FOREWORDTO THE FIRSTEDITION

Progress in restoring ftrnction has pa=lleled our gai" in knowledge of the musctrloskelell $rstem and the nature of its disabilities. Observation,'thought, a'd experience wene srrfficient to solve some pfubl"o,". Further :ulsweJs evolved e.' n'e becamu o.or" cognizant of und:tly-,g p1+ologv and phy,siology. tu6.y of the remaining problemJ art'ait i$ app[Ltion of ' biomectranical prirrciples. A major detersrinant of eftective function is the force tolerance and mobilitv of the skeletal systeur. Increass in the intensiry or activity of alr age go"p, and extended h'man longevitv pr"=orti"g new "i- to demands phvsical qpariuo. devel"op an -ggs "" dinical aPPropriate resPonse, biomechanical infoizration must b" and the knowledge translated ".quired into therapeutic guidelines. 't'ictor Frankel has been a leader in both these endeavors- FIis contribution to biomechanical research is attested to by his extensive publications. This text represnEs his second effort to introduc biomechanical knort'ledge into patient care- It is not a simple task- lvlargareta Nordin has trim in ttris ' resPonsibility for prodtcing a new ioined text. Her volvement has contrrbuted to thJ informative stvle used to lt'"tpret complex data. The value of this ,"*, JJ; been enha'ced by the added breadth pro'idud by the conEibutors. The profession has developed the "tt*eering mea-nsfor identifying- the forces, motions, and tiss'e resPonses in human firnction. A considerable arnount of information has been providd, but this information is disPrsed in a wide variety of publicatioru and is often coudred in engrneering terrrinology unfamiliar to dinicians. This book on the basic biomechanics of the musctrloskeletal system brings together the crurent knowledge and Presents it in a cle"r, conversational stlrle- ft" !T of engineering terrdnolory is restricted to that whidr is necessary to express essenrial concepts- Presentation of the literature is both inclusive and selective. The major contributions to each topic :rre cited :$ sPeeific references, and other sourcs are identified as recoulmended reading. while the text is primarily a- compendirun of information and illustrations of biomechanical principles that:rrre dinically pertinent, a small portionof the book desaibes the'me:rns for calctrtating joint and musde forces- This is presented lucidly *itti minimat mathematical formulae and very cleardiagrams. The te,++ques :ue descriH in a way that makes them usable by the interested clinici:ln. This book is a well conceived bridge between engineering concepts and dinical practici. It should provide orttropaediqts, physical and occnpational thelaPists, and other hiallh professionals with a yglki"g hol'ledge of biomechlnical principles usefut in the evaluation and treatment of musctrloskelet"I dysfunction. facquelin Petr!, M.D.

vtr
a -

PREFACE
This book has been written to serve as an introduction to biomechanics for those who deal with disorders of the musculoskeletal system- The work is the result of ?5 _years of experience in biomechanics education and many conferencs wittr colleatues in the fields of orthopaedic surgery, physical rherapy, occarpational therapy, bioengin*ri"i ertonomics, and other allied specialties. Biomechanics uses raws of physics and errgineering concepts to dessibe motibn-'ndeqton. 6y the various bodl setments and the forces actir,g or, th"r" body parts during nonnar daily activities. The interrelationship of force and motion is importa.t, and must be understood if rational heaturent programs ane to be.Spptied to muscrrloskeletat disorders. Deleterious effecG-*ly be produced if the forces acting on the areas with disorders rise to hith revers d'lng exercise or activity" The pu{pose of this volume is to acqgaint the readers with the force-motion relatior,ships within the musctrJoskeletal system and the vario's technioues used to understand these relationships. The volusre is intended to be usd as a textbook_, either conjunction with a biomechanics course or for independent sfudy. The references a.d sug_ gested readings at the end of each chapter can be ufili-gd to amplify the discussions in these cnaPters. Although we undertook an extensive review of the rvorld literature on biomechanics in preparing this book, it has not been our purpose to pubrish a review of the material- Rather, wL hive selected exasrples to illustrate the..gtr.9pts needed for a basic knowledge of musculoskeretaf biomechanics. In add.itior, we have developed important engineering concepts throughout the volume. The text *iII srve as a gurde t? understanding of musctrloskeretal 1""p"r biome" chanics gained through Frrther read.ing, analvsis of
t .

case material, artd independent rese.uch. The inf,ormadon presented should also gurde the reader in the literatnre on biomechanics. No attenrpt -s"ft"g has been made to disctrss theftpy, as it was not .,ur PuPose to over this area. Rather, we have descn1red the undedying basis for rational therapeutic Pr.,otrarns. This book has been strengthened by the work of many excellent contributing authors. ;\n initial section on the international system of meaflrrement serves as :rn introduction to the physical measure-The ments used throughout the book. reader needs no more ftan a basic knowledge of mathematics to fuIIy comPnehend the material in the book, but ir is important to first review the section on the SI systeur and its application to biomechartics. The five drapters in Part One of the book deal with the biomechanics of the tissues and stnrcttrres of the muscrrloskeletal system: biomechanics of bone, Homechanics of artictrlar cartila Be, biomechanics of tendons and -ligaments, biomechanics of penpheral neryes, and biomechartics of skeletal muscle. This section has been exPanded from the first eCition to Sve the reader:rn understanding of the differences in mechanical behavior among the principal tissues composing the musculoskeletal system. The ten drapters in Part Two cover the biomechdrics or' the maior joints of the musculoskeletal systern. Each of these chapters contains an anatomic overvierr follorved by a discussion of the biomechanics specific to- the partictrlar ioint or ioint complex. In thi; nerv edition chapters on the biomechanics of the cervical spine' the biomechanics of the wrist, and the biome chanics of the hand have been added. we feel that our efforts h *l-ti.g and expandirg this book will be iustified if it biings about an increasedawarenessof the importance of bio-echa'ics and engenders discussion.
Margareta Norci:n Victor H. Frankel

ix

ACKNOWLEDGMENTS
This book rt'as made possible through the efforts of all the contributors. Their outstanding knowledge, their understanding of the basic concepts of biomechartics, and their wealth of experierrce have brought both breadth and depth to this worlc We:rne honored and gratefuI for their contributions and for fteir devoted work in preparing and finalizing this new edition. We are deeply saddened by th" recent death of one contributor, Carl Carlstedt, who finalized his chapter from his hospital bed, near the end of tris valiant stmggle with leukemia. A book of this size, with its large nunber of figr*s, legends, and references,czrnnot be produced without editorial efforts. laude Yelle's intense efforts shine throughout the entire booL Not only did she function as a trzrmmarian and stylist, but her logical pattern of thinking had a great deal to do wittl the final organization of the book. IGis" Forssn and Hugh Nachartie, illustrators, h'ene vital, energetic, and never-failing members of our publication team. Their quick Fasp of the concepts to be illustrated and the datity of their art work weFe of the greatest importance in the production of ttris book. Our colleagues in the O.*pational and lndustrial Orthopaedic Center of the Hospital for Ioint Diseases Orthopaedic Institute functioned as critical reviewers of the chapters. A sFdat thanlcs is extended to Mohamad Parnianpour for his iilraluable assistance. Our sincerest thanks also-goes to Shdly Bade, Oscar Cartas, Narlia Greenidge, Irura Gitsevitch, Manny Halpern, foan IGlur, Ali Sheikhzadeh, I.rdy Trucios, Pat Tnriello, IGthy Viola, and Sherri Weiser. In the Department of Orthopaedic Surger4, lrene Co*pbell, Abe Moshel, and Alisa Rivera deserve our greatest appreciation for their valuable help. We thank ludy Raymond and Ffita{y Winter for word processint assistanceand consbnrctive sugtestions. We Errealso most gratefuI to Drs. AIex Nonrurn, PauI Bisson, and SterrenLubin for supplying vital roentgenoFams for the new edition. This new edition of the book was supported throughout its production by the Research and Development Foundation of the Hospital for Joint DiseasesOrthopaedic Institute and the hospital administration, to whom we forward our sincerest gratitude. To all who helped, hiardigt tack! Ma5gareta Nordin Victor H. Frankel

xt

CONTRIBUTOR
FAOI JOSEPH BEJJANT. M.D.. D.E'[/I., MA., Ph.D. ResearchProfessorand Director Human PerformanceAnatysis taborarory NernrYork University New Yorfc New York @RAN LUNDBORG. M.D.. Ph.D. Prdesss aN Chairman Divbion d l{urd Llrgery Departrrrrt d Orthopaedics UUwrvty of lrrnd Utfr, Sucden atrt Laboravy of Experimernal Biolosy Departrrrnt d Anatomy t lrUver:rry of Crcfienburg GotherU.rg, Surcden

arrt
Corisuftant in Occupattmaf Omfropaedicr Electrodiagnosis, Mcirr Anat)4sis, ud Ans ldedicine CARL A. CARLSTEDT, M.D., Ph.D. fGrolirska trstitute Huddinge Hospinl Stocfnolm, Sweden arxl ReseardtFeflow Department of Bioengineering Hospial for Joint Diseasesorfiopaedic fn*iu.ne New York, New York DENNIS R. CARTER, Ph.D. Associare Professorof Mechanicat Engineering Sunford Univeniry Spnford, Catifomia VICTOR H. FRANKEL M.D., Ph.D. President Hospial for Joint Diseasesorthopaedic lrtsdu.rte chairmaru Depanmenr of odropaedc g.lrge4y New York, New york and Profesrcr of OrrhopaeOicfurgery New York Univers,ry Sdtoof of Medicine New york, New york MICIT \ELA. KELLY. M.D. Assisranrprofessorof Offropaedic grrgery Coflege of phpiciars and furgeons CofumbiaUniversity New York, New york JOF{AN M. F. TANDSMEER, prof. Dr. ProfessorEmerinJs . Deparrmenr of Anatomy and EmOryorogl RrjksUniversiteir Leiden, Holland ANARGARETAUNDH, M.D., R.P.T., Ph.D. Depanmenr of Rehabifhadon - !--'s" r Medicine Santgren Hospitaf Unrversiryof Gothenburg Gotnenburg. Sweden

FREDERICKA. MATSEN III. M.D. Professorand Chainnan of Orfiopaedics @artnrnt Univeniry of Washingrton Seatde, Washirgton

VAAI c. MOW, Ph.D. Director Nov Ytrk Onhopaedic Hospial Researcfr Laboratory Professorof Mecl'ranicafEngineer-ing and ortlropaedic Bioengineering

:fffrffiT"nMedicaf
Neul Yq*, New York

center

MARGARETA NORDIN, R.P.T., Dr. Sci. fJrector Ocapaoonal and frxCctrial Ortlropaedic Center Fbspital for Jcint Diseasesordrcpaedic lrudnlte f\h^/ Yqfc f\h^/ York aN Program Director Prrogram of Ergonomics and Occupadonal Biomecfnnics Neur Y6k University New Yqk, Nerry York

I.ARS PETERSON, M.D., Ph.D. AssociaceProfessor Depanmenr of Orfiopaedic furgnry East Hospiaf C:otfrerourg, Sweden

xiii

XiV

CONTRIBUTORS M'D., M'S' ITAN SHAPIRO, OnhoPaedic Surgery illedical Associates H"-#"d Watnnraua' \I/iscon$n

'I'IARK I. PITMAN, M.D. Chief of SPors MedicirP of ortrropaedic $rgety Anendir physician, Departmerrt lrsdufie Hospitat ior Joirn Diseasesodropaedk NernrYorK New York and OrtlroPaedic 9rgery Assi$ant Clinic;t Prroftsor of Medcine of NernrYork Unirrcrsity School York New YorK New M'D' CHRISTOPHER S. PROCTOR' ResearchFellow Re<earchtaboratory Nerrvyork orfropaedic Hospital Cerner Medical Columbhfresbyterian New York New York BJORN RYDA/IK M.D.' Ph.D' Associate Professor I Department of Ortfropaedic furgrery Biologl Laboratory of Experimmtal DePartment of Ana@mY Universiry of Gotltenburg Gothenburg, Srarcden

SKATAK Ph'D' RICtsIARD Institute ttioengi'neering Utu.ot' D.P"'-''.or-au!EngirEefigunEngirEeringMedanrc Cdurroia UniwtsitY f{ew YorK N6'v York

srB/EN SrucFllN'ill'D'
chiefdArfiritisMarragfr'er'tSeryice Assignt Chiefof HandSurgerY H6pita|brJoirnDiseasesoftfppaedc|rstiurte YorK NeurYork Nerlrr
4i

Assisrarrtftoftsgof'ortropadicg.r]gery Departmdltoforhopaedlc9rgeqy cJ Medkine New Y"" Univenity Scfrool York Nerr YorK Neur M'D' JOSEPH D. ZUCKERIT/TAN' Chief, ShoulderClinic H6PidforJointDiseasesortrropaedklnsiurte NernrYorK f\h^t York afi AssisnntProfessorofOrthop:edic9lrgery DePartmentof OrtrroPaedit ttgtw of Medlcine NerryYork University Scfrool York N6'v Nerr York,

:--1

F-A'C.S' G. JAMES SAMruiARCO' M'D" Professor Clinical Associate Department of Ortlropaedic furgery UniversiryofCirrcinnatiMedicalCenter Cincinnati' Chio and Director of Foot and Ankle Cerner Good SamaritanHosPital Cincinnati,Ohio

{-

CONTENTS

Sf: THE INTER|\AT|O,\AL STSTEMOF UNTTS

Dennis R- C-arter

xvii

part one EIOMECFTANICS OF TISSUES AND STRUCTURES OF THE M USCULOSKELEXAL SYSTEM I. BIOMECI-{ANICS OF BONE
Margareta Nordin, victor H. Frankel

I 3

z'

BtoMEcFtANfcsoF ARTtcutARCARTTLAGE
Van C- Mow, Christopher s. proctor, Michaer A. KeIl'

3r

3'

BtoMEcFtANlcs oF TENDONS AAJDL|GA,\TENTS

Carl A. Carlstedt, Margareh Nordin

59

4'

BloMEcFtANtcsoF pERfpHERAt NERvEs

Bjorn Rydevik, G6ran Lundborg, Richard skarak

75

5' BfoMEct{ANfcs oF sKELFTAI MuscLE

Mark I. pitman, Lars peterson

89

pan two BIOMECFT, \NICS OF JOIIG 6. BIOMECT-{ANICS OF THE KNEE

Margareta Nordin, Victor H" Frankel

rt3
I t5

xv

xlri

coMENrS OF THE HIP 7. BIOMECI.{ANICS

Margareta Nordin, Victor H' Frankel

I35

8.

OF THE A IKLE BIOMECH/qNICS

Victor H. Frankel, Margareta Nordin

| 53

9.

OF THE FOOT BIOMECFLANICS

G. lames Samrnarco

163

OF TI-IE LUMBARSPINE IO. BIOMECI.UANICS

Margareta Lindh

I83

I I.

