See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/318183354

Evaluating Different Shapes of Cranial Fixation Mini-plates Using Finite

Element Method

Conference Paper  in  IFMBE proceedings · June 2018

DOI: 10.1007/978-981-10-5122-7_187

CITATIONS READS

3 647

4 authors:

Jakub Chamrad Petr Marcián

Brno University of Technology Brno University of Technology
7 PUBLICATIONS   25 CITATIONS    43 PUBLICATIONS   515 CITATIONS   

SEE PROFILE SEE PROFILE

Nathaniel Narra Libor Borak

Tampere University Brno University of Technology
31 PUBLICATIONS   478 CITATIONS    18 PUBLICATIONS   181 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

The role of physical activity on entheseal changes and distribution of cortical bone in light of clinical data View project

Effect of exercise on proximal femur strength to prevent future hip fracture View project

All content following this page was uploaded by Jakub Chamrad on 06 March 2018.

The user has requested enhancement of the downloaded file.

 EMBEC-NBC2017, 399, v1: ’Evaluating Different Shapes of Cranial Fixation Mini-plates . . . 1

Evaluating Different Shapes of Cranial Fixation Mini-plates Using Finite Element Method
J. Chamrad1, P. Marcián1, N. Narra2 and L. Borák1
1Institute of Solid Mechanics, Mechatronics and Biomechanics, Brno University of Technology, Brno, the Czech Republic
2BioMediTech Institute and Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland

Abstract—Medical grade 3D printing offers the possibility

to manufacture patient-specific implants to treat cranial de-
fects. The performance of the implant assembly depends on
many factors, such as material, thickness, size and manufac-
turing accuracy. A significant factor in the stability and suc-
cess of the assembly is the fixation method. Cranial implants
are usually fixed to the skull by means of mini-plates. Biome-
chanical assessment of fixing the implant to the skull might be
helpful not only for mini-plate design but might be beneficial
also for the surgeons. In this study, four different mini-plate
designs were analyzed and compared based on the stress-strain
analysis of one cranial implant fixed at three locations by mini-
plates. Computational simulations were done using Finite
Element Method.

Keywords— Cranial implants, fixation mini-plates, FEA,

Polymethyl Methacrylate, stress-strain analysis.

