Effects of Loading Orientation on the Morphology of the Predicted Yielded Regions in Trabecular Bone

While the effects of bone mineral density and architecture in osteoporotic bone have been studied extensively, the micromechanics of yielding and failure have received less attention. However, understanding architectural features associated with failure should provide insight into assessing bone quality. In this study, microstructural finite element models were used to compute regions of tissue level yielding in ten bovine tibial trabecular bone samples. The morphology, number, and mean volume of the yielded regions were quantified for four apparent strains under two loading conditions. For on-axis loading, the mean aspect ratio of the tissue that yielded due to compressive strain increased with increasing apparent strain, expanding along the principal trabecular orientation. This suggests that tissue level yielding progresses along vertical trabeculae when a specimen is loaded on-axis. The number, but not the volume, of the regions yielded due to tensile strain increased with increasing applied load, consistent with relaxation and redistribution of stresses around the yielded regions. When the specimens were compressed perpendicular to the principal axis, the aspect ratio of the yielded regions was close to one, while the number, mean volume, and mean thickness of the yielded regions increased. This indicates that localized high strains consistent with bending rather than axial deformation of struts occur at the tissue level. Overall, the results provide new insight into trabecular bone failure, which is relevant to assessing diagnostic tests for fracture risk or evaluating osteoporosis treatments.     

Improved prediction of proximal femoral fracture load using nonlinear finite element models.

Hip fracture, which is often due to osteoporosis or other conditions affecting bone strength, can lead to permanent disability, pneumonia, pulmonary embolism, and/or death. Great effort has been directed toward developing noninvasive methods for evaluating proximal femoral strength (fracture load), with the goal of assessing fracture risk. Previously, computed tomographic scan-based, linear finite element (FE) models were used to estimate proximal femoral fracture loads ex vivo in two load configurations, one approximating joint loading during single-limb stance and the other simulating impact from a fall. Measured and computed fracture loads were correlated (stance, r=0.867; fall, r=0.949). However, precision for the stance configuration was insufficient to identify subjects with below average fracture loads reliably. The present study examined whether, for this configuration, nonlinear FE models could be used to identify these subjects. These models were found to predict fracture load within +/-2.0 kN (r=0.962). This level of precision is sufficient to identify 97.5% of femora with fracture loads 1.3 standard deviations below the mean as having below average fracture loads. Accordingly, 20% of subjects with below average fracture loads, i.e. those with the lowest fracture loads and likely to be at greatest risk of fracture, would be correctly identified with at least 97.5% reliability. This FE modeling method will be a powerful tool for studies of hip fracture.     

Load/strain distribution between ulna and radius in the mouse forearm compression loading model

Finite element analysis (FEA) of the mouse forearm compression loading model is used to relate strain distributions with downstream changes in bone formation and responses of bone cells. The objective of this study was to develop two FEA models - the first one with the traditional ulna only and the second one in which both the ulna and radius are included, in order to examine the effect of the inclusion of the radius on the strain distributions in the ulna. The entire mouse forearm was scanned using microCT and images were converted into FEA tetrahedral meshes using a suite of software programs. The performance of both linear and quadratic tetrahedral elements and coarse and fine meshes were studied. A load of 2N was applied to the ulna/radius model and a 1.3N load (based on previous investigations of load sharing between the ulna and radius in rats) was applied to the ulna only model for subsequent simulations. The results showed differences in the cross sectional strain distributions and magnitude within the ulna for the combined ulna/radius model versus the ulna only model. The maximal strain in the combined model occurred about 4mm toward the distal end from the ulna mid-shaft in both models. Results from the FEA model simulations were also compared to experimentally determined strain values. We conclude that inclusion of the radius in FE models to predict strains during in vivo forearm loading increases the magnitude of the estimated ulna strains compared to those predicted from a model of the ulna alone but the distribution was similar. This has important ramifications for future studies to understand strain thresholds needed to activate bone cell responses to mechanical loading.     