OF THE CERVICALSPINE BIOMECFTANICS

Ilan ShaPiro, Victor H. Frankel

209

OF THE SHOULDER 12. BIOMECI.I,ANICS Itr A' Matsen Frederick D. Zuckerman, Joseph I3. OF THE ELBOW BIOMECFI.,ANICS
III Joseph D. Zuckerm:I1, Frederick A- Matsen

22:

241

OF THE WRIST 14. BIOMECFLANICS

Steven Sruchin
.a.'A r 5. etoMecHAtlcs oF THEI{AND

26

27

Fadi J. Beiiani, JohanM. F- Landsmeer

TERMS OF BIOMECF1ANICAL GLOSSARY INDEX

t .

3C 3l

'I

Sl: THE INTERNATIONAL SYSTEMOF UNITS

DennisR. Cafter

The need for establisning systems of weights and measures for use in bt'ilding, making clotf,es, and engaging in simple trade .o*oi"rce was rec"ia The or:nized by primitive societies. Bible and earlv records from Babylonian and Eglptian civilizations indicate that man first used parts- of his body and common elements in his environment to establ.ish simple svstems of measurement. Time was commonlv measured by p.riods of the sun. At the time '[ Noah, l-"t s,h was measured in terms of the . crrbit, which was equivalent to the dishnss from the elbow to the tip of the middle finger. A span, (quivatent to one half a cubit, was taken as the distance from the tip of the thumb to the tip of the little finger with the hand fuIly spread. For smalrer measurements the digrt, or width of the thumb, rvas used- For measurements of volumes or fluid capacities, containers were fi.tled with seeds, whictr rvere then poured out and counted to establish the of the container in terms of the n'rrrber of "lume sr.t-dsit could holci. Prirr.itive societies found that th"y could deter_ mine if one object rvas heavier thin ariother bv placing th: two_obiects on a balance.The Babyro"i;; retined this,,olruqy_" uy barancing an object with a set of standard, *"u-porirnua stones. These stones probably the fusi standards, |sre and the measurement later evolved into the er,Irish legarstone, which tt'r the imperial svstem is to 14 pounds t6l-27 nervtons). "qii*raleni The Eglprians and the Greeks both used the wheat =eedas the sta'dard for the smalrest unit of rveight. This concept e'olved into the unit of the gEain,which rs srill t""d toclav ,,..ri*rr.J-"pprications. The Arabs eshblished a standard of weights for precious stones and metals based oi-tt weight of a sman bean cated a carob' a measurement " which has evorved into the presenrunit of the carat.

lncreasing trade among tribes and nations caused the measuring svrstems developed by early civilizations to become intermixed. Measuring ltandards were widely disseminated by the Romans. As the Roman soldiers marched in their conquests, distances were measured in terms of the pace, which was the distance between the points *here one foot struck the ground on successivesteps. A pace was therefore equivalent to two steps.

THE ENGUSH SYSTEM

The E"glish system of weights and measures evolved from me-*5ing systems used bv the Babylonians, Eglptians, Rorna'1, Angro-sa:<o.s, and Norman French. Elodv measurernents such as the digit, p"h, span, and crrbit rA,erereplaced by the inlh, foot, and yard. Th Romans contributed the use of the base unit 12 to the English systffi, as the Roman foot, pes, had 12 divisions called unciae.The English words inch and ounce were derived from this Latin word. The earlv Sa,ron ki.gt rvore a sash or girdle around their waists which could be removed lonvenientlv and used for linear measurement. The word yard,was derived from the Sa:<on word gird, *""r,irg the circtrmference of a person's wailt. In the rielftn century, Henry I decreed the standard yard to frg be equivalent to the distance betrveen his nose and the end of his thurnb with his arrn extended. In the thirteenth cenhtr.r', King Edward I took an important step forward in tLt a"iii=it g linear measurement bv ordering a permanent measuri.g stick made of iron to be used as the standard yard f"r the kingdom. This measurement stick was coined the "iron ulna" in reference to the b'one of the forearm. The measurext/il

xl/iii

sf:THEINTERNATTONAL sysTEM oF uNrrs

defined as the volume contained by a cube which measured one tenth of a meter on each side. Most Frenchmen thought that the new metric system of measurement was confusing and expended a great deal of effort converting from the new system to the familiar measuring system of yards and feet that had been used previously. Widespread resistance to the new system forced Napoleon to renounce the metric system in 1872. In 7837, however, France returned to the metric system in the hope that it would spread throughout the world. In the nineteenth century, the metric system found favor among scientists because (1) it was an international system, (2) the units were independently reproducible, and (3) its use of a decimal system greatly simplified calculations. The British system had been designed for trade and commerce, but the metric system appeared to have significant advantages in the areas of engineering and science. In the latter haU of the nineteenth century, scientific advances necessitated the development of better metric standards. In L875 an international treafy, the Treaty of the Meter, established well-defined mefric standards for length and mass. In addition, the permanent machinery for further refinements of the metric system was established. This treaty was signed by L7 countries. By 1900, 35 nations had officially adopted the metric system. At the time the Treaty of the Meter was signefl, a Permanent secretariat, the International Bureau of Weights and Measures, was established in Sdwes, France, to coordinate the exchange of information about the metric system. The diptomatic organuatton concerned with the metric system is the General Conference of weights and Measures, which meets periodically to ratify improvements in the system and the standards. In L960, the general ionference adopted an extensive revision una simplification of the system. This modernued metric lystem was named Le systeme International d'unites (International system of units), and was given the international abbreviation SI. The general conference adopted improvements and additions to the sI system in L964, L968, 79T1, and I9TS. Between L965 and LgTz, the united Kingdom, Australia, Canada, New zealand,, and tt ur,/other English-sp:3king countries adopted the metric system- rn 1975, the united states Congress passed inu Metric Conversion Act, providing foithe idopUon of the SI metric system as the predominant ryit"* of measurement units. Today, nearly the entire world either is using the metric system or is committed to its adoptiorl.

ment of a foot was established as one third the length of the measuring stick, and an inch was established as one-thirty-sixth of the standard yard. King Edward II apparently found this new measuring system to be confusing and passed a stafute decreeing an inch to be equivalent to "three barleycorns, round and dry.,, The English system of measurement evolved and became refined primarily through royal decrees. The earlyTudor rulers established 220 yards as equivalent to 1 furlong. In the sixteenth century, eueen Ehzabeth I changed the traditional Roman mile from 5,000 to 5,280 feet, making the mile equivalent to exactty B furlongs. In 1824 the English Parliament legalized ihe new standard yard, which was based on the measurements taken from a brass bar with a gold button ne;r each end. A single dot was engraved on each button, and the yard was taken to 6e the distance between the two engraved dots. The English colonization and dominance of world commerce in the seventeenth, eighteenth, and nineteenth centuries served to spread- the English system of _weights and measures throughout the world, includi.g the American colonius. Athough refined in some ways to meet the demands of commerce, the system has remained essentially unchange,c.

THE METRICSYSTEM
In the early eighteenth century no uniform system of weights and measures existed on the European continent. Measurements not only differed frorn country to country, but also from town to town. the French Revolution in r7g0, Kirg Louis P_gi"g xu and the National Assembly of France pissed a decree calling on the French Academy of sciences and the Royal society of London to ,,,ceduce an invariable standard for all of the measures and all weights." The English, however, did not participate in this undertaking, and so the French alone set out to establish a new and uniform system of measures. The result was the metric system. In 1793 the French gorr"*ment adopted a standld_ system of measurement based or, the meter, which was defined as one ten-millionth of the distance from the North pole to the equator on a line passing through Paris, All other linear measurements were established as decimal fractions of the meter. The metric unit of mass was established as the gr"rr, which was defined as the mass of L cubic centimeter of water at its temperafure of maximum density. The unit of fluid capicity was named the ,,ritre,, and

5l:Tl':3 NTE:)nION.- SYSTE:IA OF UNITS

XiX

THE SI METRIC SYSTEM The systeme lnternational d'unites (sr), the modern metric system, has evolved into the most devised.In this secrion, systemof measures exacting

the 5I units of measurernent used in the science of mechanics are described. SI trnits used in electrical and light scienceshave been omitted for the sake of simplicit-vThe SI units can be considered in three groups: (1) the base gnits; (Z) the supplementry uniL; and (3) the derired units (Fig. 1)- The base units are a small group of standard measr.rrementswhich have been arbitrarilv defined. The base unit for length is the metef i*), and the base unit of mass is the"kiJogr; (kg). The base units for time and temperahrre ari the second (s) and the kelvin (R, respectively. Definjtions of the base units have become increasi"gty sophisticatedin resPonse to the expanding needs capabilities of the scien"fic couununity glUte l). "i.,a For e,xample' the meter is now defined in terms of the wavelength of radiation emitted from the krlr;ptond atom. The radian (rad) is a supplementary unit to measure p.laneangles. This unit, like the b.se units, is arbitrarily defined (Table 1). Although the radian is the SI unit for plane angte, the unit of th" degree has been retained for general use, since it i; firmlv

established and '.ridely used around the rvorld. A degree is eguivalent to , lg0 rad, N{ost units of the sI system are derived units, meaning that ther are establishedfrom the base units in accordance with ftrndamental physical principles. some of these units are e(pressed in terms or theb.r" units from which th"y are derived. Examples are area, speed, artd acceleration,which are exptlssed in the SI units of squ;re meters (m2), meters per second (mr's),and meters per second squared (m/it), respec_ tively. Other derived units are similarly established from the base units but h]-" been given special names (see Fig- I and Table 1). These ,rnits ;rre defined through the use of firndarnental eqgatioru of physical laws-in coniunction with the arbiuarily definia 3t base units" For o<ample, Newton's second law of motion states that when a bodv which is free to move is subiected to a force,.it wilf experience an acceleration proportional to that force and inversely proportionil 6 its owTl mass. Mathematicallv this principle ca,n be eJ(pressedas force = r,,ass x acceleration. The sI unit of force, the newton (t D, is therefore defined in tenns of the base sI units as

1}I:1kgx1m/sz

FtG. t. fhe fnreradonal Sysrem of Unis.

OUAilTMES F(PRESSED IN TERMS OF U}{TS FROtr WHICH THEIT WERE DERTYED MOilENT OF FORCE ACCELERANON

|
I
I

oERfvED uxfTs
wfTH SPEC|AL NAMES

FOrcE
nffrcn kg nl s2

PRESSURE & STRESS pascaf xlr#

ENEHGY& WORK Joule Nm POWER watt J/s TEMPERATURE degreeCelsius K - 27iL15

radian (rad) PI.ANE ANGLE SUPPIMET{T.ARYUNIT rnetef (m) LENGTH kifogram fig IrASS =onct TiuE (s) kelvin (K! .TEMPERAruRE

BASE uilrrs

SI:THE INTERNATIONAL OF UNITS SYSTEM tation was purportedly spurred by being hit on the head by an apple falling from a tree. If is perhaps poetic justice that the SI unit of one newton is approximately equivalent to the weight of a mediumsized apple. Newton was knighted in 1705 by eueen M"ry for his monumental contributions to science. The unit of pressure and stress, the pascal, was named after the French physicist, mathematici?il, and philosopher Blaise Pascal (1,629-1612). pascal conducted important investigations on the characteristics of vacuums and barorneters and also invented a machine which would make mathematical calculations. His work in the area of hydrostatics and hydrodynamics helped luy the foundation for the later development of these scientific fields. In addition to his scientific pursuits, Pascal was passionately interested in reliFon and philosophy and thus wrot-e extensively on a wide range of subjects. The base unit of temperafure, the kelvin, was named in honor of Lord William Thomson Kelvin (L824-790n He was of Scottish-Irish descent, and his given name was william Thomson. He was educated at the University of Glasgow and CamTABLE3 SI UNITS NAMED AFTERSCTENTTSTS SYMBOL
A C "C F H Hz J K

nl

TABLE2 SI PREFIXES
PREFIX
exa peta tera giga mega kifo hecto deka

SYMBOL
E P T G M k h da

MEANING quintilf ion quadrillion ion trilf lion bif milfion thousand hundred ten

EXPONENT OR POWER
l0r8 l0rs lot2 l0e

rc6 td
l02 l0l l0-' rc-2 I o-3
I0-6 | 0-e l0- t2 l0- rs f0-r8

deci centi mifli micro nano pico femto atto

d c m l-r n

p
f a

BASEUNIT tenth hundredth thousandth milf ionth ionth bilf rilfionth quadrilf ionth quintrillionrh

UNIT
ampere coulomb degree Celsius farad henry henz joule kefvin newton ohm pascal siemens tesfa volt watt weber

OUANTIry
efectriccurrent electric charge temperaure electric capaciy inductive resistance frequency energy temperature

SCIENTIST
Ampere, Andre-Marie Coulomb, CharfesAugustin de Celsius,Anders Faraday, Michael Henry, Joseph Heru, Heinrich Rudofph Joufe, James Prescott Thomson, Wifliam fater Lord Kelvin Newton, Sir lsaac Ohm, Georg Simon Pascaf.Blaise Siemens,Karl Wilhelm, later Sir Wilfiam Tesla,Nikola

COUNTRY OF BIRTH
France France Sweden England UnitedStates Germany England England England Germany France Germany (Englandf Croatia (United Statesf Italy Scotland Germany

DATES
t 7 7 5 -t 8 3 6 t736- I 806 t 7 0 t- 1 7 4 4 1791-1867 - 1878 1797 - 1894 1857 r 8 r 8 -t 8 8 9 182+- 1907 | 642- t727 - 1854 t7B7 | 623- | 662 1823-1883 r856- 1943 t745- 1827 t 7 3 6 -t 8| 9 r804-1891

force efectric resistance pressure/stress efectric conductance

o
Pa S T V W wb

magnetic flux density

electrical potentiaf power magnetic flux

Volta, Count Afessandro watt, James Weber, Wilhelm Eduard

;11jii

Sl:THE INTERNATIONAL SYSTEM OF UNITS

bridge Universityand earlyin his career investigated the thermal propertiesof steamat a scientific laboratory in Paris"At the age of 32 he returned to the
University of Glasgou/ to accept the chair of Natural Philosophy. His rieeting with |ames |oule in lg41 stimulated interesting discussions on the nature of heat which eventually led to the establishment of Thomson's absolute scale of temperature, the Kelvin scale. In recognition of Thomson's contributions to the field of thermodynamics, King Edward VII conferred on him the title of Lord Kelvin. The conunonly used unit of temperafure, the degree Celsius, was named after the Swedish astronomer and inventor Anders Celsius (170L-L7M). Celsius was appointed professor of astronomy at the University of Uppsala at the age of 29 and remained at the university until his death"'!, years later. In L742 he described the centigrade thermometer in a paper prepared for the Swedish Academy of Sciences. The TABLE+ CONVERTINGTO St FROM OTHERUNITS
LENGTH To convertto meters(mf multiply in ft yd mife AREA To convertto squaremeters(m'l muttipty inz ft'z yd' VOLUME To convento cubic meters{mtl multipty in3 ftn
ydt (Note: A liter is equivalent to I m' x l0-3.)

name of the centigrade temperature scale was officially changed to Celsius in L948.