I. INTRODUCTION

Surgeons usually use implants to protect the brain and to

provide mechanical support for damaged bone tissue that
can be caused by an impact of another object or by cranial
bone cancer.
Implantology has gone advanced rapidly in the past dec-
ade. Thanks to 3D printing technology with medical grade
materials [1], patient specific approach has become a possi-
ble way of manufacturing implants.
3D printing in medicine provides opportunity to manu-
facture very complex shapes, e.g. of cranial implants. There
are several ways to define implant geometry. If available,
computed tomography (CT) image data of the patient can be
used to precisely contour the defect site. Thus the defect
surface contour can be either mirrored or curvature-based
algorithms [2]. As soon as the implant geometry is obtained,
it can be manufactured using a 3D printer, where the im-
plant material is usually Poly-Methyl-Methacrylate
(PMMA), Poly-Ether-Ether Keton (PEEK) or a titanium
alloy.
Cranial implants are fixed to the skull by means of mini- Fig. 1 Geometry model: a) Skull with cranial implant (Transparency was
plates and micro-screws. There are numerous mini-plate used for visualization of cancellous bone); b) I-shape mini-plate; c) T-
types on the market, designed for general purpose or suita- shape mini-plate; d) X-shape mini-plate e) Square-shape mini-plate.
ble for some specific situations.
2 EMBEC-NBC2017, 399, v1: ’Evaluating Different Shapes of Cranial Fixation Mini-plates . . .
The simplest mini-plate shape available is the I-shape
(see Fig. 1b). Other frequently used mini-plates are T-shape
(Fig. 1c), X-shape (Fig. 1d) and Square-shape (Fig. 1e). The
selection of the mini-plate shape as well as its location suit-
able for the particular case are usually based on a surgeons’
experience. Nevertheless, their selections might not respect
some significant technical phenomena, such as stress or
strain distribution within the region of interest and in the
participating parts. Therefore, engineering methods might
be helpful and might provide objective arguments for the
best selection.
The aim of this study is the comparison of four afore-
mentioned types of mini-plates. The comparison is based on
the stress-strain analysis of three mini-plates fixing one
cranial implant manufactured from PMMA. The locations
of the mini-plates were the same for all variants differing by
the mini-plate type. The locations were assumed to mimic
typical representation of a surgeons' decision for the particu-
lar case shown in Fig. 1.
The performance comparison was based on computa-
tional simulations using the Finite Element Method.
II. MATERIALS AND METHODS
A. Geometry model
For this study, the CT dataset of a male undamaged skull
was used. The voxel size was 0.4 x 0.4 x 0.7 mm. CT data
was processed in software STL Model Creator developed in
MATLAB program (MathWorks, USA) by the authors [3].
Using automatic [4] and manual segmentation, STL (stereo-
lithographic) model was prepared. The model of the skull
consisted of both cortical as well as cancellous bone as
indicated in Fig. 1a. The STL model was modified in soft-
ware Catia V5 (Dassault Systèmes, France) and a volume
mesh of the skull was created containing the defect. The
implant was modeled and meshed such that its thickness
was similar to the bone it is modeled to replace. The analy-
sis was focused on the mini-plates shapes only; therefore,
the details of the micro-screws were neglected using un-
threaded cylinders (Ø1 mm) as sufficient representations of
the screws [5].
Finite element analysis was performed in ANSYS Work-
bench 17.2 (ANSYS Inc., USA). Model was discretized
using quadratic element types SOLID186 and SOLID187.
All parts in contact were connected using contact elements
TARGE160 and CONTA174. The total amount of elements
was around 1,600,000. It corresponds to 2,500,000 nodes.
Mesh sensitivity test was performed for each computational
model.
B. Material model
Material was assumed to be linear, isotropic and homo-
geneous in the model assembly. Material properties were
therefore defined by Young's modulus and Poisson ratio.
In this study, the implant was assumed to be made from
PMMA, which is a common biomaterial in cranioplasty.
Fixating mini-plates and screws were made from titanium
alloy Ti6Al4V. The mechanical properties of all materials
in the model are listed in Table 1.
C. Boundary conditions and loads
In all model configurations, the skull was fixed at the
bottom. The constraint is sufficiently far from the region of
analysis and mimics the physiological constraint on the
head with respect to the body.
The implant, mini-plate and bone were fixed together by
means of micro-screws; therefore, no mutual movement
between these parts at their interfaces was allowed (using
Ansys “bonded contact” algorithm [5]). Friction coefficients
for each contact pair (with an exception of micro-screws)
were assumed to be as follows: 1. PMMA-Ti6Al4V = 0.1;
2. PMMA-Bone = 0; 3. Ti6Al4V-Bone = 0.1.
The models configurations were subjected to a static
force over the area (~ 83 mm2) in the center of the implant.
This loading force was assigned to be 50 N [6] to mimic the
weight of a human head. In addition, the bone and implant
were loaded with an intracranial pressure (ICP) of 2 kPa (15
mmHg) which is a physiological value of ICP [7].
Table 1 Material properties of model materials
Young’s modulus Poisson ratio [-]
Material
[MPa]
Ti6Al4V [8] 114 000 0.3
Cortical bone [9] 15 000 0.2
Spongy bone [10] 100 0.2
PMMA [10] 3 000 0.38
III. RESULTS AND DISCUSION
In this study, total displacement of the implant, von Mis-
es stress in the mini-plates and implant and von Mises strain
in cranial bone were analyzed.
A. Total displacement of the implant
The highest total displacements of the implant were ob-
served when using T-shape mini-plates (0.20 mm). Total
displacements are lower in case of I-shape mini-plates (0.15
 EMBEC-NBC2017, 399, v1: ’Evaluating Different Shapes of Cranial Fixation Mini-plates . . . 3

mm). The reason for the difference might be that the micro-
screws are further apart from each other in the T-shape
mini-plate, than in the I-shape mini-plate (Fig. 1b and Fig
1c). Interestingly, another difference is that in T-shape mini-
plates, two micro-screws were used for fixing to the skull.
In I-shape mini-plates, there was only one micro-screw
used.
Lower displacements were achieved when the implant is
fixed using Square-shape (0.09 mm) and X-shape (0.12
mm) mini-plates. In both of these variants, the implant is
fixed by two micro-screws which increases the rigidity of
the assembly. Displacements are approximately 55 % and
40 % lower than displacement of the implant fixed by the T-
shape mini-plates.

B. Von Mises stress in mini-plates

Von Mises stresses in mini-plates are shown in Fig. 2a.
The maximum stress values are concentrated in the fillets
and in regions with significant cross-section changes. This
applies to all analyzed configurations (details in Fig. 2a).
The highest stress out of all configurations is in T-shape a)
mini-plate (see Fig. 2b). The lowest values of stress are in
Square-shape mini-plates. In case of I-shape and T-shape
mini-plates, higher concentrations of von Mises stress are
observed in the mini-plate sections closer to implant micro-
screw. In case of X-shape and Square-shape mini-plates, the
connection to the implant and bone is stiffer than the T-
shape mini-plate, mainly due to the advantageous location
of the micro-screws. Another critical cross-section of all
mini-plates is located near the bone-implant interface.
Those cross-sections are subjected to a significant bending
and, therefore, there might be observed higher values of von
Mises stresses. This phenomenon, however, is not that sig-
nificant in case of Square-shape mini-plates due to two
parallel parts bridging the interface.

