Biomechanics

Dr Sharew (Orthopedics & trauma surgery

resident)
Adama Hospital Medical College

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Outline
Introduction to Biomechanics
Biomechanics of bone,muscle,tendon & ligament
Biomechanics of fracture & fracture fixation
Biomechanics of orthopedic implant

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Objectives
To understand basic biomechanical concepts
To understand the effect of forces applied on tissues
To have a basic understanding about how orthopedic pathologies
occur and how to best manage them
To understand the biomechanical properties of basic implants and
failure seen with their application

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Introduction
Biomechanics is science that deals with action of force on living body
(motion and deformation) and moments acting on tissue such as
tendon , ligament and bone.
A force causes an object to either accelerate or decelerate.
 When a force causes rotation, it is termed a moment and has a
moment arm.
 Muscles typically cause a bone to rotate.

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Moment of a force
 Moment or torque is turning effect of a
force acting on an object.
The moment of a force depends on the
magnitude of force and perpendicular
distance from the force to the axis(also
known as the lever arm):
Moment [Nm] = Force [N] × Distance [m]

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Stress
is the force divided by the area of an object
over which it acts.
 Tensile Stress - stress that tends to stretch
or lengthen the material - acts normal to
the stressed area
 Compressive stress - stress that tends to
compress or shorten the material - acts
normal to the stressed area
 Shearing stress - stress that tends to shear
the material - acts in plane to the stressed
area at right-angles to compressive or
tensile stress
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 Strain
 is simply the change in height or
length that a material undergoes
during loading, divided by its
original height or length.

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Stress strain curve

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 Young’s modulus of elasticity(E)
Measure of stiffness or ability to resist deformation in tension
E= Stress/Strain
 slope in the elastic range of stress-strain curve
The steeper the slope, the stiffer the material
 Hooke’s Law:
 In the elastic zone, the stress is proportional to the strain

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Relative values of young’s modulus

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Material Properties related to Stress-Strain curve
Toughness: a material which can absorb more
energy prior to failure (Larger area under the
stress-strain curve)
Weakness: a material; which can absorb little
energy prior to failure (Small area under the
curve)
Ductile: large plastic deformation region before
they fail (Ex. Copper)
Brittle: little plastic deformation before they fail
 Undergo elastic deformation only
 Ex. Glass
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Viscoelastic property:
Deformation characteristics dependent
upon the rate of loading
Described in terms of:
 Creep: constant stress but increasing
strain
 Stress Relaxation: decrease in stress
required to maintain constant strain

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 Hysteresis: ability to dissipate energy
b/n the loading & unloading cycles
 Anisotropy: mechanical property is
dependent upon direction of loading

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Levers
Levers are used to alter the resulting direction of the applied force
A lever is a rigid bar (bone) that turns about an axis of rotation or fulcrum (joint)
The lever rotates about the axis as a result of a force (from muscle contraction)
The force acts against a resistance (weight, gravity, opponent, etc.)

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Pulleys
Fixed pulley is one attached to a
beam. It acts like a first class lever, it
is used to change directions of force
application.
Medial malleolus for instance acts as
a pulley for the Tendon of peroneus
longus.

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Bones
Constituents:
Organic - Type I collagen 25-30%
 Flexibility, elasticity, low young modulus
 Contribute to tensile strength
Inorganic - Ca10Po46OH2 (65-70%)
 Stiffness, brittleness
 Primary determinant for compressive
strength

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Cortical bone: 80%
Considerable resistance to bending &
torsion(twisting)
High young modulus(stiff)
Cancellous bone:
More flexible & elastic
25% as dense, 10% as stiff & 500% as
ductile as cortical bone
Resists compression & shear

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Bone is anisotropic - its modulus is
dependent upon the direction of
loading.
Cortical bone can with stand greater
stress in compression (~190 mpa)
than in tension (~130 mpa) and
greater stress in tension than in shear
(~70 mpa).