Buttressing angle of the double-plating fixation of a distal radius fracture: a finite element study

Treatment of a distal radius fracture should consider principles including stable fixation and early motion. The aim of this study was to investigate the biomechanical interactions of plate-fixation angles in the internal double-plating method coupled with various load conditions using non-linear finite element analysis (FEA). A 3D finite element distal radius fracture model with three separation angles (50, 70, and 90°) between the buttressed L- and straight plates was generated based on computed tomography data. After model verification and validation, frictional (contact) elements were used to simulate the interface condition between the fixation plates and the bony surface. The stress/strain distributions and displacements at the radius end were observed under axial, bending, and torsion load conditions. The simulated results indicated that the bending and torsion increased the stress values more than the axial load. The radius and straight plate stress values decreased significantly with increasing fixation angles for all load conditions. However, the L-plate stress values increased slightly under the bending buckling effect. The displacements at the radius end and strains at the fracture healing interface decreased with increasing fixation angles for axial and torsion conditions but displayed a slight difference for the bending condition. The findings using FEA provide quantitative evidence to identify that much larger plate fixation angles could provide better mechanical strength to establish favorable stress-transmission and prevent distal fragment dislocation.     

Cement mantle stress under retroversion torque at heel-strike

The paper presents a theory of fixation failure and loosening in cemented total hip prostheses and proceeds to investigate this using an experimentally validated finite element model and two prosthesis types, namely the Charnley and the C-Stem. The study investigates the effects of retroversion torque occurring at heel-strike in combination with a loss of proximal cement/bone support and distal implant/cement support with a good distal cement/bone interface. A 3D finite element model was validated by comparison of femoral surface strains with those measured in an in vitro experimental simulation using an implanted Sawbone femur loaded in the heel-strike position and including a simplified representation of muscle forces. Results showed that the heel-strike position applies a high retroversion torque to the femoral stem that when combined with proximal debonding of the cement/bone interface and distal debonding of the implant/cement interface increases the strain transfer to the cement that may ultimately lead to the breakdown of the cement mantle leading on to osteolysis and loosening of the prostheses. Experimental fatigue testing of the implanted Charnely stem in a Sawbone femur produced cracks within the cement mantle that were located in positions of maximum stress supporting the finite element analysis results and theory of failure.     

基于不同应变判定准则模拟皮质骨断裂的准确性

文题释义：基于等效应变断裂模拟：即在大鼠股骨皮质骨断裂模拟过程中，应用皮质骨有限元模型在外部载荷作用下所产生的等效应变数值，与皮质骨组织的失效应变进行对比，当等效应变数值大于皮质骨组织失效应变时，有限元模型内的单元便发生失效，直至失效单元达到一定数量，模型便发生整体失效，此过程为基于等效应变的断裂模拟。 基于主应变断裂模拟：即在大鼠股骨皮质骨断裂模拟过程中，应用皮质骨有限元模型在外部载荷作用下所产生的主应变数值，与皮质骨组织的失效应变进行对比，当主应变数值大于皮质骨组织失效应变时，有限元模型内的单元便发生失效，直至失效单元达到一定数量，模型便发生整体失效，此过程为基于主应变的断裂模拟。 背景：由于意外碰撞等外力因素所产生的皮质骨裂纹是引起骨折的重要原因之一，要防止此类骨折发生，首先需弄清不同载荷作用下皮质骨裂纹的产生与扩展机制。由于实验分析对样本具有破坏性，难以同时了解骨结构在断裂前后的内部力学状态，找到一种能够准确模拟皮质骨从裂纹产生、扩展，直至断裂过程的有限元方法就显得尤为重要。当前模拟方法主要应用主应变或等效应变判定模型单元力学状态，继而进行断裂模拟，却鲜有关于这2种应变进行模拟准确性的探究。 目的：验证应用主应变与等效应变进行皮质骨断裂模拟的准确程度。 方法：结合实验与仿真分析，应用主应变与等效应变进行皮质骨断裂模拟，将仿真与实验结果进行对比，确定应用哪种应变进行模拟更加准确。 结果与结论：①应用主应变模拟的皮质骨断裂时间要明显晚于应用等效应变；②通过与实验对比发现，相比主应变，应用等效应变进行仿真所得结果与实验值更为接近；③因此，应用等效应变进行皮质骨断裂模拟相对更加准确。 ORCID: 0000-0003-0313-1359(王伟军) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程     

腰椎疲劳骨折的有限元分析

目的：了解腰椎疲劳骨折后各结构力学变化。方法：建立腰椎三维有限元模型模拟腰椎疲劳骨折的载荷状态。结果：骨折后各结构位移增加,椎间盘膨出半径增大,皮质骨,松质骨,裂纹两端应力增加。结论：腰椎疲劳骨折后各结构应力增加,小梁裂纹表现出明显的裂纹扩展趋势,增大的椎间盘膨出半径是引起下腰痛的主要原因。     

