored in the material

during loading
 exceeds the area under the unloading curve
 Unloading curve - release of strain energy during

unloading
 Difference between the two curves is the energy

that is dissipated
Tissue in Orthopaedic Biomechanics
 Viable tissue in situ with no necrosis
 Viable tissue in vitro maintained in a suitable

medium and at body temperatures

 Nonviable (dead) tissue maintained in some sort of

medium and at body temperatures, and

 Nonviable tissue maintained moist, but either dried

or cooled at some time.

Joint Biomechanics

General joint biomechanics

Degrees of freedom
- Joint motion is described as rotations and
translations in the x, y, and z planes.
Joint Biomechanics….
 Joint reaction force (R)
is the force within a joint in response to forces
acting on the joint.
 Joint contact pressure (stress) can be minimized:

• Decrease R
• Increase contact area
Joint Biomechanics….
 Coupled forces—rotation about one axis causes
obligatory rotation about another axis (occurs in
some joints).
 Such movements (and associated forces) are

coupled.
Example: lateral bending of the spine
accompanied by axial rotation.
Joint Biomechanics….
 Joint congruence
•Related to the fit of two articular surfaces
• A necessary condition for joint motion
• Can be evaluated radiographically
• High congruence increases joint contact area
• Low congruence decreases joint contact area
Joint Biomechanics….
- Instant center of rotation
-point about which joint rotates.
-It lies on a line perpendicular to the
tangent of the joint surfaces at all points of
contact
Joint Biomechanics….
Rolling and sliding
• During motion, almost all joints roll and slide
to remain in congruence
-Pure rolling
-pure sliding
Joint Biomechanics….
• Friction: resistance between two objects as
one slides over the other.
• Not a function of contact area
• Coefficient of friction: 0 = no friction
• Lubrication: decreases resistance between
surfaces(synovial fluid).
Hip joint
 Functional anatomy
 The hip is a stable ball and socket joint, formed by the

femoral head and pelvic acetabulum. The abductor

muscles are the main stabilisers of the pelvis in the
coronal plane. The total compressive force acting on
the hip joint is the resultant of forces due to body
weight, tension in the abductor muscles and any impact
loads transmitted upwards through the body from the
foot during everyday activities. A static analysis can be
used to estimate the magnitude of hip joint reaction
force under different circumstances.
 Double-leg stance

 Single-leg stance
Elbow joint
Bone biomechanics
Bone is composed of collagen and hydroxyapatite
• Collagen: low E, good tensile strength, poor
compressive strength
• Calcium apatite: stiff, brittle, good compressive
strength
 Bone Tissue…
Inorganic Components Organic Components
(e.g., calcium and phosphate) (e.g. collagen)

65-70% 25-30%
(dry wt) (dry wt)
H2O
(25-30%)

ductile
one of the body’s
hardest structures
brittle
viscoelastic
 Strength and Stiffness of Bone Tissue
Evaluated using relationship between
applied load and amount of deformation
i.e Stress-Strain curve

Bone Tissue Characteristics

Anisotropic Viscoelastic Elastic Plastic

Bone biomechanics…cont’d
 Bone is anisotropic - its modulus is dependent upon
the direction of loading applied.It is strong to
support loads in longitudinal directions.
 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…cont’d
 Mineral content is the main determinant of the
elastic modulus of cortical bone.
• Cancellous bone is 25% as dense, 10% as stiff,
and 500% as ductile as cortical bone.
• Cortical bone excellent at resisting torque.
• Cancellous bone good at resisting compression
and shear.
Bone biomechanics….Cont’d
 Bone is viscoelastic-bone reveal different stress-
strain curves depending upon the speed and
duration at which the force is applied.
Bone biomechanics….Cont’d

Bone is dynamic.
 Able to self-repair
 Changes with aging: stiffer and less ductile
 Changes with immobilization: weaker
Bone biomechanics….Cont’d
 A hole 20% to 30% of bone diameter reduces strength
up to 50%.
Regardless of whether it filled with screw.
Areas returns to normal 9 to 12 months
after screw removal
• Cortical defects can reduce strength 70%.
Bone biomechanics….Cont’d
 Stress concentration effects occur at defect points
within bone or implant bone interface (stress
risers).

 Stress shielding by load-sharing implants Induces

osteoporosis in adjacent bone by decreasing normal
physiologic bone stresses.
It is common under plates and at the femoral
calcar in high-riding THAs.
Fracture biomechanics
 Fracture type is based on mechanism of injury.
Fracture biomechanics….Cont’d
Fracture biomechanics….Cont’d
Fracture biomechanics….Cont’d
Fracture biomechanics….Cont’d
 Bending load:
◦ Compression strength >
tensile strength
◦ Fails in tension

Figure from: Tencer. Biomechanics in Orthopaedic

Trauma, Lippincott, 1994.
Fracture biomechanics….Cont’d
 Torsion
◦ The diagonal in the direction of the applied force is in
tension – cracks perpendicular to this tension diagonal
◦ Spiral fracture 45º to the long axis

Figures from: Tencer. Biomechanics in Orthopaedic

Trauma, Lippincott, 1994.
Fracture biomechanics….Cont’d
 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…
1.6 x stronger
 Fracture Callus
◦ Moment of inertia
proportional to r4
◦ Increase in radius by
callus greatly
increases moment of
inertia and stiffness

0.5 x weaker
Biomechanics of implants…

Screw
• Root diameter:
proportional to tensile
strength
• Outer diameter:

determines holding
power
(pullout strength)
Biomechanics of implants….
 Cannulated Screws
Increased inner
diameter required
Relatively smaller
thread width results in
lower pull out strength
Screw strength
minimally affected
(α r4outer core - r4inner core )
Biomechanics of implants….

Interlocking
Screws

 Advantages
Axial and rotational stability
 Disadvantages
Time and radiation exposure
Stress riser
Biomechanics of implants….
Plates:
 Are load-bearing devices.
• Most effective on a fracture’s tension side
• Primary function of the plate is to
maintain alignment as an internal
splint, and to create compression
  Based on biomechanical function plates perform
1. neutralization
2. Buttressing or anti glide plate
3. compression
4. bridging
5. formation of a tension band.
 Biomechanics of implants…
 Plates:
◦ Bending stiffness
Height
proportional to the
(h)
thickness (h) of the Base (b)
plate to the 3rd power.
I= bh3/12
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 Implants….
 Unstable constructs
◦ Severe comminution
◦ Bone loss
◦ Poor quality bone
◦ Poor screw technique
Biomechanics of implants….
Applied Load
 Fracture Gap /Comminution
◦ Allows bending of plate with
applied loads
◦ Fatigue failure
Gap

Bone
Plate
Biomechanics of External Fixation

• A device placed
outside the skin
that stabilizes bone
fragments with pins
or wires connected
to bars by a clump.
Biomechanics of External Fixation
• Allowing fracture ends to come into contact is the most
important factor for stability of fixation with external
fixation.
Increase Ex-Fix stability by:

-Increasing the pin diameter.

-increasing the number of pins.
- Increasing the spread of the pins.
-Multiplanar fixation.
-Reducing the bone-frame distance.
- Predrilling and cooling (reduces thermal
necrosis).
- Radially preload pins.
Increase Ex-Fix stability by…..

 Increased mass of the rods or stacked rods

 A second rod in the same plane increases

resistance to bending.
 Place central pins closer to the fracture site
 Place peripheral pins farther from the fracture site

(near-near, far-far)
• Pin Location
Avoid zone of injury or future ORIF
Pins close to fracture as possible
Pins spread far apart in each fragment (near near & far far)
REFERENCES
THANK YOU!