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Bone is viscoelastic
 Stiffer the faster it is loaded.
Bone is dynamic
 Function determines structure - Wolff’s Law
 Subtle density changes greatly changes strength and Modulus of elasticity (Ex:
aging, disuse)

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Fracture Mechanics
Nature of applied force evident by type
of fracture
Axial load-Transverse/oblique
Bending load-Fails in tension 1st
Torsion-Result in Spiral fracture
Combined bending & axial load
 Oblique fracture
 Butterfly fragment

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Fatigue of Bone Under Repetitive Loading
Bone fractures can be by
repeated applications of a lower-
magnitude load.
Fatigue fractures fall into two
main subcategories:
 A,Fatigue type stress fractures are
seen in normal bone after
excessive activity,
 B,Failure type by normal activity
and are frequently caused by
osteoporosis and osteomalacia
Can be tension or compression
fatigue fracture
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Fracture Callus
Moment of inertia proportional to r4 1.6 x stronger
Increase in radius increases moment of
inertia and stiffness
Callus & stiffness increase with time
 Near normal stiffness at 27 days
 Does not correspond to radiographs

0.5 x weaker
Biomechanics of IMN
Metallic rod that provides stability
Intramedullary implant would act as an internal
splint, allowing a fractured bone to heal.
It is load sharing internal fixation device

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Stability of fixation depends on:
 Mechanical properties of nail
 Cross-sectional shape
 Diameter,
 Curvature of the nail
 The ability to place interlocking devices (such as bolts)
 Mechanical properties of locking screw and
 Extrinsic factors, such as reaming of the medullary
canal, inherent fracture stability, and the use of adjuncts
for stability (such as blocking screws)
Bending and torsional stiffness depends on nail
diameter
 The larger the diameter the higher the stiffness
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In the majority of applications, nails are
relative stability constructs.
When the limb is loaded, they allow some
movement at the fracture site and promote the
formation of callus.
How much movement takes place is governed
chiefly by three factors:
 The fracture
configuration/comminution.
 The diameter of the nail.
 The working length of the nail

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Biomechanics of Screw
Is simple machine that converts torque
into axial force.
Screws are the workhorses of internal
fixation
Parts of screw includes:
 Head
 Shaft
 Inner diameter
 Outer diameter
 Pitch
 Cont.
Stiffness Increase with increase in core diameter

Pullout
 Increase outer diameter
strength
 Decrease inner diameter
 Increase thread density
 Increase thickness of cortex

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 Biomechanics of Plate Fixation
Plates may result in absolute or relative
stability of a fracture site.
Absolute stability requires
circumferential contact of the fracture
site, which is obtained by anatomical
reduction.
Relative stability is based on an
indirect reduction of the fracture site
aiming to restore the overall length,
rotation, and alignment of the bone.
Factors increasing stiffness:
Bending stiffness proportional
to the thickness (h) of the plate
to the 3rd power
Distance b/n the screws closest
to fracture (working length)
 Inversely proportional to plate
stiffness

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Length of plate: the longer &
more spread the screws
Number of screws (cortices)
recommended on each side of
the fracture:
 Forearm 3
 Humerus 3-4
 Tibia 4
 Femur 4-5

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Modes of application:
Neutralization: neutralizes
force and protects lag screw
from failure
Compression: compresses
fracture fragments

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Buttress: prevents sliding
motion b/n fragments.
Tension Band: plating
tension side will convert
eccentric loading to
compression

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Bridging: hold fracture
fragments in place & minimize
soft tissue disruption & blood
supply

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 Non-Locking Vs Locking Screws

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Unstable constructs
 Severe comminution
 Bone loss
 Poor quality bone
 Poor screw technique
Fixation Plate Failure
Repeated loading and unloading of a material will cause it to fail, even
if the loads are less than the ultimate stress (Simon, 1994).
Each loading cycle produces a minute amount of microdamage that
accumulates with repetitive loads until the material fails.