CONVERTING TO SI FROM OTHER UNITSOF MEASUREMENT

Table 4 has been provided to allow conversion of measurements expressed in English and non-Sl metric units into SI units. One fundamental source of confusion in converting from one system to another is that two basic types of measurement systems exist. In the "physical" system (such as SI) the units of length, time, and massare arbitrarily defined, and other units (induding force) are derived from these base units, In "technical" or "guurtational" systems (such as the English system) the units of length, time, and force are arbitrarily defined, and other units (including mass) are derived from these base units. Since the units of force in gravitational systems are in

by

0.a254 0.3048 0.9144 r609.3

by

6.4s 1 6x t o - 4 0.0929 0.8361

by

x t0-s t .5387 0.0283 0.7646

PRESSURE AND STRESS To conven to pascafslPal or, equivafently, to N/mz muttiply lbf/inz by kgflmz mm Hg ENERGY.WORK, AND MOMENT OF FORCE To conven to joufes (Jl or, equivafently, to Nm mutriply ft fbf by in lbf kgf m Btu caf TIME To convertto seconds(sf multiply min by
h d

6894.8 9.8067 133.32 t. 1.3558 0.I 130 9.8067 1055. I 4.1868

MASS To convertto kilograms(kgl multiply fb by slug kgf sz m- | DENSIry To conven to kg/m3 multipty tb/in3 by fbld MOMENT OF INERTIA To convertto kg mt or, equivalently, [o Nm secz muttipty lo rt2 by fb in2 kgf s2m FORCE To convertto newtons lNl mutriPty kgf (:kpl by tbf

50 3600 96,+o0

0.+536 14.594 9.8067

SPEED To conven to m/s multiply

fus kmlh mile/h

by

0.3048 0.2778 0.4+70

27,680 r6.0 t8

0.0421 x l0-4 2.9264 9.8067

ACCELERATION To conven to mlsz multiply ftlsz by 0.30+8 TEMPERATURE To convertto degreesCelsius fromdeg K: deg C: deg K - 273.15 ftom deg F: deg C : 5/9 (deg F - 3Zl PLANE ANGLE To convertto radians(radl multiply deg by nlt80 (or 0.017451 rev 2t (or 6.28321

9.8067 4.4482

n
TABLEI

SI:THE INTERNATIONAL SYSTEM oF UNITS

DEFINITIONS OF SI UNITS meter(ml (kg) kilogram second(sf kelvin[Kf BASE SI UNITS The meter is the length equal to 1,650,763.73 wavelengthsin vacuum of the radiarioncoffespondingto the Uansition between the levels2p,o and 5ds of the krypton6 atom. The kilogramis the unit of massand is equal to the massof the international prototypeof the kilogram. The secondis the durationof 9,192131,770 periodsof the radiailonconesponding to the transitionbetween the two hyperfinelevelsof the ground stateof the cesium_133 atom. The kelvin,a unit of thermo-dynamic temperature, is rhe fraction 11273.16 of the thermodynamic temperature of the triplepoinr of warer.

radian {rad)

SUPPLEMENTARY SI UNIT Theradian is the plane anglebetween two radiiof a circle whichsubtend on thecircumference an arcequalin length to the radius.
DERIVED SI UNITS wlTH SPECIALNAMES The newton is that Force which, when applied to a massof one kilogram,gives it an acceleration of one meter persecondsquared. lN = I kgm/s2. The pascalis the pressure producedby a forceof one newton applied.with uniformdistribution, over an area of one squaremeter. I Pa = I N/m2. The joule is the work done when the point of applicationof a force of one newton is displacedthrough a distanceof one meter in the directionof the force. I J = I Nm. The wafi is the power which in one secondgivesriseto the energyof onejoule. I w = I J/s. . The degreecelsiusis a unit of thermodynamic temperature and is equivalentto K - 273.15.

newron (Nl

pascal (Pal

joule (J)

waft (wl degree Cefsius{"Cf

The SI unit of pressureand stressis the pascal(pa). Pressure is defined in hydrostatics as the force divided by the area of force application. Mathematically this t"r, be expressedas Pressure- q* area The sI unit of pressure,the pascal(pa), is therefore defined in terms of the base sI units as

1pa: 1ry.
1m2 the SI base unit of temperature is the }lthough kelvin, the derived unit of degree Celiius ("C or c) is much more commonly used. The degree Celsius is equivalent to the kelvin in magnitude, but the absolute value of the Celsius scale differs from that of the Kelvin scale such that "C _ K ZTg.15. When the SI system is used in a wide variety of measurements, the quantities expressed in terms of the base, supplemer,tul, or derived units may be either very large or very small. For example, the area on the head of a pin is an extremely small number when expressed in terms of square meters (*t). on the other hand, the weight of a whale is an extremely large number when expressed in terms of newtons

(N). To accommodate the convenient representation of small or large quantities, a system of prefixes has been incorporated into the SI system (Table 2). Each prefix has a fixed meaning and can be used'with all SI units. When used with the name of the unit, the prefix indicates that the quantity described is being expressed in some multiple of ten times the unit used. For example, the millimeter (mm) is used to represent one thousandth (10-3) of a meter and a Sgapascal (GPa) is used to denote one billion (10') pascals. one of the more interesting aspects of the sI system is its use of the names of famous scientists as standard units. In each case, the unit was named after a scientist in recognition of his contribution to the field in which that unit plays a major role. Table 3 lists a number of SI units and the scientist for which each was named. The unit of force, the newton, was named in honor of the English scientist Sir Isaac Newton (1624-LT2n. He was educated at Trinity College at Cambridge and later returned to Trinity College as a profesior of mathematics. Early in his career he made fundamental contributions to mathematics which formed the basis of differential and integral calculus. His other major discoveries were in the fields of optics, ashonomy, gravitation, and mechanics. His work in gravi-

r
Sf: THE fNTERr,tAflor{AL OF UNrTs SYSTEM Uiii

fact the weightsof standard masses, conversion to SI is dependent uPon the accelerationof mass due to the gravity. By international agreement the Eartl-,'s accel-

been frT:iln,'*#:fl"1;'ffiu:[T ","d: factors in Table 4.

Pennycrrick, C. I.: Handy Matrices of Unit Conversion Factors for Biology and Medranics. Ne* york, Iotrn wil.y ard sons, rgTL ' world Heal$ O$anization. The SI for the Healtr hoftssionsC'enerra, World Health qBarriza6on, lg;n.

eration du

BIBUOGRAPF{Y
Fcirr. I- L-: sI Metic Flandbook. New yorrg chartes scribner,s Sons, lgn-

panone

BIOMECH\NICSOF TISSUE AND STRUCTURES OF THE ITflUSCULOSKELETAL SYSTEM

BfOfl/IECFI,ANIC OF BONE

MargareaNordin VictorH. Franke

The purpose of the skeletal qrstem is to protect internal organs, provide ritrd icinematic rinl6 and murle attachnrent sites, ana facilitate muscle action 'tnd t'*cdy movemenl Bone tras unique siruct.oal and nrtrhanical groperties that allow it io cary out these r'lt"s' Bone is among the bod/s turdest stnrct'res, 'nlv dentin and enasrel in the teeth being harder. It is ()ne of the most dynasdc and metaboEllly active tissues -. body and remains active throughout *.. lifc- A highlv vasgular tissue, it has -rn excetent t"lpacit)' for self-repair and ctn alter its properties and '; t''nfigu:ation in t"tpot t" to changes mechanical tlcmand- Fo1 *.o,pi.,,."h"og, in bone dersity are ('()mmonly observed after Ft.ar of diilse and of grcatlv increased *: o*g, in bone shape :rre note'd during fracturS hearini"r,a after certain or)eratt,ns' Thus, bon" adapts * a" mechanicat demands placedon it. This chapter des,qibes the composition and stmcture of bone dszue, the mechanical prcperties of bone' and $,e--uetnvior of bone trnder different loading conditio*various hctors that affect the mechanical behavio, of bone -r rzr''rlE rrl ir, ,.iuo and in vivo are .rlso di_<ctrssgd.

STRUCTURE"

BON.E CO,tfpOStTION VUITTVI' AND

Bone 6ssue is a specialized -rG connective tissue "r'hose *,r.g ."*p"sitigir i, for its supportive -tn.i pro:ectire 'ollr- ut* o-,h.] connective tissues, it

pliable, have rirtre I.t t"r resist sreiching atensibility. collagen cgmposesapproximatery "r,l gsvo of the ocracellular-matrix a .*d,i"ts for abodt 25 "t of bone. to 30% of the dry weight A universal building block of the bodt, gollag.r, ir also the chief ftrous component of oti ei 'skeietal ,t ,r.t rr.r. (A detailed dToiption of the misostmchrre and me_ chanicalbehaviorof collagen is provided in Chapters 2 and 3.) The g"l".ti"gys tround substancesurrounding the mineralizecl.c.ollagen fibers coruists mainly of pr3t"ir, polysaccharides, or Srcosaminoglycanr icairl, pimaril)rin the form of iomprex macromorecules calred

consists of cells and art orgarric extracellular matrix of fibers and gronnd substance by til ..ttr. _produced The distinFishing feattue of bone is ie t igh .oii.r,t of inoqganic materiah, in the forur of mineral salts, ftat combine intimately with the organic matrix. The inorganic cornponent of bone maki ur. tissue hard Td-rrtrd, while the o{gardc component gives bone its flelibility and resilience. The ffi:=l portion of bone consists primaril y of calcitun and phosphate, mainly in the fo'rm of smatt crystels resmbli"g slEthetic h.yto*Jr"patite cystals with the pmposition Gro(poj.(oH)r.'These miner-the als, which account for at to /On of bone,s dry weight, F e bone its sotid coruistency. Bone seryes :ls a reservoir for essential minerah'in the body, partiailarlv calciun. Bone mineral is embedded in rrariously oriented fibers of tg protein 5o!s9n, the fibrous portion of the octracellular matrix. CJUagen fibers are tough and

BIOMECHANICS OF NSSUES AND STRUCTURES sYsTEM OF THE MUSCULOSKELETAL proteoglycans (PGs). The GAGs ser:\reas a cementing substance between layers of mineralized collagei fibers. These GAGs, along with various nonco[Jgunous glycoproteins, constitute about svo of the "*iucellular matrix. (The structure of PGs, which are vital components of articular cartila ge, is described in detail in Chapter 2.) Water is fairly abundant in live bone, accounting for up to 25% of its total weight. About gsvo of the water is found in the organic matrix, around the collagen fibers and ground substance, and in the hydration shells surrounding the bone crystals. The other L57o is located in canals and cavities that house bone cells and carry nutrients to the bone tissue. At the microscopic level, the fundamental strucfural unit of bone is the osteon , ot haversian system (Fig. t-1). At the center of each osteon is a small channel, called a haversian canal, that contains blood vessels and nen/e fibers. The osteon itself consists of a concentric series of layers (lamellae) of mineralized matrix surrounding the central canal, d configuration similar to growth rings in a tree trunk. Along the boundaries of each layer, or lamella, are small cavities known as lacunae, each containing one bone cell, or osteocyte (see Fig. l-tc). Numerous small channels, calea canali*-li, rad.iate from each lacrrna/ connecting the lacunae of adjacent lamellae and ultimately reaching the haversian canal. Cell processes extend from the osteorytes into the canaliculi, allowing nufrients from the blood vessels in the haversian canal to reach the osteocytes. At the periphery of each osteon is a cement line, a narrow area of cementlike ground substance composed primarily of glycosaminoglycans. The canaliculi of the osteon do not pass this cement Line. Like the canaliculi, the collagen fibers in the bone matrix interconnect from one lamella to another within an osteon but do not cross the cement line. This intertwining of collagen fibers within the osteon undoubtedly increases the bone's resistance to mechanical stress and probably explains why the cement line is the weakest portion of the bone's microstructure (Dempster and Colemdrr, L960; Evans and Bang,

Le67). A typicalosteonis about200micrometers (pm) in

diameter. Hence, everypoint in the osteonis no more than 100 F.mfrom the centrally located blood supply. In the long bones, the osteons usually run longitudi

LAMELLAE

CANALICULI OSTEOCYTE LACUNA

CIRCUMFERENTIAL IAMELLAE HAVERSIAN SYSTEMS C E M E N TL I N E INTERSTITIAL LAMELLAE TRABECULAE HAVERSIAN CANALS BLOODVESSEL

F I G .I - I A. The fine structureof bone is iflustrated schematicalfy in a sectionof the shaft/ofa long bone depictedwithout inner marrow.The osteons, or haversian systems, areapparent as the structuraf units of bone. fn the center of the osteonsare the haversian canafs, which form the main branches of the circulatory networkin bone.Eachosteonis boundedby a cementline. One osteonis shown exten ding from the bone (20x1. fAdaptedfrom Bassen,1965.lB, Each osteon consistsof famef lae, concentricrings composedof mineral matrix surroun ding the haversiancanaf . (Adapted from Tortora and Anagnostakos, l9g4.l C. Along rhe boundaries of the lamelfaeare small cavitiesknown as lacunae, eachof which contains a singfebone celf,or osteoqrte. Radiatin g fromthe lacunae are tiny canafs, or canaliculi, into which the rytopfasmic processes of the osteoq/tes extend. (Adapted from Tortora and AnagnostakoS, te8+.1

VOLKMANN'S CANALS

BRANCHES OF PERIOSTEAL BLOODVESSELS

OF BONE BIOMECHANICS

nally, but they branch frequently and anastomose extensively with each other. Interstitial lamellae span the regions between complete osteons (see Fig. 1-1A). Th"y are continuous with the osteons and are just the same material in a different geometric configuration. As in the osteons, no point in the interstitiat lamellae is farther than 100 pm from its blood supply. The interfaces between these lamellae contain an array of lacunae in which osteorytes lie and from which canaliculi extend. At the macroscopic level, all bones are composed of two types of osseous tissue: cortical, or compact, bone and cancellous, or trabecular, bone (Fig. l-Z). Cortical bone forms the outer shell, or cortex, of the bone and has a dense structure similar to that of ivory. Cancellous bone within this shell is composed of thin plates , ot trabeculae, in a loose mesh structure; the interstices between the trabeculae are filled with red marrow. Cancellous bone tissue is arranged in concentric lacunae-containing lamellae, but it does not contain haversian canals. The osteorytes receive nutrients through canaliculi from blood vessels passirg through the red marrow. Cortical bone always surrounds cancellous bone, but the relative quantity of each Vpe varies among bones and within individual bones according to functional requirements.