压缩载荷下不同应变判定皮质骨断裂准确性分析

目的 寻找适合压缩断裂工况下的应变判据。方法 基于连续损伤力学理论进行皮质骨在压缩载荷下的断裂模拟。分别将等效应变与主应变设置为有限元模型单元损伤与失效判据进行断裂模拟,通过对比两种预测结果与动物实验数据,探究应用两种应变判据进行断裂模拟的准确性。结果 应用等效应变判据模拟的断裂时间晚于应用主应变模拟;相比等效应变,应用主应变进行仿真所得结果与动物实验结果更为接近。结论 压缩载荷下,应用主应变判定皮质骨单元力学状态进行断裂模拟较为准确。通过对比分析找到准确模拟皮质骨在压缩载荷下断裂的数值方法,能够为临床中提高骨折预测精度提供理论基础。     

The effect of strain rate on fracture toughness of human cortical bone: a finite element study

Evaluating the mechanical response of bone under high loading rates is crucial to understanding fractures in traumatic accidents or falls. In the current study, a computational approach based on cohesive finite element modeling was employed to evaluate the effect of strain rate on fracture toughness of human cortical bone. Two-dimensional compact tension specimen models were simulated to evaluate the change in initiation and propagation fracture toughness with increasing strain rate (range: 0.08–18 s⁻¹). In addition, the effect of porosity in combination with strain rate was assessed using three-dimensional models of micro-computed tomography-based compact tension specimens. The simulation results showed that bone’s resistance against the propagation of a crack decreased sharply with increase in strain rates up to 1 s⁻¹ and attained an almost constant value for strain rates larger than 1 s⁻¹. On the other hand, initiation fracture toughness exhibited a more gradual decrease throughout the strain rates. There was a significant positive correlation between the experimentally measured number of microcracks and the fracture toughness found in the simulations. Furthermore, the simulation results showed that the amount of porosity did not affect the way initiation fracture toughness decreased with increasing strain rates, whereas it exacerbated the same strain rate effect when propagation fracture toughness was considered. These results suggest that strain rates associated with falls lead to a dramatic reduction in bone’s resistance against crack propagation. The compromised fracture resistance of bone at loads exceeding normal activities indicates a sharp reduction and/or absence of toughening mechanisms in bone during high strain conditions associated with traumatic fracture.     

腕保护器抗冲击载荷的有限元分析

背景：人体防滑倒腕部保护支具对手腕部有明显的保护作用。 目的：采用有限元分析验证腕保护器防护腕部骨折的有效性。 方法：以中国力学可视人原始资料为依据,应用Abaqus 6.51软件构建带软组织的正常手腕和佩带腕保护器手腕的三维有限元模型,对整个手腕模型加载2 m/s的速度载荷,经程序运算后对比手腕部三维有限元模型佩带腕保护器前后的应力应变分布云图及腕部尺骨远端掌面最大应力值随时间变化规律图。 结果与结论：与未佩带腕保护器比较,佩带腕保护器后在跌倒过程中小鱼际和腕关节背面的软组织等效应力、腕部桡尺骨下段的等效应力均明显变小,力学结构最薄弱的桡尺骨远端应力变小尤为最明显,而第2~4掌骨、食指近节、钩骨等力学结构相对坚强的短管状骨和不规则骨所受应力明显增大,提示腕保护器可分散、吸收一部分桡尺骨远端应力,转移至腕、掌、指骨上一部分,对保护腕关节尤其是防止桡尺骨远端骨折有积极的作用。     

Assessing mechanical function of the zygomatic region in macaques: validation and sensitivity testing of finite element models

Crucial to the interpretation of the results of any finite element analysis of a skeletal system is a test of the validity of the results and an assessment of the sensitivity of the model parameters. We have therefore developed finite element models of two crania of Macaca fascicularis and investigated their sensitivity to variations in bone material properties, the zygomatico-temporal suture and the loading regimen applied to the zygomatic arch. Maximum principal strains were validated against data derived from ex vivo strain gauge experiments using non-physiological loads applied to the macaque zygomatic arch. Elastic properties of the zygomatic arch bone and the zygomatico-temporal suture obtained by nanoindentation resulted in a high degree of congruence between experimental and simulated strains. The findings also indicated that the presence of a zygomatico-temporal suture in the model produced strains more similar to experimental values than a completely separated or fused arch. Strains were distinctly higher when the load was applied through the modelled superficial masseter compared with loading an array of nodes on the arch. This study demonstrates the importance of the accurate selection of the material properties involved in predicting strains in a finite element model. Furthermore, our findings strongly highlight the influence of the presence of craniofacial sutures on strains experienced in the face. This has implications when investigating craniofacial growth and masticatory function but should generally be taken into account in functional analyses of the craniofacial system of both extant and extinct species.     