C. Von Mises stress in implant

The highest stresses in the implant were observed in
the I-shape mini-plate configuration (Fig. 2b); the other
configurations produced values up to 40% lower. In all the
configurations, the maxima are located around the micro-
screws. It should be noted that values in Fig. 2b do not re-
flect precise stresses in the implants as the threads of the
micro-screws were neglected. However, they are sufficient-
ly representative to compare between the model configura-
tions.
b)
Fig. 2 a) Distribution of von Mises stress in mini-plates; b) Maximum
values of von Mises stress while using different mini-plates shapes.
D. Von Mises strain in skull
The highest values of von Mises strain in the bone were
observed in the I-shape mini-plate configuration (see Fig.
3). On the contrary, the lowest strains were produced in the
Square-shape mini-plate configuration which can be at-
tributed to stiffer connection provided by this mini-plate.
4 EMBEC-NBC2017, 399, v1: ’Evaluating Different Shapes of Cranial Fixation Mini-plates . . .
Fig. 3 Maximum values of von Mises strain in skull while using differ-
ent mini-plate shapes.
The strain maxima were located around the micro-screws.
While they do not represent precise values for strains, they
are sufficient for a comparative analysis.
IV. CONCLUSIONS
FEA is a useful methodology for the assessment of the
implant behavior and for the selection of fixation mini-plate
type in terms of biomechanical and structural conditions. In
this study, performances of four different fixating mini-
plates were analyzed. Of the four plate shapes, the Square-
shape mini-plate showed the lowest values of von Mises
stress and the lowest stresses and strains in the implant and
bone, respectively. However, this mini-plate may have
limitations in its application because of its size; especially,
when skull damages of complicated shape and edge are to
be treated.
ACKNOWLEDGMENT
The research was supported by the Czech science
foundation by grant no. 16-08944S.
CONFLICT OF INTEREST
The authors declare that they have no conflict of inter-
est.
REFERENCES
1. Narra N, Valášek J, Hannula M et al. (2014) Finite element
analysis of customized reconstruction plates for mandibular
continuity defect therapy, J Biomech 47(1):264–268
View publication stats
2. Wicher J van der Meer, Bos R, Vissink A, Visser A (2013) Dig-
ital planning of cranial implants, Br J Oral Maxillofac Surg
51(5):450–452
3. Marcián P, Konečný O, Borák L et al. (2011) On the Level of
Computational Models in Biomechanics Depending on Gained
Data from CT/Mri and Micro-CT. In MENDEL 2011 - 17th In-
ternational Conference on Soft Computing. Brno, 2011, pp
255–267
4. Huotilainen E, Jaanimets R, Valášek J et al. (2014) Inaccuracies
in additive manufactured medical skull models caused by the
DICOM to STL conversion process, J Craniomaxillofac Surg
42(5):259–265
5. Hsin-Yi K Ch, Chun-Li L, Yu-Hao L et al. (2007) Biomechani-
cal evaluation of the modified double-plating fixation for the
distal radius fracture, Clin Biomech 22(5):510–517
6. Ridwan-Pramana A, Marcián P, Borák L et al. (2016) Structural
and mechanical implications of PMMA implant shape and inter-
face geometry in cranioplasty – A finite element study, J Crani-
omaxillofac Surg, 44(1):34–44
7. Czosnyka M, Pickard J (2004) Monitoring and interpretation of
intracranial pressure. J Neurol Neurosurg Psychiatry 75(6):813–
821
8. Niinomi M (1998) Mechanical properties of biomedical titani-
um alloys. Mat Sci Eng A 243:231–236
9. Freedman M, Ring M, Stassen L F (2013) Effect of alveolar
bone support on zygomatic implants: a finite element analysis
study. Int J Oral Maxillofac Surg 42:671–676
10. Bosisio M R, Talmant M, Skalli W et al. (2007) Apparent
Young’s modulus of human radius using inverse finite-element
method. J Biomech 40:2022–2028
11. Preusser, T, Rumpf, M, Sauter S et al. (2011) 3D Composite Fi-
nite Elements for Elliptic Boundary Value Problems with Dis-
continuous Coefficients. SIAM J Sci Comput 33:2115–2143