Since the lamellar pattern and material composition of cancellous and cortical bone appear identical, the basic distinction between the two is the degree of porosify. Biomechanically, the two bone types can be considered as one material whose porosify and density vary over a wide range (Carter and Hayes, 1977b). The difference in the porosif of cortical and cancellous bone can be seen in cross sections from human tibiae (Fig. 1-3). The porosity ranges from 5 to 30Vo in cortical bone and from 30 to over 90Vo in cancellous bone. The distinction between porous cortical bone and dense cancellous bone is somewhat

arbitrary. All bones are surroundedby a dense fibrous

membrane called the periosteum (see Fig. 1-1A). Its outer layer is permeated by blood vessels and nen/e fibers that pass into the cortex via Volkmann's canals, connecting with the haversian canals and extendi*g to the cancellous bone. An inner, osteogenic layer contains bone cells responsible for generating new bone during growth and repair (osteoblasts). The periosteum covers the entire bone except for the joint surfaces, which are covered with articular cartilage. In the long bones, a thinner membrane, the endosteum, lines the central (medullary) cavity, which is filled with yellow fut!y marrow. The endosteum

FrG.1-2 Frontal longitudinal section through the head, neck, greater trochanter,and proximaf shaft of an aduft femur. Cancellous bone, with its trabecufae oriented in a lattice, lies within the shell of cortical bone. (Reprinted with permission from Gray, H.. Anatomy of the Human Body. l3th American Ed. Edired by C. D. Clemente. Philadelphia"Lea & Febiger,

ff*

^&--* dt

le8s.)

#*

{fr

(t

BIOMECHANICS OF TISSUES AND STRUCTURES SYSTEM OF THE MUSCULOSKELETAL

| -3 FrG. r{. Reflected-f ightphotomicrograph of

cortical bone from a human tibia (+}xl. (Courtesy of Dennis R. Carter, Ph.D.l B. Scanningelectron photomicrograph of cancelfous bone from x,. (Courtesy a human tibia {30 of Dennis R.Caner, Ph.D.|

contains osteoblasts and also giant multinucleated bone cells called osteoclasts, which play a role in the resorytion of bone.

A hypothetical load-deformation curve for a somewhat pliable fibrous structure, such as a long bone, is shown in Figure "1,-4. The initial (straight line) portion of the curye, the elastic region, reveals the elasticify of the structure, i.e., its capacity,for return-

BIOMECF{ANICAL PROPERTIES OF BONE

Biomechanically, bone tissue may be regarded as a two-phase (biphasic) composite material, with the mineral as one phase and the collagen and ground substance as the other. In such materials (a nonbiologic example is fiberglass)-in which a strong, brittle material is embedded in a weaker, more flexible one-the combined substances are stronger for their weight than either substance alone (Bassett, 7965). Functionally, the most important mechanical properties of bone are its strength and stiffness. These and other characteristics can best be understood for bone, or any other structure, by examining its behavior under loadinB, r.e., under the influence of externally applied forces. Loading causes a deformation, or a change in the dimensions, of the structure. When a load in a known direction is imposed on a structure, the deformation of that structure can be measured and plotted on a load-deformation curve. Much information about the strength, stiffness, and other mechanical properties of the structure can be gained by examining this cun/e.
PI.ASTICREGION C

o o
J

F 8

YIELD ,/ POINT ;
I f I I f I I f f I

ULTIMATE FAILURE POINT

ENERGY

DEFORMATION FIG.I _4 Load-deformation curue far a structure composedof a somewhat pfiablematerial. ff a loadis applied within the elastic range (A to B on the curvefand is then refeased, of the structure no permanent deformation occurs. lf loadingis continuedpastthe yieldpoint (B)and into the structure's pfastic range(Bto Con the curvef and the load is then released, permanentdefoimation Theamountof permanent results. deformation if the that occurs is foadedto point D in the plasticregion and then structure is represented unfoaded by the distance betweenA and D,. lf within the pfasticrange, loadingcontinues an ultimatefailure point (C)is reached.

ffi i!: a
a,,!.rlt

r*

Ni,
ii:,

;+

OF BONE BIOMECHANICS

,tl
rl;;i

# ::::: +
,:l; :,i'

ir:

ing to its original shape after the load is removd. As the load is applied, deformation occurs but is not permanen| the structure recovers its original shape when unloaded. As loading continues, the outermost fibers of the structure begin to yield at some point. This yield point signals the elastic limit of the structure. As the load exceeds this limit, the structure exhibits plastic behavior, reflected in the second (curved) portion of the curve, the plastic region. The structure will no longer return to its original dimensions when the load has been released; some residual deformation will be permanent. If loading is progressively increased, the structure will fail at some point (bone will fracture). This point is indicated by the ultimate failure point on the curve. Three parameters for determinirg the strength of a structure are reflected on the load-deformation curve: (1) the load that the structure can sustain before failing, (2) the deformation that it can sustain before failing, and (3) the energy that it can store before failing. The strength in terms of load and deformation, or ultimate strength, is indicated on the curve by the ultimate failure point. The strength in terms of energy storage is indicated by the size of the area under the entire curve. The larger the area is, the greater the energy that builds up in the structure as the load isr applied. The stiffness of the strucfure is indicated by the slope of the curve in the elastic region. The steeper the slope is, the stiffer the material. The load-deformation curye is useful for determinirg the mechanical properties of whole structures such as a whole bone, an entire ligament or tendon, or a metal implant. This knowledge is helpful in the study of fracture behavior and repair, the response of a strucfure to physical stress, or the effect of various treatment programs; however, characterizing a bone or other structure in terms of the material that composes 7t, independent of its geome{r, requires standardization of the testing conditions and the size and shape of the test specimens. Such standardized testing is useful for comparing the mechanical properties of two or more materials, such as the relative strength of bone and tendon tissue or the relative stiffness of various materials used in prosthetic implants. More precise units of measure can be used when standardized samples are tested, i.., the load per unit of area of the sarnple (stress) and the amount of deformation in terms of the percentage of change in the sample's dimensions (strain). Tha curve generated is a stress-strain curve. Stress is the load, or force, per unit area that develops on a plane surface within a structure in

response to externally applied loads. The three units most commonly used for measuring stress in standardtzed samples of bone are newtons Per centimeter squared (NI/cm2); newtons per meter squared, or pascals (N/m2, Pu); and meganewtons per meter squared, or me gapascals (MN/m2, MPa). Strain is the deformation (change in dimension) that develops within a strucfure in resPonse to externally applied loads. The two basic tyPes of strain are linear strain, which causes a change in the length of the specimen, and shear strain, which causes a change in the angular relationships within the structure. Linear strain is measured as the amount of linear deformation (lengthening or shorted^g) of the sample divided by the sample's original length. It is a nondimensional parameter expressed as a percentage (for example, centimeter per centimeter). Shear strain is measured as the a*onttt of angular change (^y)in a right angle lying in the plane of interest in the sample. It is expressed in radians (one radian equals approximately 57.3 degrees) (International Society of Biomechanics, 1988). Stress and strain values can be obtained for bone by placing a stan dardtzed specimen of bone tissue in a testing jig and loading it to failure (Fig. 1-5). These values can then be plotted on a stress-strain curve

FfG. I -5 Standardizedbone specimen in a testing machine. The strain in the segment of bone between the two gauge arms is measured with a strain gauge. The stressis calculated from the totaf foad measured.(Courtesyof Dennis R. Carter,Ph.D.)

SYSTEM BTOMECHA.N|CS OF n55UE5AND STRUCTURES OF rHE MUSCULOSKEJTAL

(Fig. 1-6). The regions of this cr.rn'eare similar to those of the load-deformation curve. Loads in the elastic region do not cause perrnanent cieformation, but once the yield point is exceeded, some deformation is permanent. The strength of the material in terms of enerry storage is represented by the area under the entire curve. The stiffness is represented by the slope of the curve in the elastic region. A value for stiffness is obtained by dividing the stress at any point in the elastic (straight line) portion of the curve by the strain at that point. This value is called the modulus of elasticity (Young's modulus). Stiffer materials have higher moduli. Mechanical properties differ in the two bone t1pes. Cortical bone is stiffer than cancellous bone, withstanding greater stress but less strain before failure. Cancellous bone in vitro does not fracture until the strain exceeds 75Vo,but cortical bone fracttrres when the strain exceeds ZVa.Becauseof its porous stnrcture, cancellous bone has a large capacity for energy storage (Carter and Hayes, 1975). Stress-strain curves for cortical bone, met-|, and glass illustrate the differences in mechanicalbehavior among these materials (Fig. L-n The variations in stiffness are reflected in the different slopes of the curves in the elastic region. Metal has the steepest slope and is thus the stiffest material.

a U' UJ E F o

STRAIN FlG. | -7 Sress-straincun/s for three materials. Meal has rhe steepest sfope in rhe etasricregion and is thus the sdffestmaterial.The elasticporcionof trre cune br menf is a suaight fine, indicating lineartyetasucbefravior.The fact dut meaf has a long pfastic region irrdicates fiat trris tlpical ducdle material deforms a brinfe material,exhibis linearty beforefailure.Gla<s. exrensivcly elastic befravior but faifs abrupdy wifr licle deformadon, as curve. indicaredby me |act of a plasdcregion on trte sUess-strain both ductile and brinle qualities. Conicalbone. u/hicfi possesses e,rhibirs nonlinear elasric behavior. This behavior is demonstraredAy a slight curue in trre elastic region, which it'dicates some yefding durlng loading witrrin dris region. Conical bone condnus to deform before failure but to a lesserextent than does meal.

a a l,rl

(r
F

U'

B"
FlG. | -6 !

STRAIN

c'

curve for a conrcalbone sampfe tested in tersion Sress-strain (pufledf. Yield poinr (Bl pornt past whrch some permanent deformarionof the bone sampleoccurred.YieldsresslB'l: foad per untt area susrarnedby rhe bone sampfe before plasdc svain lB'l' amount of de!'onnauon deformationtook place. Yield wrthsrood by rhe sampte before plasticdeformauonoccuned. The strain at any point in the elasucregion of the cun is proponional to rhe srress at that pornl tJtomarcfatlurepoint (Cl: the pofnr pasr which faitureof fie sample occuned.Ultirnarc srresslC'l: ioad per unir areasustainedby the sarnplebefore by farfure. Ultimatesrran lCl: amount of deformauonsusulinecl the samplebeforefallure.

The elastic portion of the cturle for glass and metal is a straight line, indicating linearly elastic behavior; virtually no yielding takes place before the yield point is reached. By comparisor, precise testing of cortical bone has shown that the elastic portion of the curye is not straight but is slightly cruved, indicating tlrat bone is not linearly elastic in its behavior but yields somerr"hat dudng loading in the elastic region @onefield and Li, I95n. After the )""td point is reached, glass deforms very little before failing, ?s indicated by the absence of a plastic region on the stress-strain curve. By contrast, metal rKhibits extensive deformation before failing, as indicated by a long plastic region on the curve. Bone also deforms before failing but to a much lesser extent than metal. The difference in the plastic beharior of metal and bone is due to differences in

EiCMECHAAJICS OF EONE

micromechanical et'ents at yield. Yield.ing in metal (tested in teruion,-or pulled) is caused Uy pLil flow and formation of prastic rlp lines; ,fup n ,., are iormed when the molecul"r oi the lattice srrrcture of metal dislocate' Yieldingin bone (tested in tension) is caused by debonding of the osteons at the cement lines and microfriactrrre. lvlaterials are classified as brittle or ductile depending on the extent of deformation before failure.'Ct * is a t'"ical brittle material, and soft metal is a tletductile material- The difference in the of deforrration is reflected in the fractrrre surfaces "o,o#t of the hvo materi* -(Hg- l-g). when pieced together after trachue, the ductile material *iit not conform to its origrnal shaPe whereas the brittle material will. Bone e.xhibits more brittte or more ductile behavior depelding on its age bl"being more ducrile) 9-o,*ger and the rate at whidr it is loaded (b"i" being more I brittle at higher loading speeds). Because the stmchrre of Uor,e is dissimilar in the transverse and the longitudinal directions, it exhibits different mechariicat pioperties when loaded along different axes, a characteristic known as arrisotropy. Figure l-9 shows the variations in strength and sriffness for cortical bone samples from a human femoral shaft, tested in tension in four d.irections (Frankel and Burstein rg70). , The 'alues for both parameters.T highest for the sampres loaded in the longitudinal direcfion. Although the relatior,ship be_ trveen loading_patterns and tf," mechanical prop"r_ ties of bone throughout the skereton is ..*t"*er), complX, it cat g".'-*rally be said that bone strength and stiffness are gre-atestin the direction in which loads are most co'uncnty imposed (Franker and Burstein, 1970).

li DUCTILE FRACTURE

FlG. I _g Fracure surftces of sarnplesof a ducrile and a britde marenal. The broken frnes on fte dr,rcrifemateriat indicate tfre origirul lengfi of dre sampfe. before ft deformed. The bride marenat deformed rcry lirde befure ftacnrre.

rest or moring at a speed); toaaing prod,r.., T"rTt an internal deforrning effect'on the structure. Tersim

these loading modes- The folrowing descriptions of these *dappb' to strrcturr in equilibri,.r* (at

Dudry teruile equal and opposite .l*dTg, Ioads are applied outward Fo^ the strrface of the stmchrre' and tensrle shess and strain result inside the sbnrchre- Tensrle stness can be thought of as Erany small forces directed aw ay from the surface of the stnrchrre- ldaximal tensile stress occurs on a pJT" perpsrdicular to the applied load (Fig. 1-11). under tens.le loading, the rt*.t ,," lengthens and narrows- At the microscopic level, the far,rre mechanism for bone tissue loaded in tension is mainlv

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BIOMECT{ANTCAL BEFI,AWOR OF BONE

The mechanicalbehavior of bone-its behavior under the influence of forces and moments-is aftected by its mechallcal properties, its geometric characteriiHcs,the roading ;-,ode applied, the rate of luadi.g, and the fr"qr"ncy of loadirg.
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f

BON-EBEF{,AVIOR UNDER VARIOUS LOADING MODES

Forces and moments can b" to a stmcture in various "pplied dite.dons, producing tension, com_ 'torsion, pression, bendi f,g, shear, and combined loadits (Fig1- l0i. &rne in rivo is subjected to all of

STRATN

Ffc. t-9 Anisotroplcbe-avior of c3nicalbone specrmensftoma human femoral s|Eft :esred in rension (puiledl in four direcrions: fongirudinal (L,-:lted 30 cegreeswirh respec to g1e neuraf axrs of dre bone. =:ed & decrees.and rransverse (Data from fTl. Frankel and B,-iern . lg73 l

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SYSTEM oF TrssuEs ANDsrRUCfuREs oF THEMUSCULOSKELETAL BtoMEcHANrcs

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TENSION C O M P R E S S I O NB E N D I N G

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F r G .| - 1 2 of a human corficalbone light photomicrograph Reflected at debonding indicate x Arrows in tension tested specimen }. {30 (Courtesy of the cementlinesand pullingout of the osteons. Ph.D.) DennisR.Carter,

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F r G .I - l 0 of various loading modes. representation Schematic

debonding at the cement lines and pulling out of the osteons (Fig. L-Lz). Clinic ally, fractures produced by tensile loading are usually seen in bones with a large ProPortion of cancellous bone. Examples are fractures of the base of the fifth metatarsal adjacent to the attachment of the peroneus brevis tendon and fracfures of the calcaneus adjacent to the attachment of the Achilles tendon. Figure 1- L3 shows a tensile fracture through the calcaneus; intense contraction of the triceps surae muscle produced abnormally high tensile loads on the bone.

nil UU
F t G .t - t l Tensile loading.