Local strain and damage mapping in single trabeculae during three-point bending tests

The use of bone mineral density as a surrogate to diagnose bone fracture risk in individuals is of limited value. However, there is growing evidence that information on trabecular microarchitecture can improve the assessment of fracture risk. One current strategy is to exploit finite element analysis (FEA) applied to 3D image data of several mm-sized trabecular bone structures obtained from non-invasive imaging modalities for the prediction of apparent mechanical properties. However, there is a lack of FE damage models, based on solid experimental facts, which are needed to validate such approaches and to provide criteria marking elastic-plastic deformation transitions as well as microdamage initiation and accumulation. In this communication, we present a strategy that could elegantly lead to future damage models for FEA: direct measurements of local strains involved in microdamage initiation and plastic deformation in single trabeculae. We use digital image correlation to link stress whitening in bone, reported to be correlated to microdamage, to quantitative local strain values. Our results show that the whitening zones, i.e. damage formation, in the presented loading case of a three-point bending test correlate best with areas of elevated tensile strains oriented parallel to the long axis of the samples. The average local strains along this axis were determined to be (1.6±0.9)% at whitening onset and (12±4)% just prior to failure. Overall, our data suggest that damage initiation in trabecular bone is asymmetric in tension and compression, with failure originating and propagating over a large range of tensile strains.     

Robust QCT/FEA Models of Proximal Femur Stiffness and Fracture Load During a Sideways Fall on the Hip

Clinical implementation of quantitative computed tomography-based finite element analysis (QCT/FEA) of proximal femur stiffness and strength to assess the likelihood of proximal femur (hip) fractures requires a unified modeling procedure, consistency in predicting bone mechanical properties, and validation with realistic test data that represent typical hip fractures, specifically, a sideways fall on the hip. We, therefore, used two sets (n = 9, each) of cadaveric femora with bone densities varying from normal to osteoporotic to build, refine, and validate a new class of QCT/FEA models for hip fracture under loading conditions that simulate a sideways fall on the hip. Convergence requirements of finite element models of the first set of femora led to the creation of a new meshing strategy and a robust process to model proximal femur geometry and material properties from QCT images. We used a second set of femora to cross-validate the model parameters derived from the first set. Refined models were validated experimentally by fracturing femora using specially designed fixtures, load cells, and high speed video capture. CT image reconstructions of fractured femora were created to classify the fractures. The predicted stiffness (cross-validation R ² = 0.87), fracture load (cross-validation R ² = 0.85), and fracture patterns (83% agreement) correlated well with experimental data.     

Strength Prediction of the Distal Radius by Bone Densitometry—Evaluation Using Biomechanical Tests

Osteoporotic fractures represent an important medical problem as they are often early predictors of future fractures at other skeletal sites. The distal radius is one such fracture site. To determine the individual's risk of fracture, different measurement techniques have been developed. These methods differ in physical background, measurement site, output parameters, and cost. If correctly applied, biomechanical testing can be an efficient tool for the preclinical evaluation of these techniques. With biomechanical testing it is possible to determine the structural strength of bone which can then be correlated with various densitometric parameters. Here we will review experimental work performed in this context. Biomechanical testing conditions vary considerably from study to study with 3-point bending (shaft), axial compression (metaphysis), and fall simulations being some of the techniques used. Experimental evidence suggests that site-specific osteodensitometric measurements can predict the mechanical strength of the distal radius with moderate to high accuracy, but that measurements at remote sites display considerably lower predictive value. Geometry-based parameters of cortical bone are also good predictors, but have not been shown to offer significant advantage over measurement of bone mass. Some (but not all) studies have found that quantitative ultrasound and microstructural parameters contribute significant additional information to bone mass measurement. The most accurate prediction of distal radius fractures, however, appears to be (patient-specific) microstructural finite element modeling.     

