Biomechanical investigation into the torsional failure of immature long bone |
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| Authors: | Peter S Theobald Assad Qureshi Michael D Jones |
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| Institution: | 1. Trauma Biomechanics Research Group, Institute of Medical Engineering and Medical Physics, Cardiff University, The Parade, Cardiff CF24 3AA, UK;2. Division of Orthopaedic and Accident Surgery, University of Nottingham, Queens Medical Centre, Nottingham NG7 2UH, UK;1. Professor and HOD, Orthopedics Department, P.D.U. Medical College and Hospital, Rajkot 360001, India;2. Assistant Professor, Orthopedics Department, P.D.U. Medical College and Hospital, Rajkot 360001, India;1. Assistant professor, Department of Orthopaedics, Era Medical College, Lucknow, India;2. Senior Medical Officer, Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India;3. Specialist and Assistant Professor, Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, Janakpuri, New Delhi 110001, India;4. Associate Professor, Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India;1. Professor of Orthopaedics, Lady Hardinge Medical College and Associated Hospitals, University of Delhi, Delhi, India;2. Senior Resident, Lady Hardinge Medical College and Associated Hospitals, University of Delhi, Delhi, India;3. Medical Officer, Central Health Services, C1/160-161, 2nd Floor, Sector 16, Rohini, Delhi 110089, India;4. Director, Professor of Orthopaedics, Lady Hardinge Medical College and Associated Hospitals, University of Delhi, Delhi, India;1. Department of Anesthesiology, Beaumont Health System, 3601 West 13-Mile Road, Royal Oak, MI 48073, USA;2. American Anesthesiology, Mednax National Medical Group, 1301 Concord Terrace, Sunrise, FL 33322, USA;1. Professor of Orthopaedics, Government Medical College Hospital, Chandigarh, India;2. Junior Resident Orthopaedics, Government Medical College Hospital, Chandigarh, India;3. Junior Research Fellow, Orthopaedics, Government Medical College Hospital, Chandigarh, India |
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| Abstract: | Approximately 50% of infant and toddler long bone fractures are attributed to non-accidental trauma; however, differentiating from benign mechanisms is subjective, due to an absence of evidence-based diagnostic tools. Previous studies investigated small ranges of rotational velocities in animal long bone models, although did not report the variation in the spiral fracture angle. This study considered the fracture angle as a potential clinical measure, correlating this data with a wider range of rotational velocities. The spiral fracture angle was measured relative to the long axis, whilst noting the narrowest diaphysial diameter, location of the fracture, and the extent of comminution and periosteal disruption. Twenty-six bones failed in spiral fracture, with the potting material failing in the remaining tests. All spiral fractures centred on the narrowest diaphysial diameter. Slower rotational velocities caused fracture angles approaching 45°, whereas fractures at greater velocities caused fracture angles nearer 30°. A relatively strong trend (R2 = 0.78) is reported when the normalised fracture angle (against the narrowest diaphysial dimension) was plotted against the rotational rate. A relationship has been identified between the angle of spiral fracture and the rotational velocity using the immature bovine metatarsal model. This trend forms a scientific foundation from which to explore developing a diagnostic, evidence-based tool that may ultimately serve to assist differentiating between accidental and non-accidental injury. |
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| Keywords: | Spiral fracture Immature bone Mechanical testing Torsion |
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