F t G .I - t 3 Tensilefracturethrough the calcaneusproduced by suong suraemuscleduringa tennismatch. of the triceps contraction M.D.) Winquist, A. Robert of {Courtesy Compression During compressive loading, equal and oPPosite loads are applied toward the surface of the structure and comPressive stress and strain result inside the strucfure. Compressive stress can be thought of as many small forces directed into the

OF BONE BIOMECHANICS

ll

F l G .1 - t 4 loading. ComPressive

surface of the structure. Maximal compressive stress occurs on a plane PerPendicular to the applied load (Fig. 1,-1,4). Under comPressive loading the structure shortens and widens. At the microscopic level, the failure mechanism fof bone tissue loaded in comPression is mainly oblique cracking of the osteons (Fig. 1- 15). Ctinically, compression fractures are commonly found in the vertebrae, which are subjected to high compressive loads. These fractures are most often seen in the elderly, whose bones weaken as a function of apng. Figure 1,-1,5 shows the shortetitg and widening that took place in a human vertebra subjected to a high comPressive load. In a joint, compressivb loading to failure can be produced by abnormally strong contraction of the surrounding muscles. An example of this effect is Presented in Figure L-L7; bilateral subcapital fractures of the femoral neck were sustained by u patient undergoing electroconvulsive therapy; strong confractions of the muscles around the hip joint comPressed the femoral head against the acetabulum.

F f G .t - 1 6 The fractureof a human first lumbar vertebra. Compression and widened. vertebra hasshortened

F f G .t - 1 5 graph photomicro of Scanning electron a human coftical bone specimen testedin compression {30x). Arrows indicateoblique crackingof the osteons. (Courtesy of Dennis R. Carter, Ph.D.l

l2

AND STRUCTURES OF TTSSUES SYSTEM B|OMECHAN|CS OF THE MUSCULOSKELETAL

L
LOADING UNDERSHEARLOADING BEFORE
F f G .| - 1 9 at right is loaded in shear,lines originally When a structure changetheir within the structure angleson a pfane surface and the angle becomesobtuse or acute. This orientation, angular deformationindicatesshear strain. (Adapted from Frankel and Burstein , 11970.1 F r G .| - t 7 in necks fractures of the femoral Bilateraf subcapital compression therapy. electroconvulsive a patientwho underwent Human adult cortical bone exhibits different values for ultimate stress under compressive, tensile, and shear loading (Fig. L-22). Cortical bone can withstand greater stress in comPression than in tension and greater stress in tension than in shear (Reilty and Burstein, 1975). The value for the stiffness of a material under shear loading is known as the shear modulus rather than the modulus of elasticity. Bending

Shear During shear loading, a load is applied parallel to the surface of the structure, and shear stress and strain result inside the structure. Shear stress can be thought of as many small forces acting on the surface of the structure on a plane Parallel to the applied load (Fig. 1-18). A structure subjected to a shear load deforms internally in an angular manner; right angles on a plane surface within the strucfure become obtuse or acute (Fig. L-L9). Whenever a structure is subjected to tensile or comPressive loading, shear stress is produced. Figure L-20 illustrates angular deformation in structures subjected to these loading modes. Clinic ally, shear fracfures are most often seen in cancellous bone. Examples are fracfures of the femoral condyles and the tibial plateau. A shear fracture of the tibial plateau is shown in Figure L-zL.

f.

In bendirrg, loads are applied to a structure in a manner that causes it to bend about an axis. When a bone is loaded in bendin1, it is subjected to a combination of tension and comPression. Tensile

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FfG. | -21 fractureoF the lateraftibial plateau. Shearand compression M.D.) Lubin, of Steven {Courtesy

stresses and strains act on one side of the neutral axis, and compressive stresses and strains act on the other side (Fig. 1,-23); there are no stresses and strains along the neutral axis. The magnitude of the stresses is proportional to their distance from the neutral axis of the bone. The farther the stresses are from the neutral axis, the higher their magnitude. Because bone is asymmetrical, the tensile and comPressive stresses may not be equal. Bending may be produced by three forces (threepoint bending) or four forces (four-point bending) (Fig. 1,-24). Fractures produced by both tyPes of bending are commonly obsenred clinically, Particularly in long bones. Three-point bending takes place when three forces acting on a structure Produce two equal moments, each being the product of one of the two peripheral forces and its perpendicular distance from the axis of rotation (the point at which the middle force is applied) (see Fig. 1,-24A). If loading continues to the yield point, the structure, if homogeneous and symmetrical, will break at the Point of application of the middle force. A typical three-Point bending fracture is the "boot top" fracture sustained by skiers. In the "boot toP" fracture shown in Figure 1 -25, one bending moment acted on the proximal tibia as the skier fell fonnrard over the top of the ski boot. An equal mornent, produced by the fixed foot and ski, acted on the distal tibia. As the proximal tibia was bent fonvard, tensile stresses and strains acted on the Posterior side of the bone and compressive stresses and strains acted on the anterior side. The tibia and fibula fractured at the top of the boot. Since adult bone is weaker in tension than in compression, failure begins on the side subjected to tension. Immature bone may fail first in compression, and a buckle fracfure may result on the compressive side. Four-point bending takes place when two force couples acting on a structure produce two equal moments. A force couPle is formed when two parallel forces of equal magnitude but oPPosite direction are '1,-248). Because the applied to a structure (see Fig.

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FfG. | -22 Ultimate stressfor human adult corticafbone specimenstested in compression,tension,and shear {averageof data from Reilly and Burstein, 1975l|. shaded area indicates ultimate stressfor human aduft cancellousbone with an apparent densiryof 35o/o tested in tension and compression {Carter,1979).

FfG. | -23 Cross section of a bone subjected to bending, showing distribution of stresses around tne neutral axis. Tensile stresses act on the Superiorside, and compressiveStresses act on the inferior side. The stressesare highest at the peripheryof the bone and lowest near the neutrafaxis.The are Unequal because the tensile and compressiveStresses bone is asymmetrical.

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l4

OF TISSUES AND STRUCTURES OF THE MUSCULOSKELFTAL SYSTEM BIOMECHANICS

FrG. | -2+ B. bending. Twotypes A.Three-point of bending. Four-point bending. A

rnagnitude of the bending moment is the same throughout the area between the fwo force couples, the stmcture breaks at its weakest point. An example of a four-point bending fracture is shown in Figure I-26. A stiff knee joint was manipulated incorrectly during rehabilitation of a patient with a femoral fracture. Duting the manipulation, the posterior knee joint capsule and tibia formed one force couple and the femoral head and hip joint capsule formed the other. As a bending moment was applied to the femur, the bone failed at its weakest point, the origrnal fracture site.

Torsion In torsion, a load is applied to a structure in a manner that causes it to twist about an axis, and a torque (or moment) is produced within the structure. When a strucfure is loaded in torsion, shear stresses are distributed over the entire structure. As in bendin1, the magnitude of these stresses is ProPortional to their distance from the neqtral axis (Fig. L-27). The farther the stresses are from the neutral axis, the higher their magnitude. Under torsional loading, maximal shear stresses act on planes parallel and PerPendicular to the neutral axis of the structure. In addition, madmal tensile and compressive sfresses act on a plane diagonal to the neutral axis of the structure. FigUre 1-28 illustrates these planes in a small segment of bone loaded in torsion. The fracture pattern for bone loaded in torsion suggests that the bone fails first in shear, with the formation of an initial crack parallel to the neutral axis of the bone. A second crack usually forms along the plane of maximal tensile stress. Such a pattern can be seen in the experimentally produced torsional fracfure of a canine femur shown in Figure L -29. Combined Loading Although each loading mode has been considered separately,living bone is seldom loaded in one mode only. Loading of bone in vivo is complex for two principal reasons: bones are constantly subjected to multiple indeterminate loads, and their geometric strucfure is irregular. Measurement in vivo of the

FrG. | -25 producedby Lateralroentgenogram of a "boot top" fracture A. Winquist, M.D.) of Robert three-point bending.(Courtesy

OF BONE BIOMECHANICS

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AB FfG. | -26 r{. Duringmanipulation rehabiliof a stiff kneeduring fracture tation,four-pointbendingcausedthe femur to fracture at its weakestpoint, the originaffracture roentgenosite.B. Lateral gramof the fractured of Kaj Lundborg, M.D.) femur.{Counesy

FrG.| -29 of a canine femur. producedtorsionalfracture Experimentalfy The short crack(arrow)parallefto the neutralaxis represents angleto the neutraf fineat a 30-degree failure; the fracture shear stress. tensife the pfaneof maximal axisrepresents

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strains on the anteromedial surface of a human adult tibia during walking and jogstg demonstrated the complexity of the loading patterns during these common physiologic activities (Lanyon et dl., 1975). Stress values calculated from these strain measurements by Carter (1978) showed that during normal walking the stresses were comPressive during heel strike, tensile during the stance phase, and again compressive during push-off (Fig. 1-30A). Values for shear stress were relatively high in the later portion of the gait cycle, denoting significant torsional loaditg. This torsional loading was associated with external rotation of the tibia during stance and push-off. During jogpng the stress pattern was quite different (Fig. 1-308). The compressive stress predomineiting at toe strike was followed by high tensile stress during push-off. The shear stress was low through-

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EIOMECI{ANIC5 AND SIRUCTURES CF NSSUES SYSTEM OF T}JEMUSCULOSKELEI'AL

WALKING (1.4 m/sec)
STRESS TENSTLE _-.@UPRESSI\IE SIGAR (EXTEF RNAL ROTATION} STRESS . -IE}ISiLE @UFRESSIVE $An GXTERI{AL ROTATIOiO slGAlR (INTERNAL ROTATION)

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11. Calculatedsucses on the ancromedial conex of a hurnan adult tibia durirg wdking. HS-heel strike: FF-foot llat; FlO-heel-ofr TO-toeofr S-virq. et al.. {After|.arDon 1975; Ph.D.lB. Calculated cortexof an counesy of DennisR C-aner, $resses on fte anteromedial aduft human tibb during jqgirg.TS-toe srike; TO-toeotr hfter Lanlon et al- 1975; Ph.D.l courtesy of DennisR.Caner, t

out the stride, denoting minimal torsional loading produced by slight external and internal rotation of the tibia in an alternating pattern. The increase in speed from slorv walking to jogpng increased both the stress and the strain on the tibia (I-anyon et al., L975). This increa* in strain with greater speed was confirmed in studies of locomotion in sheep, which demonstrated a fivefold increase in strain values from slow walking to fast trotting (Lanyon and Bourn, 1979). Clinical exarrrination of fracture patterns indicates that few fractures are producd by one loading mode or even by hvo modes. lndeed, most frachrres are produced Ly cornbination of severalloading modes. "

INFLUENCEOF MUSCLEACTIVIW ON DISTRIBUTION STRESS IN BONE

When bone is loaded in vivo, contraction of the musdes attached to the bone alters the stress distribution in the bone. This musde contraction decreases

or eliminates tensile sress on the bone by producing compressive stress that neutralizes it either partialll' or totally. The effect of muscle contraction can be illustrated in a tibia zubjected to three-point bending. Figure 1-31A represents the l"g of a skier who is falting forward, zubjecting the tibia to a bending moment. High tensile stress is produced on dre posterior aspect of the Hbda,and high compressive stress acts on the anterior aspect. Contraction of the triceps surae muscle produces great comPressive stress on the posterior aspect (Fig. 1-3lB), neutralizt4g the great tensile sfress and therebv protecting the tibia from failnre in tension. ThiS musde contraction may result in higher comprressivestress on the anterior strrface of the tibia. Adult bone can usually withstand this stress, but imrnahue bone, which is weaker, rnay fail in compression. Musde contraction produces a similar effect in the hip joint (Fig. 1-32). During locomotion, bending moments aneapplied to the femoral neck and tensile stressis produced on the superior cortex- Contraction

EfoMECFr N|CSOF BONE

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of the gluteus medius musde produces compressive stress that neutralizes this tensile stress, with the net result that neither compressive nor tensile stress acts on the superior cortex. Thus, the uruscle contraction allows the femoral neck to zustain higt er loads than would otherwise be possible-

RATE DEPENDENCYIN BONE

Because bone is a viscoetasfic material, its biomechanical behavior varies with the rate at which the bone is loaded (Le., the rate at rryirictrthe load is applied and removed). Bone is stiffer and sustains a higher load to failure when loads are applied at higher rates. Bone also stores morre energy before failure at higho loading rates, provided tnat these rates are within the physiologic range. The loaddeformation curves in Figure l-33 show the difference in the mechanical properties of paired canine tibiae tested in vitro at a high and a very low loading_rate, 0.01. second and 200 seconds, respectively (Sammarco et aI., l97L)- The amount of enirry stored before failure approximately doubled at tfie higher loading rate. The load to failure almost doubld, but the deformation to failure did not change significantly. The bone was about sa% stiffer at the high"r speed. The loading rate is dinically significant because it influences both the fracture pattern and the aurount of soft tissue damage at fnacture. When a bone fracfures, the stored energy is released. At a low loading rate, the ener6y can dissipate through the formation of a single crack; the bone and soft tissues

AB
FfG. | -3 | A. Disribmion of cornpressir'eaN tersite $ressesin a dbia subleced to firee-point bending. 8. Conracion of trre riceps suraemuscle produceshigh cqnpressirrre $rcss on trte po*erior aspecLneuualang dre hgh tensilestress.

LOADING RATE O.O1 SEC

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FtG. I _32 stress crsrnbuuon in a fernoralrrecksubjecredto bending.when ine -oluteus rnecrusmuscreis refaxed acE on fopl. tensilestress ine sucerlorcorTex and compressive acE sress on dre inferior cciex' conc'acton of drismuscle(bonomfneuralizes ':lieSS. trle tensile

FfG. r -33 Rate dependency of bone is demonsrrated in paireC canine ubiaetestedat a high arrt a low foad,ngrare-The foad ro failure andthe energystoredro faifureafrpst doubled at d'rehigh rare. lAdaptedftom Sammarco er al., lg7l.l

DEFORTATION

T8

BIOMECHANICS OF NSSUES AND STRUCIUREs OF THE MUSCULOSKELETAL SYSTEM FtG. | -34 Human tibia experimentafly testedto failure in torsion at a high loadingrate. Displacement of the numerousfragmentswas pronounced.

remain relatively intact, and there is little or no displacement of the bone fragments. At a high loading rate, however, the greater energy stored cannot dissipate rapidly enough through a single crack, and comminution of bone and extensive soft tissue damage result. Figure 7-34 shows a human tibia tested in vitro in torsion at a high loadin g rate; numerous bone fragments were produced, and displacement of the fragments was pronounced.