不同载荷作用下头部生物力学响应仿真分析

目的建立符合解剖结构的人颅骨三维有限元模型,研究多种载荷作用下头部生物力学响应。方法通过建立具有解剖结构的高精度头部有限元模型,颅骨采用能模拟骨折的弹塑性材料本构模型,结合已发表的正面冲击颅内压实验、动态颅骨骨折实验、头部跌落实验结果,仿真再现实验过程中头部受冲击载荷作用下的生物力学响应、颅骨骨折及头部不同速度下的跌落响应。结果前碰撞表现出冲击与对冲侧正-负颅内压分布,相近载荷下枕骨变形比前额、顶骨严重,跌落中速度越快损伤越大。结论建立精确解剖结构的头部有限元模型可以较好模拟头部在冲击、跌落等载荷下的生物力学响应。通过量化接触力、颅内压力等参数来评价头部损伤风险,为防护系统的设计提供科学依据。     

The material mapping strategy influences the accuracy of CT-based finite element models of bones: an evaluation against experimental measurements

Aim of the present study was to evaluate the influence on the global model's accuracy of the strategy adopted to define the average element Young's modulus in subject-specific finite element models of bones from computed tomography data. The classic strategy of calculating the Young's modulus from an average element density and the one that averages the Young's moduli directly derived from each voxel Hounsfield Unit were considered. These strategies were applied to the finite element model of a real human femur. The accuracy of the superficial stress and strain predictions was evaluated against experimentally measured values in 13 strain-gauge locations for five different loading conditions. The results obtained for the two material distributions were statistically different. Both models predicted very accurately the superficial stresses, with regression coefficients higher than 0.9 and slopes not significantly different from unity. The second strategy definitely improved the strains prediction accuracy: the regression coefficient raised from 0.69 to 0.79; the average and peak errors decreased from 45.1% to 31.3% and from 228% to 134% of the maximum measured strain, respectively. The stress fields predicted inside the bone were also significantly different. A new software implementing the second strategy was made available in the public domain.     

Prophylactic vertebroplasty can decrease the fracture risk of adjacent vertebrae: An in vitro cadaveric study

Adjacent level vertebral fractures are common in patients with osteoporotic wedge fractures, but can theoretically be prevented with prophylactic vertebroplasty. Previous tests on prophylactic vertebroplasties have been performed under axial loading, while in vivo changes in spinal alignment likely cause off-axis loads. In this study we determined whether prophylactic vertebroplasty can also reduce the fracture risk under off-axis loads.In a previous study, we tested vertebral bodies that were loaded axially or 20° off-axis representing vertebrae in an unfractured spine or vertebrae adjacent to a wedge fracture, respectively. In the current study, vertebral failure load and stiffness of our previously tested vertebral bodies were compared to those of a new group of vertebral bodies that were filled with bone cement and then loaded 20° off-axis. These vertebral bodies represented adjacent-level vertebrae with prophylactic bone cement filling.Prophylactic augmentation resulted in failure loads that were comparable to those of the 0° group, and 32% greater than the failure loads of the 20° group. The stiffness of the prophylacticly augmented vertebrae was 21% lower than that of the 0° group, but 27% higher than that of the 20° group. We conclude that prophylactic augmentation can decrease the fracture risk in a malaligned, osteoporotic vertebra. Whether this is enough to actually prevent additional vertebral fractures in vivo remains subject of further study.     

Influence of occlusal geometry on ceramic crown fracture; role of cusp angle and fissure radius

ObjectivesTo develop an approximate analytical model that identifies the influence of both cusp angle and notch radius on the failure load of all-ceramic premolar crowns.MethodsThe scatter of failure loads in a crown fracture resistance test was analyzed based on the stress intensity and stress concentration factors from mechanics models developed for simple compact tension to more sophisticated blunt V-notch specimens. Based on the same loading conditions and dimensions, the predicted loads were systematically compared with fracture loads of laboratory-tested crowns to identify the most relevant model. Finally, based upon these models a safe range of cusp angles and notch radii were identified for posterior all-ceramic crowns with various veneering materials’ fracture toughness values as the selection criteria.ResultsThe failure loads of the crowns were distributed in the range between the classical compact tension (lower bound) and blunt V-notch model (upper bound). Additionally, when considering the effect of different materials, the predicted trend of failure loads moves to higher loads well above typical occlusal forces when the fracture toughness of veneering porcelain is increased. The effects of notch radius on the failure load are still inconclusive due to the relatively complex shape of occlusal surfaces. Further studies on crowns with a range of material properties are required to substantiate the model.SignificanceCusp angle is a key factor that controls the stress generated at the crown fissure. This study provides the rationale for evaluating such effects and clinical guidelines for occlusal design are proposed.     

