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, 8 (1), 14196

Application of a Mechanobiological Algorithm to Investigate Mechanical Mediation of Heterotopic Bone in Trans-Femoral Amputees

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Application of a Mechanobiological Algorithm to Investigate Mechanical Mediation of Heterotopic Bone in Trans-Femoral Amputees

Naomi M Rosenberg et al. Sci Rep.

Abstract

Heterotopic ossification (HO) is the process of bone formation in tissues that are not usually osseous. It occurs in 60% of those with blast-related amputations. HO can result in reduced range of motion, pain, nerve impingement and can affect prosthesis fitting and is caused by a combination of mechanical, biological, local and systemic factors. As with normal bone formation and remodelling, it is expected that heterotopic bone responds to mechanical stimuli and understanding this relationship can give insight into the pathology. The objective of this research was to investigate whether a physiological 2D computational model that considers both mechanical and biological factors can be used to simulate HO in the residual limb of a trans-femoral amputee. The study found that characteristic morphologies of HO were reproduced by adjusting the loading environment. Significant effects were produced by changing the loading direction on the femur; this is potentially associated with different initial surgical interventions such as muscle myodesis. Also, initial treatment such as negative pressure through a dressing was found to change the shape of heterotopic bone.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Images of the three different residual stump models.
Figure 2
Figure 2
Soft tissue Mechanical Properties used for the FE model.
Figure 3
Figure 3
Classifications of heterotopic bone used in this paper.
Figure 4
Figure 4
Loading cases applied to the femoral model. The top arrows represent the input load directions and the bottom arrows represent the resultant forces at the fixation nodes.
Figure 5
Figure 5
Upright loading stiffness results showing Type 1 morphology. Lighter shading represents higher Young’s Modulus.
Figure 6
Figure 6
Abducted (30° anticlockwise) loading stiffness results showing Type 2. Lighter shading represents higher Young’s Modulus.
Figure 7
Figure 7
Adducted (30° anticlockwise) loading stiffness results showing non-physiological heterotopic bone morphology. Lighter shading represents higher Young’s Modulus.
Figure 8
Figure 8
Upright loading stiffness results with skin stiffness reduction to 60kPa showing Type 3. Lighter shading represents higher Young’s Modulus.
Figure 9
Figure 9
Stiffness results when the peak indicator of inflammation (ρMSC) was located in the mid lateral region for Models 1 and 2 and a mid medial region for Model 3 showing Type 4 morphology. Lighter shading represents higher Young’s Modulus.
Figure 10
Figure 10
Stiffness results from 1135 iterations of standard loading applied after 115 iterations of negative pressure application. Lighter shading represents higher Young’s Modulus. The direction of pressure applied is indicated by the arrows.
Figure 11
Figure 11
Stiffness distribution after the first iteration with tourniquet application.

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