Clinic ally, bone fractures fall into three general categories based on the amount of energy releasedat fracture: low-en ergf , high-energy, and very highenergy. A low-enerry fracture is exemplified by the simple torsional ski fracture; ahigh-energy fracture is often sustained during automobile accidents; and a very high- energy fracture is produded by very high- muzzle velocity gunshot. only a small proportion of the total energy storage capacity of bone is utilized during normal activity. Figure 1-35 illustrates just how little of this capacity is used during the normal physiologic activity of jogsrg.

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FATIGUE OF BONE UNDER REPETITIVE LOADING

Bone fractures can be produced by u single load that exceeds the ultimate strength of the bone or by repeated applications of a load of lower magnitude. A fracture caused by repeated applications of a lower load is called a fatigue fracture and is Vpically produced either by few repetitions of a high load or by many repetitions of a relatively normal load. The interpluy of load and repetition for any material can be plotted on a fatigue curye (Fig. l-g1). For some materials (some metals, for example), the fatigue curve is asymptotic, indicating that if the load

PHYSIOLOGIC

STRAIN

FrG.I -35 Tensile strainvaluesfrom a human adult tibia duringlogging et al., 19751 havebeen pfottedon a stress-strain {Lanyon curue for bone samples in tension. tested A smallproponion to failure of the totalenergy of the boneis utilize storage capacity d during this normalphysiologic activiiy.

OF EONE BIOMECFTANICS

l9

fracture in the lower extremities is outlined in the following schema:

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FATIGUED IIUSCLE

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\/ ABNORMAL LOADING is kepl below a certain level theoretiolly, tre material will remain intact, no matter how many repetitions. For bone tested in vito, the curve is not asymPtotic- When bone is s,tbiected to repetitive low loads, it may sustain fatigue microfractires (C-arter and Hayes, l9T7a). Testing of bone in vitro also reveals that bone fatigues rapi<tly nrhen load or deformation aPProadres the )aeld strength of the bone (Carter and Hayes, l9i7a); that is, tfre nnrrrber of rePetitions needed to produe a fractr:re diminishes rapidly. In repetitive loading of living bone, the fatigue Processis affected not only by the arnount of load i"a the number of -t"P"titions b'trt afso by tt* nrrnber of applications of the load rrithin a gro, time (ftequ-encyof loading). sin-celiving bon"L selt-rpairing, a fatigue frachrre results onlir,nhen the ,e-bdeling Processis outpaced by the f",is"e process, Le., rvhen loading is so freg.r"t i that it irerrudes the remodellng necessary to prrevent faillrrre. Fatigue fractures :rre 'sually' zustained drrring continuous strenuo's physical which cluses the muscles to become r"ugu"d "cti"ity, i reduces their ability to contract- As a r"tirt "t ane less able thev to store enerty and thus to neutrilize the stresses imposed on the bone. The resulting alteration of the stress distribution in the bone cluses abnormally nrgn loads to be and a fatigue fract're may Tposed, result- Bone f"il on the tensile sile, the comp'esT"y sive side, or uour sides. Failure on the tensile side results in a transverce sack, and,'the bone proceeds rapidly to complete fractrrre. Fatsue fract'res on the comPressive a.ppearto_b" produced rnore srowly; Id: the remodeling is less easily oltp"ced h. th" fatigue and the bone -"i; complete i**d-to [:H::: This theory of muscle iatigue as a cause of fatitue
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ALTERED STRESS OISTRIBUTION

HIGH COMpRESStOfTf + COMBTNED-6Gg

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taow -pRocESS- FAST

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DEBONDING OF OSTEONS TRANSVERSE CRACKS TRANSVERSE FRACTURE

INRUENCE OF BONE GEOMETRY ON BIOMECI{ANICAL BEFI,AVIOR

The teometry of a bone greatly influences its meclranical behavior. In tension a'd compression, the load to failure and the stiffiress are proportional to the cnoss-sectional area of the bone. ft e larger the :rnea is, the stronger and stiffer the bone. I" bending, both the cross-sectional :uea and the distribution of bone tissue around a neutral axis affect the bone's mechanical behavior. The quantilv that takes into account these two factors in bending is called the area moment of inertia. A laqger anea moment of inertia results in a stronger and stiffur bone. Figure t-37 shows the influence of the area moment of inertia on the load to failure and the stiffness of three rectangutar stmcj1rres that have the same :rrieabut different shalres. tir uending bea' Itr is the stiffest of the three and c:ln wi**tana the highest load, because the greatest asrount of material is distributed at a distance from the neutral anis. For rectangular cnoss sectiors, the forrrrula for the anea

20

BIOMECI.IANIG OF I65UE5 AND STRUCTURES OF fiE

MUSCT'LOSKELETAT SIsIEM FfG. | -37 Three beams of equal area brx different shapessubjecredto bending. Fs recangular ooss secdors. fie area moment of inerua is B: cahrlarcd ry fie formura $ rahere B is t2 tfn widtrt aN H. trte height The area mqnent of inenia for beam I is elZ: for beam tf, lUlZ: aN for beam ltl. 64112.[Adapred fiorn FrankefaN Bursrein l970-t

2x2 ll

1x4 til

moment of inertia is the width (B) multiplied by the cube of the h.ight (H1 dividedby 12: B.H3

t2
Because of its large area moment of inertia, beasr III can wiftstand four times more load in bending than bearn IA third facbr, the length of the bone, influencs the strength and stiffness in bending. The longer the bone is, the greater the magnitude of the bending moment caused by the application of a force. In a

rectangutar stnrcture, the magnitude of the stresses produced at the point of application of the bending moment is proportional to the length of the stmcttrre. Figure l-38 dqplcts the forces acting on two beams wift the same width and height but different lengths: beam B is twice as long as bearn A. The bending moment for the longer beasr is twice ilrat for the shorter bearu coruiequently, the stress magnitude ttuoughout the beam is twice as high. Becauseof their leogth, the long bones of the skeleton are subjected to high bending moments and, so, high teruile and compressive stresses. Their tubuiar

BEAM A

STRESS =S MAGNITUDE

FlG. | -39 Eearn B is rwice as fong as beam A and sr.rsEinstwice fie berxling momenl Hence. fie $ress rnagniude firo4hour beam B is twice as high. fAdapred from Frankel and Bur$ein. 1970.1

-.

BEAM B

L-.-J
I

STRESS = 2S MAGNTTUDE

OF BONE EIOMECFdAT'.IICS

2l

shape gives them the ability to resist bending moments in all directions. These bones have a large area moment of inertia becausemuch of the bone tissue is distributed at a distance from the neutral a)ds. The factors that affect bone strength and stiffness in torsion are the same ones that operate in bending the cross-sectional area and the distribution of bone Hssuearound a neutrial axis. The quantity that takes into account these two factors in torsiornl loading is the polar moment of inertia. The larger the polar moment of inertia is, the stronger and sfitrd the ' bone. Figure 1-39 shows distal and proximal cnoss sections of a tibia subjected to torsional loading. Although the proximal section has a slightly suraller bony area than does the distal section, it tras a much higher polar moment of inertia becausemuch of the bone tissue is distributed at a distance from the neutral ilds. The distal section, while it has a larger bony area, is subjected to much high"r shear stress becausemuch of the bone tissue is distributed close to the neutral axis. The magnifude of the shear stress in the distal section is approximately double that in the proximal section. Clinically, torsiornl fractrrres of the tibia conrmonly occrr distally. when bone begins to heal after ftactnre, blood vessels and connective tissue from the periosteusr migrate inlo the region of the fracture, forrting a cuff of dense fibrous tissue, or callus, anound the fr"ct rru site, which stabiti-es that area (Fig. l-40A). The callus significantly increases the ate and polar moments of inertia, thereby increasing the strength and stiffness of the bone in bending and torslon during the healing period. As the fracture heals and ,h: bone gradually regains its norrnal strength, the callus cuff is progressively resorbed and th" bone returns to as near its normal size and shape as possible(Fig. l-4OB). certain surgical procedures produce defects that greatly weaken the bone, partiarlarty in tonsion. These defects fall into two categories: those whose length is less than the diameteiof the bone (stress raisers) and those whose length exceeds the bone diarneter(open section defects). strength is reduced because the stresses imposed during loading_ are prevented from beirg distributed s1'ehlt throufhout the bone and instead become concentrated around the defect. This defect is anaL .Bousto a rock in a stream, which diverts the water, producing high water turburence around it (Fig.

V (-

V
\ .A \\-/ \ B

.-.

\-o'rl

Fv

FfG. t -39 Disribtttion of sfiear stress in two cross secrions of a ribia subjeced to tqsirnal loadlng. The proximaf section (Al fras a higher morrfem d Frnia dran does fre disal secion (Bl. becausemore Wry nEterial is distributed away from trre netrral axis. fAdaptedfun frankel and Bursrein, l971.l

.t"'I,Til:T o' ::HllH: : :Hffi ffiH il*

1-41). The wealcening effect of a stress raiser is partictrlarly marked under torsional loading the total decrease in bone strength in this loading mode can reach 60Vo. Bnrstein and associates (1972) showed the effect of stress raisers pTdrced by screws and by empty screw holes on the eneqty storage capacity of rabbit bones tested in torsion at a high loading rate. The immediate eftct of drilling a hole and inserting a scnewin a rabbit femnr was a74vo decrease in energy storage capacity. After 8 weel$, the stress raiser effect produced W the scrervrsand by the holes without scrrewshad disappeared completely because the bone had resrodele& bone had been laid down around the screws to stabilize them, and the empty screw holes had been fiUed in with bone. In femora from which the screws had been removed immediately before testing howetrer, the energy storage capacity of the bone decreased by 50%, mainly because the bone tissue arund the scnew sustained microdamage during screw removal (Fig. !-42). An open section defect is a discontinuity in the bone caused by s,rrgrcal remorral of a piece of bone longer than the bone's diameter (for example, by the ctrtting of a slot during a bone biopsy). Because the outer surface of the bone cross section is no longer continuous, the bone's abitity to resist loads is dtered, partiorlarly in torsion.

22

BIOMECHANICS OF NSSUES AND STRUCTURES OF THE MUSCULOSKELF|AL SYSTEM FtG. | -40 A, Earlycallusformation in a femoraffracturefixed with an intramedullary naif.B, Nine monthsafterinjurythe fracture has heafed and mostof the calluscuffhasbeenresorbed. {Counesy A. WinquistM.D.) of Robert

o.o<-.oEMPWSCREWHOLE }.'o- < SCREWIN PLACE o SCREW REMOVEDAT TESTING

o
(f

(, tr
z

[rJ
I.IJ

012345678
FfG. | -41 Stress concentrationaround a defecg such a defect is analogous to a rock in a stream.

WEEKS FtG. | -42 Effect of screwsandof emptyscrewhofeson the energystorage capacity of rabbit femora.The energystoragefor experimentaf animalsis expressed as a percentage of the total energy storage capacity for controf animals. When screws were removed immediately before testing,the energy storagecapacitydecreased (Adapted by 50o/o. from Burstein et af., 1972.) surface is called a closed section.) In a bone with an open section defect, only the shear stress at the periphery of the bone resists the applied torque. As the shear stress encounters the discontinuity , it is forced to change direction (Fig. L-438). Through-

In a normal bone subjected to torsion, the shear stress is distributed throughout the bone and acts to resist the torque. This stress pattern is illustrated in the cross section of a long bone shown in Figure 1-43A. (A cross section with a continuous outer

OF BONE BIOMECHANICS

23

1n as sy

'rr/(

,nrN
\t'Y'//
A
__: \t I

FtG. | -43 patternin an open and closedsectionunder torsional Stress resists the section,allthe shearstress A. In the cfosed loading. onfythe shearstress at appliedtorque.B. fn the open section, the appliedtorgue.{Adapted of the bone resists the periphery 1970.1 and Burstein, from Frankel

out the interior of the bone, the stress runs parallel to to the applied torqu, and the amount of bone tissue resisting the load is greatly decreased. In torsion tests in vitro of human adult tibiae, an open section defect reduced the load to failure and energy storage to failure by as much as 90%. The deformation to failure was diminished by about 70Vo (Frankel and Burstein, 1970) (FiS. 1-M). Clinically, surgical removal of a piece of bone can greatly wdaken the bone, particularly in torsion. Figure 7-45 is a roentgenogram of a tibia from which a graft was removed for use in an arthrodesis of the hip. A few weeks after operation, the patient tripped while twisting in an attempt to rescue the Christmas ham from toppling onto the floor, and the bone fractured through the defect.

FlG. | -45 A patient sustained a tibial fracture through a surgically produced open section defect when she trippeda few weeks after operation.