Advancing the deer calcaneus model for bone adaptation studies: ex vivo strains obtained after transecting the tension members suggest an unrecognized important role for shear strains

Sheep and deer calcanei are finding increased use as models for studies of bone adaptation, including advancing understanding of how the strain (deformation) environment influences the ontogenetic emergence of biomechanically relevant structural and material variations in cortical and trabecular bone. These artiodactyl calcanei seem ideal for these analyses because they function like simply loaded short‐cantilevered beams with net compression and tension strains on the dorsal and plantar cortices, respectively. However, this habitual strain distribution requires more rigorous validation because it has been shown by limited in vivo and ex vivo strain measurements obtained during controlled ambulation (typically walking and trotting). The conception that these calcanei are relatively simply and habitually loaded ‘tension/compression bones’ could be invalid if infrequent, though biologically relevant, loads substantially change the location of the neutral axis (NA) that separates ‘compression’ and ‘tension’ regions. The effect on calcaneus strains of the tension members (plantar ligament and flexor tendon) is also not well understood and measuring strains after transecting them could reveal that they significantly modulate the strain distribution. We tested the hypothesis that the NA location previously described during simulated on‐axis loads of deer calcanei would exhibit limited variations even when load perturbations are unusual (e.g. off‐axis loads) or extreme (e.g. after transection of the tension members). We also examined regional differences in the predominance of the three strain modes (tension, compression, and shear) in these various load conditions in dorsal, plantar, medial, and lateral cortices. In addition to considering principal strains (tension and compression) and maximum shear strains, we also considered material‐axis (M‐A) shear strains. M‐A shear strains are those that are aligned along the long axis of the bone and are considered to have greater biomechanical relevance than maximum shear strains because failure theories of composite materials and bone are often based on stresses or strains in the principal material directions. We used the same load apparatus from our prior study of mule deer calcanei. Results showed that although the NA rotated up to 8° medially and 15° laterally during these off‐axis loads, it did not shift dramatically until after transection of all tension members. When comparing results based on maximum shear strain data vs. M‐A shear strain data, the dominant strain mode changed only in the plantar cortex – as expected (in accordance with our a priori view) it was tension when M‐A shear strains were considered (shear : tension = 0.2) but changed to dominant shear when maximum shear strain data were considered (shear : tension = 1.3). This difference leads to different conclusions and speculations regarding which specific strain modes and magnitudes most strongly influence the emergence of the marked mineralization and histomorphological differences in the dorsal vs. plantar cortices. Consequently, our prior simplification of the deer calcaneus model as a simply loaded ‘tension/compression bone’ (i.e. plantar/dorsal) might be incorrect. In vivo and in finite element analyses are needed to determine whether describing it as a ‘shear‐tension/compression’ bone is more accurate. Addressing this question will help to advance the artiodactyl calcaneus as an experimental model for bone adaptation studies.     

Composite time-lapse computed tomography and micro finite element simulations: A new imaging approach for characterizing cement flows and mechanical benefits of vertebroplasty

Vertebroplasty has been shown to reinforce weak vertebral bodies and reduce fracture risks, yet cement leakage is a major problem that can cause severe complications. Since cement flow is nearly impossible to control during surgery, small volumes of cement are injected, but then mechanical benefits might be limited. A better understanding of cement flows within bone structure is required to further optimize vertebroplasty and bone augmentation in general. We developed a novel imaging method, composite time-lapse CT, to characterize cement flow during injection.In brief, composite-resolution time-lapse CT exploits the qualities of microCT and clinical CT. The method consists in overlaying low-resolution time-lapse CT scans acquired during injection onto pre-operative high-resolution microCT scans, generating composite-resolution time-lapse CT series of cement flow within bone.In this in vitro study, composite-resolution time-lapse CT was applied to eight intact and five artificially fractured cadaveric vertebrae during vertebroplasty. The time-lapse scans were acquired at one-milliliter cement injection steps until a total of 10 ml cement was injected. The composite-resolution series were then converted into micro finite element models to compute strains distribution under virtual axial loading. Relocation of strain energy density within bone structure was observed throughout the progression of the procedure. Interestingly, the normalized effect of cement injection on the overall stiffness of the vertebrae was similar between intact and fractured specimens, although at different orders of magnitude.In conclusion, composite time-lapse CT can picture cement flows during bone augmentation. The composite images can also be easily converted into finite element models to compute virtual strain distributions under loading at every step of an injection, providing deeper understanding on the biomechanics of vertebroplasty.