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 Stress riser
 An important aspect of a fixation
construct is the effect of a stress riser.

 In completely uniform materials, the

stresses will be almost identical
throughout the material. But typical
fixation devices have holes, screw
threads, and other features in which the
shape changes and leads to a change of
the material properties.

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Biomechanics of External Fixation
An external fixator is a device used in bone and joint surgery and it
serves to stabilize bone fragments using pins that pass through the
parts of skeleton.
It can achieve neutralization, compression, dynamization, distraction,
angulation, rotation, osteotaxis, ligamentotaxis, elastic fixation, and
biocompression.
The primary goal of external fixation is to maintain the length,
alignment, and rotation of the fracture.

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 Factors increasing frame stability
Most significant factors in frame stability:
 Type of fracture
 Configuration, number, and thickness
of the pins.
 Contact between the bone and the pins
 Distance between the bone and the
frame
 Materials from which the pins are
made
 Method of grouping the pins and the
placement
Joint Biomechanics
Joint reaction force defined as force
generated within a joint in response to
forces acting on the joint
In the hip, it is the result of the need
to balance the moment arms of the
body weight and abductor tension
This maintains a level pelvis

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Cont.
Coupled forces
when two movements and associated forces are coupled
Joint congruence
relates to fit of two articular surfaces
high congruence increases joint contact area

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Cont.
Instant center of rotation
point about which a joint rotates
often changes during rotation due to joint
translation
center of gravity of human is just anterior to
S2
Friction and lubrication
not a function of contact area & it decreases
friction

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Factors decreasing hip joint reaction force
Increase in ratio of A/B (shift center of
rotation medially)
 moving acetabular component medial, inferior, and
anterior
 increasing offset of femoral component
 long stem prosthesis
 lateralization of greater trochanter
Varus neck-shaft angulation
shifting body weight over affected hip (Trendelenburg
gait)
Using cane in contralateral hand
Carrying load in ipsilateral hand
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Muscle:
Static work:
No mechanical work is performed and posture or joint position is
maintained through the muscle contraction
 Isometric contractions: no change in length in the muscle
Dynamic work:
Mechanical work is performed and joint motion is produced through
the following forms of muscle contraction:
 Concentric contraction: distance between the attachments decreases
 Eccentric contraction: the muscle increases in length
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Biomechanics of tendons & ligaments
Composition and Tendon Cells (Tenocytes)
Structure of Tendons Extracellular Matrix (ECM)
Collagen type- 1
Elastin
Ground Substance

Composition and Ligament cells (fibroblast)

Structure of Ligaments Extracellular matrix (ECM)
Collagen type 1
fibers are interlaced
Elastin
Ground substance

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Tendon possesses one of the
highest tensile strengths of any
soft tissue in the body
 The elastic modulus is 1,200 to
1,800 mpa,
The ultimate tensile strength of
tendon ranges from 50 to 105
mpa,and
Ultimate strain ranges from 9% to
35%

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Load-elongation curve of a tendon-ligament

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 Factors Affecting the Mechanical Properties of Tendons
and ligament
Maturation and Aging
Pregnancy and the Postpartum Period
Mobilization and Immobilization
Comorbidities
 Diabetes Mellitus
 Connective Tissue Disorders
 Renal Disease
Pharmacologic Agents
 Steroids
 Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
 Fluoroquinolones
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Viscoelasticity of tendon can be
characterized by
- creep,
- stress-relaxation, &
- hysteresis,

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Reference
Basic Biomechanics of musculoskeletal system 4th edition
Essential Biomechanics for orthopedics trauma, case based guide
Biomechanics & Biomaterials in orthopedics 2nd edition
Rockwood & Green’s fractures in Adult 9th edition
AO principles of fracture management 3rd edition
Orthobullet
The Mechanics of External Fixation Austin T. Fragomen, MD & S.
Robert Rozbruch, MD (https://doi.org/10.1007/s11420-006-9025-0)

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 THANK YOU!

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