Biomechanics of Fractures & the hierarchical structure of bone tissue

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Biomechanics of Fractures & the hierarchical structure of bone tissue Andreas Panagopoulos Assistant Professor in Orthopaedics University Hospital of Patras 1

Bone is a Complex System Bone is a hierarchical material with complex random structures at several different scales Bone is a living tissue with continuously evolving microstructure (mechanical, biological & chemical factors) Bone is a multi-functional material: Provides frame Protects organs Manufactures blood cells Stores useful minerals Maintains ph in blood, detoxifies, contributes to movement 2

Hierarchical bone structure Macrostructure (1-50 cm) Whole bone It has an irregular, yet optimized, arrangement and orientation Mesostructure of the components, (0.5 10 cm) making the material of bone heterogeneous and anisotropic Trabecular network Microstructure (10 500 mm) Single trabecula Sub-microstructure (1 10 mm) Single lamella Nanostructure (below 1 mm) Collagen fibrils Apatite crystals 3

Macrostructure (1 50 cm) Trabecular bone High porosity 30 to 90% Skeletal mass 20 to 25% Cortical bone Low porosity 5 to 30% Skeletal mass 75 to 80% Frontal longitudinal midsection of upper femur

Mesostructure (1 10 cm) Porous random network of trabeculae Scanning Electron images

Microstructure (10-500 mm) Trabecular packets 50 mm mean wall thickness 600 mm radius trabecula Plywood arrangements

TEM - Plywood Arrangements of lamellae P L P Orthogonal plywood motif (0/90) Twisted or rotated plywood motif

Sub-microstructure (1-10 mm) Single lamella level single lamella (3 to 7 mm thick) branching bundles (1-2 mm diameter) fibrils show splaying, less than 10 o ellipsoidal cavities - lacunae (1-2 mm diameter, 20 mm long)

Lamellar structure: collagen fibrils aligned Woven bone structure: no preferential fibril arrangement

Nanostructure (below 1 mm) Collagen (Type I) fibrils 20 100 nm diameter 60 67 nm periodic pattern Apatite crystals (calcium & phosphorus) Shape? Irregular Plates [e.g. Robinson, 1952; Weiner et al,1986] 50 x 25 x 5 nm Other proteins, fluids

TEM HA crystals in longitudinally-sectioned fibrils 100 nm C Plate-like shape Aligned in fibril direction M. Rubin, I. Jasiuk, J. Taylor, I. Rubin. T. Ganey, R. Apkarian, Bone 33 (2003), 270.

Basic Biomechanics Material Properties Elastic-Plastic Yield point Brittle-Ductile Toughness Structural Properties Bending Stiffness Torsional Stiffness Axial Stiffness Independent of Shape Depends on Shape and Material 15

Basic Biomechanics Force Slope = Stiffness = Force/Displacement Displacement 16

Basic Biomechanics Force Area L Stress = Force/Area Compressive Tensile Sheared Strain = Change Height ( L) Original Height(L 0 ) 17

Basic Biomechanics (E = σ/ε) Stress = Force/Area Slope = Elastic Modulus = Stress/Strain Strain = Change in Length/ Original Length ( L/ L 0 ) 18

Stress = Force/Area Strain = Change in Length/Angle Note: Stress-Strain curve is a normalized Load-Deformation Curve 19

Basic Biomechanics Elastic Plastic Elastic Deformation Plastic Deformation Energy Force Energy Absorbed Displacement 20

Elastic Biomaterials (Bone) Elastic/Plastic characteristics Load/deformation curves Brittle material fails before permanent deformation Ductile material deforms greatly before failure elastic limit ductile material brittle material Bone exhibits both properties bone deformation (length) 21

Basic Biomechanics Yield failure first arises through ultrastructural microcracks within the hydroxyapatite and the disruption of the collagen fibrils As loading continues in the plastic region, the material will eventually experience ultimate failure (catastrophic). The point of breakage is the ultimate stress in: tension (140 MPa), shear (65 MPa) and compression (200 MPa) 22

Stress (Load) Elastic & Plastic responses plastic region fracture/failure elastic region elastic through 3% deformation plastic response leads to fracturing Dstress Dstrain Strength = D area under the curve Stiffness defined as the slope of the elastic portion of the curve D Strain (Deformation) 23

Bone modulus Cortical bone (5-30% porosity) 18 GPa (longitudinal direction) 12 GPa (transverse direction) 3.3 GPa (shear) Cancellous bone (30-90% porosity) (0.1 to 3.5 Gpa) more complex, - trabecular orientation - connectivity - density - location 24

Bone modulus Reductions in the degree of mineralization (e.g., immature bone), Increases in porosity (e.g., osteoporosis), or microstructural damage (accumulation) will greatly compromise the stiffness of the bone and thereby lower the elastic modulus. 25