BONE REMODELING
Bone has the ability to rernodel, by altering its size, shape, and structure, to meet the mechanical demands placed on it. This phenomenon, in which bone gains or loses cancellous and/or cortical bone in response to the level of stress sustained, is summarized as Wolff 's law, which states that bone is laid down where needed and resorbed where not needed (Wolff , 7892). If, because of partial or total imm obllization, bone is not subjected to the usual mechanical stresses, periosteal and subperiosteal bone is resorbed (Jenkins and Cochrdn, 7969) and strength and stiffness decrease. This decrease in bone strength and stiffness was shown by Kazarian and Von Gierke (1969), who irnmobilized Rhesus monkeys in full-body casts for 60 days. Subsequent compressive testing in vitro of the vertebrae from the immobilized monkeys and from controls showed up to a threefold decrease in load to

CONTROL

rf
3

o o

I 3

) )

DEFORMATION FtG. | -+4 Load-deformation curves for hum an adult tibiae tested in vitro a tibia with under torsionalloading.The control curverepresents a tibia with an open no defecg the open section curye represents section defect. (Adapted from Frankel and Burstein,1970.1

24

BIOMECHANICS OF TISSUES AND STRUCTURES OF IHE MUSCULOSKELETAL SYSTEM

o o

IMMOBILIZED

Ffc. | _+6 Load-deformation curues for vertebral segmenE L5to L7 from normal and immob ilizedRhesus monkeys. fAdapted from ..969.) Kazarian andVonGierke,

DEFORMATTON

bonehas ' {t:::^[::yl:,lf markedly diminished in size.sucha ,cecr";;;ffi:

'fi suggest that rigid plates should be removea shortly J*

ilT#iH"',i"":":ffi1'1,1",H"
heared ulJ berore ii;

moments of inertia. A 2AVodecrease in bone diamerurtt#

it" ;F; il ;;i;'_" ilg#i. 1o,,1:o-1 :,^rl#ol."J

i:T:-#

greatly Hit*:'; *fj"::'^": : s:*-'l :! " decrea sesbone trength, parricular; ":;i,,.u ;f

re sorb# q-""i"dt and :Jff: thel",: * 3:l^? :l r:diameter of"-ff]: bu.u*L Fudiaphysis ryi:ffi ai um
e t

fracture hadheared. Thebone underth" il#fiJ$,

osteoporo_ * :i:" which *_i:l"l1m::Tl_"Tud sis, further#eakens inu-;;;;i6rrnr:i[:;

1980) 1vr'*Lrtr (tL dr', tt;

bysecondary

"J

failure uld energy sjolage capaciv in the vertebrae that had been immobilizEd, ,,iffr,um was also signif_ icantly decreased (Fig. I_4'6). An implant that remains firmry attachedto a bone after a fracfure has healed may arso diminish the strength and stiffness of the bone. In the case of a plate fixed to the bone with screws, the plate and the bone share the road l'.proporuons det"r*i'ed by the geometry and material p-roperties of eachstructure. A large plate, carryilg high t,ouJr, unroads the bone to a great extenu the bone then atrophies in responseto this diminished load. (The bone may hypertrophy at the bone-screw interface in an attempt to reduce micromotion of the screws.) Bone resorption under a prate is ilrustrated in Figure 1-47 ' A compressionplate made of a material

An imprant may cause bone hypurfrophy at its attachment sites el exampre of bohe hypertrophy around screws is illusfrated in Figure r-4g. A nail plate was applied to a femoral neck fracture, and the bone hyperirophied around the screwsin responseto the increased road at these sites Hrpertrophy may also result if bone is repeatedry ,"u;".ted to high mechanical stresses within the normal physiologic range. Hypertrophy ofnormal adult bone in response to strenuousexerciiehas been observed(Joneset ar., 7977; Dal6n and Olsson, I9T4; Huddleiton et aI., 7980)'as has an increasein bone density ---'d.'(Nilsson and Westlin, 1g7I). 1-potitive correlation exists between bone mass and body weight. A greater body weight has been associated with a largei bot mass(Exne"r et ar.,i,g7g). conversely, a proloriged condition " of weightlessness, such as that experienced ,curing space travel, has
FtG. I _47 Anteroposterior IAt andlateral tBf roenrgenograms of an ulna afterplate removalshow a decreased bone diameterdue to resorption of the bone under the plate. cancelf izatianof the cortexandthe presence of screwhores arsoweakenthe bone. {Courtesy of MarcMartens, M.D.f

,i; B
L

oF BONE BloMECHANlcs

25

been found to result in a decreased bone mass in weight-bearirg bones (Rambaut and |ohnston, 1979; Gazenkoet dl., 1981).

DEGENERATIVE CI.I,ANGESIN BONE ASSOCTATEDWITH AGING

A progressive loss of bone density has been observed aJ part of the normal aging Process. The longitudinal trabeculae become thinner, and some of the transverse trabeculae are resorbed (Siffert and Levy, 1981) (Fig. I-49). The result is marked reductionin the amount of cancellous bone and thinning of cortical bone. This decrease in the total amount of bone tissue and the slight decrease in the size of the bone reduce bone strength and stiffness. Stress-strain curves for specimens from human adult tibiae of two widely differing ages tested in tension are shown in Figure 1-50. The ultimate stress was approximately the same for the young and the old bone. The old bone specimen could withstand only half the strain that the young bone could, indicatitg greater brittleness and a reduction in energy storage caPacitY.
FfG. | -+8 of a fracturedfemoral neck to which a nail plate Roentgenogram was applied. Loads are transmittedfrom the plate io the bone via the screws.Bone has been laid down around the screws to bear these loads. ''

qffiffin

j'ffi

tnn
c
B A FtG.t-49 of young fAf and old lBf boneshow a marked specimens fromautopsy Vertebral cross sections with permission from Nordin, B.E.C.: reductionin cancellous bone in the latter.(Reprinted Livingstone, 1973.1 C. Bonereduction Churchill Edinburgh, Metabolic Boneand StoneDisease. to absorption As normalbone (top)is subjected depicted. with aging is schematically {shaded becomethinner and sometransverse trabeculae the longitudinal areafduringthe agingprocess, (Adapted and Levy,1981.) from Siffert trabeculae disappear {bottom).

lu4l

26

BIOMECI{ANICS AND STRUCruRE OFNSSUES OFTHEMTSCULOSKEI..ETAL SYsTEM

o trJ cE F o
q,

FtG. | -50 stress-srain cun es for sampfg of aduft lrurnan dbbe of nno vudely differing ages tested in tersion. (Adapredfiom Br.rrsrein et al., 1976.1

SUMII/IARY
1. Bone is a two-phas composite material, inorganic mineral salts b.irg one phase and an organic matrix of collagen and ground strbstancre the other. The inoanic component makes bone hard and rigtd, whereas the oqganic component gives bone its flexibility and resilience. 2- Microscopic"fly, the fundarnental stmctural unit of bone is the ost@n, or haversian qlsteul, composed of concntric layers of mineralized matrix srurounding a central canal containing blood vessels and nerve fibers. 3. Macroscopic"lly, the skeleton is composed of cortical and cancellous bone. Bone of both t,"es can be considered as one material whose potoiity and density vary over a wide range. . 4. Bone is an anisotropic material, exhibitirg different mechanical properties when loaded in different directions. Mahre bone is strongest and stiffest in .9-pression. 5. Bone is subjected to complex loading patterns dtrring courmon physiologic activities luch :rs walking and jogging. Most bone fracttrres ane produced by a combination of seneral loading modes. 6. Musde contraction affects stress patErns in bone by producing compressive stress that partially or totally nzutralizes the tensile stress acting on the bone7. Bone is stiffer, sustains higher loads before failing, and stores morre energ:r wherr loaded at high"" rates. E. Lirirg bone fatigues wher. the fnequencv of loading precludes the remodeling necessarv to prevent f,ailure. 9. The mechanical behavior of a bone is influenced by its geometry Oength, cross+ectional area, and distribution of bone tissue around the neutral axis). 10. Bone remodels in response to the mechanical demands placed on it; it is laid down where needed and resorbed where not needed. 11. with agng there is a marked reduction in the amount of cancellous bone and a decrease in the thicrcnessof cortical bone. These .h*ges diminish bone strength and stiffness.

REFERENCES
Bassett, c. A. L.: Electrical effects in bone. sd. An., 213:lE, 1965. Bonefield, w., and u, c. H.: Anisotropy of nonel,asticflow in bone. I. Appl. Physics, fi:Z4fl, lgGZ.

oF BONE BTOMECF{,AAJ|CS

27

Ienkins, D. P., and Cochnr, T. H.: Osteoporuis: The dramatic effect of disuse of an stremity. Clin. Orthop., *7'rE, 1969. lcres, H-, hiest, I., Hayes, W., and Nagel D.: Husreral hypenrophy in respcrse to exercise. f. Bone loint Surg., 59A2M,

tyndamage- A 1977a.

Carter, D. R, and Hayes, W. C: The compressive behavior of bone as a trro-phase Porous stnrcture. I. Bone foint Suqg., 59A#\ r9T7b. Carter, D. R, Schwab, G. H., and Spengl,er, D. tv{-: The efu of apparent density on the tenslh and compressive prroperties of cancellous bone. Transactions of the 5tr Anrrual Meeting ffiropaedic Research Society, 4:t7, ly79Ddn, N., and Olsson, K E: Bone minerat content and Scard -, 15:1V0,1y74. physical aAivity. Acta ffirop. Dempster, W. T., and Colemaru R F.: Tensile strery$ of bqre along and dcnossthe grain. I. AppL Physiol., 16355, tgff,. Evans, F. G.: Bone and bones. f. BiomecL Eng., 704:1,9A Evans, F. G., and Bang, S.: Differences and relations betrreen the phvsical properties and the micccopic strudurc of human femord, 6bial, and fibularcorticalbone- Arl. I- AnaL,720:79,l%7. Exner, G. [J., et al.: Bone densibmetry using comp'uted tomognphy. Part I: Selective deternination of trabecular bone density and other bone minsal parasreters. Normal values in children and adults. Br. I. Radiol, 52:14,ly79Frankel, V. H., and Burstein, A FL: ffiropaedic Biomechanics. Philadelphia, Lea & Febiger, 197O. Gazenko, O. G., C-nin, A trL, and Yegorotr, A- D.: Major medical results of the Salyut{@ru2 l8Sday space flight- NASA NDB A47. Proceedings of the )OOCI C-ongressof the Internadonal Astronaudcal Federation, Rome, It"lJn, Septenrber 6-17, 1981. GoJr, H.: Anatomy of the Human Body. 13OrAsrerican edition. Edited by c. D. Clemente. Philaddphia, [.ea & Rbiger, 19E5. Huddleston, A. L., Rockwell, D., Kulund, D. N., and Flarrison, R. B.: Bone mass in lifetime ternis athlaes. I-q,MA,244:ll(n,lg8/J,. International Society of Biomechanb: Quantities and UniS of Measurement in Biomechanics, lW7 (unpubli3hed).

IGzarian, L L, and Von Gierke, H. E.: Bone lr.ss as a result of imnobilization and dreladon. Pretininary resuls m tvlnaa trnt/rrtu- Cliru Orthop., 6267, 1969. l.uryoru L E, and Bourn, S.: The influerre of mechanical funrrion (trr the dwdopnent and remodeling of the ftia. An ocplimental study in sheEp. !. Bone loint Sulg,, 67A253, lgn. bttyott, L E, Hanpsut, ll\f. G. f., Goodsltip, A E, and Shah, strain gaug6 I. 5-: BqE dcfrrmation recorded in virc ftr attadred b the human dbial shaft. Acta Ortrop- Scand., 45:256,

tglslEssqu B. E, and Wesdin, N. E: Bqre dcnsit}r in athlebs. Clin- ffirop ., 77zlT), lqn. t{mdiru B. E C: Meabolic Bone ard Stoa Disease. Edinbrrdr Ctnrrdrill Livingsone, lfin. Rambaut, P. C, and lotrnsto& R S.: holonged weightlessness and caiciurr lcs in man. Acta Astrronau6@, 5:1lIl, 1y79. Reillp D., and Burstein, A.: The el-"tic and lriErate properties of urpact bon tissue. l. Biomech., ESy3, 1975Sammarco,1., Burstein, A., Davis, W., and Franket, V.: The a( tusional fracttrres: The etrect of loading on bimedunics ultimate Foperdes. f. Biomectr., 4:113,lyn. R S., and lguy, R. N.: TrabecuLar lntterns and the $fu, inEnat adriEcturc of bone. Mt. Sinai I. Med-, gfll, 19E1. SEffs, P., Paavoliainen, P., IGraturiu, E, ard Holcrstrom, T.: and biomectranical changes in bone after tigd plate Sffiurat fintbn. C-an-f. Surg.,23247,1980. Tortora, G. t., and Anagnostalcos, N. P.: Prirriples of Anatomy and Physiologr. 4th Ed. Nerv Yorlc, tlarpr & Row, lg8d.. lVolff, f.: Das C'esetz der Transformafion der Knochen. Brlin, Flirsdrwald, L$YL.

SUGGESTED READING Whole Bones

_Albritht, f . A.: Bone: Physicat properties. Iz The Scientific Basis or,hopaedics. 2nd Ed. Edited by I. A. AIhUht and R A- Brand. :1 New York, Appleton{entury<rofts, l9EZ, W- 213-240. Albright, J. A., and Skirurer, H. c. W.t Bone Stnrctunl organiretion and remodeling dynanics. ln The Scientific Basis of orthopaedics. 2nd Ed. Edita by a AlbrEht and R A. Brand,. I. New York, Appleton{entury6fu, lgg7, pp. tOf-lS.. Asang, E-: Biomechanics of the human teg itt alpinE'skiing. In Biomectranics rv. Edit"d by R c Nelson and C. A. Morehouse. Baltimore, university park press, 1974,pp. %-zttiL .Asang, E-: Applied biomechanics of the human leg. A basis for tndividual protection from skiing iniuries. ffirop. Clin. Norttr Am., jgj-103, 1976. E-: E*peri-ental biomectranics of the human reg. A ._-lT"q Dasrsfor interpreting t'?ical skiing iniury mechanisurs. ortf,op. Clin. Nonh A.rr., 7:63-73, lg15. Bassett,c- A- L-: Eectrical effecG in bone- scl Arl., 213:lg-2s, I 965. Burstein,A- H-, and Frankel, v. H.:Theviscoelasdcpropertiesof somebiological materials.Ann. N.y. Acad- sd., I4d:158-165, ll)58. Burstein, A H., et al.: Bone strength. llte effect of screw holes. 1156, lgT2. f. Bone loint Surg., SA:lliLlC:rter, D. R: Anisotlopic anatpis of strain ruette inforsradon hon cortical bone. I. Biomech., 77:199-Tn, lil;lE. Cuney, l.: The Mectranical Adapatiqrs of Bones. Princeton, Prilaton Univrsity Pness,19E4, pp. 3-l5i/. cpntent and Ilal& N., and Olsson, IC-E.: Bone mirsal phystcal activit". Acta fthop. Scand., 45:l7O-44, 1y74. Deurpster, lAf. T., and Coleman, R F.: Tensile strength of bone along and acnuis the grain. f. Appl. Phsiol., 15355-m, tt""*, F. G.: Bone and bones. I. Biomech. Eng., 1o4:1-i , y9gz Evans, R D. (ed.): Studies on the Anatomy and Fnnction of Bone and loints. New York, SpringenVerlag, l$5. Enrer, G. IJ., et al.: Bone deruitosreEry using omptrted tonography. Part k Selective detersrination d trabecrrlar bone dnsity and odrer bone mineral parartetes. Normal values in drildren and adults. Br. I. Radiol., 52:14-23, t9rTt. Frankc{, V. H.: The Femoral Nedc Frrnction, Fracture Medranisuts, tnternal Fixation. Sptingfield, Charles C Thomas, tgff.. FnnlcL V. H., and Burstein, A. H.: fthopaedic Biomechanics. Ptriladelphia,l-ea & Febiger, l!70.

28

BIOMEGTAAIICS OF NSSUES AAJDSTRUCTURES OF THE MUSCULOSKELETA SISTEM

Toridis, T. G-: Stress andysis of the femur. I. Biomech., 2:163-174, 1969.