Basic Biomechanics Load to Failure Fatigue Failure Continuous application of force until the material breaks (failure point at the ultimate load). Cyclical sub-threshold loading may result in failure due to fatigue. Common mode of failure of bone and reported in the implant literature. Common mode of failure of orthopaedic implants and fracture fixation constructs. 26

Basic Biomechanics Anisotropic Mechanical properties dependent upon direction of loading (weakest in shear, then tension, then compression) Viscoelastic Stress-Strain character dependent upon rate of applied strain (time dependent) Trabecular bone becomes stiffer in compression the faster it is loaded 27

Bone Anisotropy trabecular tension compression cortical shear tension compression 0 200 100 50 150 Maximum Stress (MPa) 28

Load Viscoelastic properties Bone will fracture sooner when load applied slowly fracture fracture deformation 30

Influence of bone geometry on biomechanical behavior Moment of inertia = P (R 4 r 4 ) / 4 R: cortical outer diameter; r: cortical inner diameter In tension and compression, the load to failure and stiffness are proportional to the cross sectional area of the bone In bending are proportional to the area moment of inertia and inversely proportional to the length (The longer the bone, the bigger the bending moment.)

Influence of bone geometry on biomechanical behavior In Torsion are proportional to the Polar Moment of Inertia (J) This takes into account the cross sectional area and the distribution of bone tissue around the neutral axis

Mechanical Loading of Bone 36

Compressive Loading Vertebral fractures Buckle fractures Crush fractures 37

Tensile Loading Main source of tensile load is muscle - tension can stimulate tissue growth - usually an avulsion - sprains, strains, - inflammation, bony deposits 38

Shear Forces The bone fails more quickly when exposed to a shear strength rather than a compressive or tensive strength. This is because the bone is anisotropic and responds differently when it receives loads of different directions Epiphyseal fractures Tibial plateau fractures Femoral condyles fracture 39

Bending Forces Compressive strength Usually a 3- or 4-point force application 40

Torsional Forces Caused by a twisting force produces shear, tensile, and compressive loads tensile and compressive loads are at an angle often see a spiral fracture develop from this load 41

Combined Forces 42

Comprehensive review of available biomechanical tests - Usually under cycling loading - torsion, bending, tensile & compressive forces - extrinsic (force/displacement curve) - intrinsic (load to failure, deformation at failure, modulus of Young etc) 43

Bone as a Composite Material New techniques in microscale bio-mechanology o Transimmision electron microscopy o X-ray microscopy o Force microscopy o Raman spectroscopy o Fourier transform infrared microspectroscopy o nanoindentation Results suggest that permanent deformation (plasticity) in bone occurs from multiple, concurrent mechanisms that are active at all hierarchical levels 44

Bone as a Composite Material During 1 st stage (10%) the number = 30 (~ 1 bond H for each amino-acid triplet) As tropocollagen straightens H bonds break until 25% strain. After that remains constant (~15) and appears to continuously break and re-form along the peptide 45

Bone as a Composite Material Hydroxyapatite (HA) in bone is critical for stiffness Continuous glide between HA and tropocollagen molecules dissipates a great deal of energy as soon after yield point. Fibrils deformation and the glue-like bonding material resists to separation during compressive loads in a vertebra mondel 46

Toughness mecanism in bone As a crack emerges encounters microcracks at the weak boundaries of the osteons As these cracks consume energy may cause the main crack to deviate from the direction of the max tensile stress thus increasing bone toughness 47

Toughness mecanism in bone The tendency of bone to develop and the repair microcracks also increase toughness as the microcracks dilate the surrounding to main crack region, which actually compresses the crack. 48

Toughness mecanism in bone An unbroken region (arrow) between a primary growing crack and another initiated ahead can carry significant loads to resist to crack spreading 49

Toughness mecanism in bone Unbrokken collagen fibrils that bridge the gap formed in a crack resist its propagation by typically 0.1MPa 50

The aim of this study is to analyze the links between ultrastructural properties and the mechanical behavior of bone tissue at the scale of osteon. Elastic deformation was only explained by degree of bone mineralization whereas plastic deformation was more correlated with collagen maturity elastic modulus (E), contact hardness (H) and true hardness (H). 51

While cortical bone was found to be overall stiffer and more highly mineralized, no apparent differences were noted in the distribution of modulus values or mineral density Therefore, differences in the mechanical behavior of trabecular and cortical bone tissue are likely to be in large part due to microstructural and collagen related compositional differences. 52

The present study examines the structure microcracking relations at the lamellar and sublamellar levels of human cortical bone subjected to compressive loading. Laser scanning confocal microscopy revealed a clear influence of the local structure and porosity of the Haversian systems lamellae on microcrack development. In particular, crack initiation and growth under transverse compression were associated with stress concentration at canaliculi. 53