Frankef, V. H-, and Burstein, A. H-: Biomechanics of the locomotor srstem. In l\ledicl E"g"eering. Ed.itea bv c. D. Rav. chicago, Year Book Medical publisher, l!i4, pp. 505-51d. Frost, H- M-: An Lntroduction to Bromeclnnics. Sprit g6eld, Charles C Thomas, 1976Hakim- N- 5-, and IGng; A. I.: hogranned replicadon of in situ (whole Uody) badiry conditions during in tii- (nrbst'ct're) testing of a vertebnl column stmenl I. Biomectr-, gfi='-6g2,

Corticaf Bone
Bonefield, w-. and u, c H.: Anisotropy of nondastk flow in bone. I. Appl. Phssics, 3824fl-2/155, 1967. Burstein, A- H-, ReilIy, D. T., and Marteru, M.: Agiry of bone tissue Mechanical properties. I. Bone Joint Surg., 58A82-E6, IyZ6. Burstein, A- fa, Currey, I. D., Frankel, v. H., and Reillv, D. T-: The ultimate p'rqerdes of bone tisstre: The effects of ygdi" & I. Biomedr., S'35 'L I*TZ C-arter, D. R, arrd Hayes, w. C: Compact bone fatigue damage. A micrwcog* exaninatbn. Clin. Orthop., 127{65-24, l%n . C-artrr, D. R, ad Hayes, w. C: The compressiw belravior of bone :u; a hrc?tras porcus stnrcture. f. Bone Ioint Suqg., 59A9il-%2, rgnCurrey, I. D.: The medranical properties of bone. crn. Ortho'p ., 73210-Z1 Lyn. DaIn, N., FHlsffim, L., and facobson, B.: Bone mineral content and mecbanical strength of the femoral neck- Acta Orthop. Scand., 47'ffi-lE, 1y76. Enneking, hl-: Principles of Musculoskeletal Patholory. Cninesyille, FL, Storter Printing Company, lg7f,. Errans, F. G: Mechanical Properties of Bone- Spngfield, Charles C Thom=, 1973. Evans, F. G-, and Bang s.: Differences and relations betrpeen the physical properdes and the microscopic strucuue of human femoral, ftial, :'yl fibular cortical bone. Asr. f. Anat , rz(hzg-gg, t967. Fredensborg N., and Mlsson, B. E.: The bone Eineral content and cortical thidmss in young women with femoral neck fracttrre. Clin. Clrthop ., 7J24:.16116,4., lEn. Frost, H. M-: The l-aws of Bone struchrre. Sprin$eld, Charles C Thomas, lgfl|. [.akes, R., and Saha, S.: long-term torsional crp in compact bone- f. Biomech- Eng., 7U2:178-180, 1980. Mueller, IC I.L, Trias, A., and R.y, R D.: Borr density and composition. AgFrelated and pathological changes in water and mineral contenl f- Bone Ioint Surg., aISA:140-148,1966. Nilsson, B. E, and wesdin, N. E.: Bone densitv in athletes. Clin. Orthop., V:179-le, lYn. PoF, M. FL, and Outwater, I. O.: The fracture draracteristics of bone nrbsara- f. Biomech., 5:457-ffi, lyn. Reilly, D. T., and BursEin, A. H.: The mechaniol p-perties of cortical bone. I- Bone loint Surg., 55A:1fi)l-1m2, lln4. Reillv, D. T-, and Burstein, A. H.: The elastic and ultimate properties of compact bone tissue. f. Biomech., 8:3S-4(E, ly71. Reilly, D. T-, Bnrsteiru a H., and Frankel, V. H.: The elastic modulus for borE- I. Biomech., 7.Zl-275, 1y74. Sdlin, E. D-: A rheologc"l model for cortical bone. A study of the physical prryerties of hunan fiemoral samples- Acta Orthop.-r Scand., Suppl. 63:1-87, f965. Viano, D., Fldferuteiru U., Anliker, M., ird Rfregsegger, p.: Elastic properties of cortical bone in female husran- fesrurs. I. Biomectr., 9:78-710, Ly76. weaver, I. lC. The mi<roscopic hardness of bone- I. Bone Ioint SrtB-, 484:273-:38, 19ff..

rn6.

w, lyn-

IrunarL V- T.: Functional aspects of the abductor murles of the hip. I. Bane loint Sqrg., ?f,A.;ffi2-6!9, L%7. Codrran, T. H.: Osteoporosis: The dramatic Inkins, D. P., d effect of disuse of a qtremity. clin. ortho,p., &{:v1-l'+ .'969. fensen, J. S., Ifanseru F. W., and loturrse&- I.: Tibial shaft ftactures- A ourpAison of consernative beatmnt and internal fixation wiffr onventbnal plates or AO compression plates- Acta Orthop. Scand-, 4,E4#212, lgn. lones, H-, Priesg I-, Hayes, w., and Nage{, D.: H'sreral in resPons to exercise. I. Bone Joint Suag., SgAiln!fp*"pLy

IGzari:rn,L, and Graves, G. A-: compressive strength characteristics of the hrrman vstebral centnln. spine , 2:l-ti, lgn. IGzarfurn, L E., and Von Gierlc, H- E.: Bot loss as a result of " immobilization and drdation. Preliminary resuls n lvInas trstIetu. Clin- Orthop -, 5SfiT-75, l%9. Lakes, R, and saha, s.: cement rine motion in bone. science, 2mflt-503, tgn. [anyan,LE.,I{anFor" W. G. J., Goodship, A. E-, and Shah, L S-: Btf,|e deformation recorded in vivo from strain tauges attadred tD th hurnan bbiat shaft. Acta orthop. scand., {6-2fr2fi, l9TtMurphy, E F., and Burstein, A. H.: physical properties of materials induding solid mechanics. In Atlas of Orthbtics. Biome chanical kinciPles and Application. St- ["ouis, C. V. Mosbry Co., \*Tt, pp. 3-30. l.letz, P., Eril$son, K, and sffimberg, L.: ultimate farllure of di"physal bqre. An ergerimenal studt on dogs. Acta orthop. Scand., 5I583-58E, f9fr). Piziatl R L, and Nagel, D. a: Modelintof the human l"t ir, ski injuries. &thop- Gin. North A.trr., 7:LT--139, 1976. Robinson, R. A-: Bone tissue: Composition and ftrnctionfohns Hopkins Med. J., ltIS:!0-Z4, lyn. Rosse' C., and Clawson, D. K: Introduction to the tvtnsctrloskeleal systen. l$ew York, Flarper & Row, ly,o. Rybicki, E F., sinonen, F. A., and weis, E. B.: on the mathemadcal andysis ot stress in the hnman fennr. f. Biomecl., 526-215, tyn. Samsrarco, G. f-, Burstein, A H., Davis, W. L., and Frankel, V- H-: The biomechanics of torsional fracttrres: The etrect of loading cr ultimate properties. I. Biomech., 4:ll3- ll7, lyn. Sandler' R 8., at'rd Herbert, D. L.: Qr,rantitative bone assssments: Applbtions and eTpecta6ons. l. Alrr. Geriatr. soc., 29:9-1G3, f!)8l. Sldnnr, FL C. tV.: Bone minerali--tion. In The Scientific Basis ot hopaedics. zrd Ed- Edited b.uI. a Alb,right and R. A- Brand. lf New York, Appletur-Centuqyr{rofts, 19g7, pp. f99- ZlZ. Sleds. P., PaavoNainen, P., Karahariu, E., and Holms6m, T.: Stntchral and biocnechanical changes in bone after ritrd ptate 6xation. Can- I. Su{g -, 23247-Lfl, igSO. Sffimbery L., and Daln, N.: Experisrental measunement of maxirnusr tonque capacitv of long bones. Acta Orthop. Scand., 47:87-2fr, 1y75. sffimberg, L., and Daln, N.: The irtfluence of freezing on the maximum torqre capaciv of long bones. An experimenal studv on dogs. Acta Ortltop. Scand-, 47:?5l-2fi, 1976.

Cancelfous Bone
Behreru, J. c, walker, P. s., and shoii, H.: Variations in strength and stlrcture of cancellorrs bone at the kne- f. Biomech., 7:2Ol-297, 1974-

OF BONE EToMECF|AN|CS
D. R., and Haves, w. c.: Bone compressivestrerrgth: C-a,r+er, The influence of densitv and strain rate. Science , Igl:1174-1176, 1975. Carter, D. R., and Hayes, w. C.: The compressive behavbr of 'r'one as a two-phase porous struchrre. l. Bone lctnt Srrt., 59.{:9il -952, 1977 Carter, D. R., Schwab, G. H., and Spengter, D- M-: The ft of appa*tt-t density on the tensile and compressive properties of cancellous bone. Transactions of the 25th Annual Meedn& ffiropaedic Research Societ-v, 4:t7, 1979. chung; 5. M- IC, Batterrran, s. c., and Brighbn, c r-: strear strength of the husran femoral capital epiphyseat plate- f- Bure Ioint Surg., fiA:91-1(8, 1Y76. Enneking, W.: Prirrciples of Musculoskeletal Fatrolo6il. Caine*'ille, FL, Storter Printing Compar/, lgTO. Errans, F. G.: Medranical Properties of Bone. Springfieid, Charles C Thomas, lgnFrankel, v. H., and Burstein, A. H.: [.oad capacity of tubqlar bone- In Biomechanics and Related Bio-engineerint Topics- Effi bl' R. M. Kenedi. New York, Perganon Press, 1965, pp. 3gl -ffi. Frost, H. M.: The laws of Bone Stmctrrre. Spri"gfield, Charles C Thomas, 196/.. C,alante,f., Rostoker, W., and Rav, R. D.: Ph)rsicalproperties of trabecnlar bone. Calcif. Trssue Res., 5:236-245, lg7o. Haves, w. c., and C-arter, D. R.: Postyietd behavior of sutrhondral trabectrlar bone. f. Biomed. Mater. Res-, 7-S3Z-::p4, 1e76. Haves, w. c., Boyle, D. 1., and velez, A.: Ftrnctional adaFtion in the trabecular architecttrre of the human patdla. Transactions of the 23rd 4ry1'r:l Meeting, Orthopaedic ResearchSciety, J: I l{, 1977. Undail, O.: Mechanical properties of dded defatted spongy trrnc. Acta Orthop. Scand., 47-.tl-19, 1976. PoP., M- H., and Outrrater, f. O.: The fracture ctraracteristics trl txrne substance.I. Biomech., 5:457-16s, 1972. Pop", M. H., and outrnrater, I. o.: Mechanical properties of htnt' as a fnnction of position and orientation. l. BiomecL., l:61-66, ly74siffert, R. s., and L"ny, R. N.: Trabectrlar patterns and the internal architecture cf bone. Mt. Sinai Med. ig-J!]t-ZEt, f$l. , I. lveaver' I- K-: The microscopic hardness of bone. Bone I. loint 5rrg., 484:273-288, 1966. lveaver, I. K., and chalmers, I.: cancellous bone: Is strerrgth rnd changes with agng and an evaluation of some mettrods for ntcasuring its mineral content. I. Age changes in cancellousbone. | &rne.foint Surg., #A.2gg-Zgg, l-gffi.

Zg

Frankel, v. H., and tlang, Y.-S-: Recent advances in the biomedranics of sport iniudes. Acta Orthop. Scand., 4G-.48+-497, 1975. Friedenber& Z B.: Fa6gue fractnres of the tibia. CIin- Orthop., 76:lll-115, 1971. McBryde, A. M.: stress fractures in athletes. t. Spora \fed., 32t2-2t7,1976. Wdter, N. F-, and Wolf, M. D-: Stness fractgres in Fung athletes- Arl. I. Sports Med-, 5:165-lI , lgn-

Bone Remodellng
Abramsm, A-:8ate rncturbances in iniuries to the spinal cord and cauda eqdna (panplegh). Their prcven6on by ambuhbn. fBone lcint Surg ., XDMUiL-gEf7, 194E. Bartley, lf,- fL, Anold, f. S., Fladam, R trC, and tee, W. S. S.: The reladonstrip of bone strcngth and bone qgantitf in health, disease, and aglry- I. Gerqrol,2l:5l7-Sll, !gff'. Bassett, C A- L: Bblogic significance of piezoelectridt-v. Caldf. Tissue Res., 725i2-Zn, 196E. Ctramaf, A., and TschanE, P.: Mectranical influences in bone remodeling. Experimental research on Wolff's Law. J. Biomectl., 5:lT3-180, lyTZ Daln, N., and Otssort K-E.: Bone mineral curtent and, phrical activity. Acta ffirop. scand-, 4szl70-174, lg74Franlce, 1., et aL: Ph1nnd properties of fluorosis bone- Acta Orttrop. Scand.,. 4l/.A-27, 1976Gietsvik, A.: Bone respdeling and piezoelectricit)'-L |. Biomech., 6:69-77,1973. Horal I-, Nadresrsoru A., and scheller, s.: cliniel and radiologitzl long Eur follow-up of rrertebral fractures in ctulldren. Acta Orthop. Scand-, 43:491-5(8, lytz Huddleston, A L, Ro*rreII" D., Kulund, D. N., and tlarrison, R. B.: Bone m;rss in lifetime teruris athletes. fAtvIA , 2ti4:!lg7-ll0g, 1980. fawoski, Z. F- G.: Ph''sblogy and patholoy of bqre renrodeling, Ceilular bads of bone stmcture in health and in oseoporosis. ffirop. Clin. Nordr An., 12:485- SXL,1981. Ienkins, D. P., and Coduan, T. FL: Osteoporosis: The dnsratic effect of disuse of an octrenity. Gin- orthop., 64:128-13+ 1969. fones, H. H., et al.: Hunerat hlpertnophy in respqrs to exercise- I. Bone tcint Surg-, SIA2CF.-208, lgTZ. I-arryon, L. E, and Bcrrn, 5.: The influence of medranical function on the derelcpment and resrodeling of the &ia. An experimental study in sheep. f. Bone loint S*g., 61A26"-2TZ, t979. I\rlartin, R 8., Plckett, I- C., and Znaich, S.: Studies of skeletal remodding in aging men. CIin. Orthop., 149:269-282, 19fl1. Rambaut, P. C, and fotrnston, R. S.: Prolonged weighdessness and calciusr loss in man. Acta Astronautica, 6:1113-ll??, lyn. *hock, C. C, Noyes, F. R, Madrws, C. H. 8., and C-rcuch, M. M.: The effect of activitv on surface remodetling in the Rhesqs monkey rib and fennrr. Transactions of the 23rd Annuat Meeting; Orthopaedic Researdr Sod,ety, 2:36, 1977. sharpe, w. D.: Age changes in hurnan bone: An o.erview. BuIl. N.Y. Acad. Med., 55tr37-773, 1929.

Fatigue Fracture
Baker,I-, Frankel, v. H., and Burstein, A. H.: Fatiguefractures: Bt'rmechanical considerations.f. Bone foint s*g., 5{r{:1345-r}rf,
I e ;1 .

Burrorvs, H- I-: Fatigue infraction of the middle of the tibia in b'-rflet dances. f. Bone _g4,195d. ioint Srrg., 3gB:g3 Dt'vas, M-: stress io.trr"r. Edinburgh, London, and New I rrrh.
\ t

Lhurchill

Livingstone,

tgTS.