Microstructural contributions of different polyolefins to the deformation mechanisms of their binary blends

The mixing of polymers, even structurally similar polyolefins, inevitably leads to blend systems with a phase-separated morphology. Fundamentally understanding the changes in mechanical properties and occurring deformation mechanisms of these immiscible polymer blends, is important with respect to potential mechanical recycling. This work focuses on the behavior of binary blends of linear low-density polyethylene (LLDPE), low-density polyethylene (LDPE), high-density polyethylene (HDPE), and polypropylene (PP) under tensile deformation and their related changes in crystallinity and morphology. All of these polymers plastically deform by shear yielding. When unmixed, the high crystalline polyolefins HDPE and PP both exhibit a progressive necking phenomenon. LDPE initiates a local neck before material failure, while LLDPE is characterized by a uniform deformation as well as clear strain hardening. LLDPE/LDPE and LLDPE/PP combinations both exhibit a clear-cut matrix switchover. Polymer blends LLDPE/LDPE, LDPE/HDPE, and LDPE/PP show transition forms with features of composing materials. Combining PP in an HDPE matrix causes a radical switch to brittle behavior

Quantification of 3D microstructural parameters of trabecular bone is affected by the analysis software

Over the last decades, the use of high-resolution imaging systems to assess bone microstructural parameters has grown immensely. Yet, no standard defining the quantification of these parameters exists. It has been reported that different voxel size and/or segmentation techniques lead to different results. However, the effect of the evaluation software has not been investigated so far. Therefore, the aim of this study was to compare the bone microstructural parameters obtained with two commonly used commercial software packages, namely IPL (Scanco, Switzerland) and CTan (Bruker, Belgium). We hypothesized that even when starting from the same segmented scans, different software packages will report different results. Nineteen trapezia and nineteen distal radii were scanned at two resolutions (20 mu m voxel size with microCT and HR-pQCT 60 mu m). The scans were segmented using the scanners' default protocol. The segmented images were analyzed twice, once with IPL and once with CTan, to quantify bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N) and specific bone surface (BS/BV). Only small differences between IPL and CTan were found for BV/TV. For Tb.Th, Tb.Sp and BS/BV high correlations (R-2 >= 0.99) were observed between the two software packages, but important relative offsets were observed. For microCT scans, the offsets were relative constant, e.g., around 15% for Tb.Th. However, for the HR-pQCT scans the mean relative offsets ranged over the different bone samples (e.g., for Tb.Th from 14.5% to 19.8%). For Tb.N, poor correlations (0.43 We conclude that trabecular bone microstructural parameters obtained with IPL and CTan cannot be directly compared except for BV/TV. For Tb.Th, Tb.Sp and BS/BV, correction factors can be determined, but these depend on both the image voxel size and specific anatomic location. The two software packages did not produce consistent data on Tb.N. The development of a universal standard seems desirable

High-Resolution Cone-Beam Computed Tomography is a Fast and Promising Technique to Quantify Bone Microstructure and Mechanics of the Distal Radius

Obtaining high-resolution scans of bones and joints for clinical applications is challenging. HR-pQCT is considered the best technology to acquire high-resolution images of the peripheral skeleton in vivo, but a breakthrough for widespread clinical applications is still lacking. Recently, we showed on trapezia that CBCT is a promising alternative providing a larger FOV at a shorter scanning time. The goals of this study were to evaluate the accuracy of CBCT in quantifying trabecular bone microstructural and predicted mechanical parameters of the distal radius, the most often investigated skeletal site with HR-pQCT, and to compare it with HR-pQCT. Nineteen radii were scanned with four scanners: (1) HR-pQCT (XtremeCT, Scanco Medical AG, @ (voxel size) 82 mu m), (2) HR-pQCT (XtremeCT-II, Scanco, @60.7 mu m), (3) CBCT (NewTom 5G, Cefla, @75 mu m) reconstructed and segmented using in-house developed software and (4) microCT (VivaCT40, Scanco, @19 mu m-gold standard). The following parameters were evaluated: predicted stiffness, strength, bone volume fraction (BV/TV) and trabecular thickness (Tb.Th), separation (Tb.Sp) and number (Tb.N). The overall accuracy of CBCT with in-house optimized algorithms in quantifying bone microstructural parameters was comparable (R-2 = 0.79) to XtremeCT (R-2 = 0.76) and slightly worse than XtremeCT-II (R-2 = 0.86) which were both processed with the standard manufacturer's technique. CBCT had higher accuracy for BV/TV and Tb.Th but lower for Tb.Sp and Tb.N compared to XtremeCT. Regarding the mechanical parameters, all scanners had high accuracy (R-2 >= 0.96). While HR-pQCT is optimized for research, the fast scanning time and good accuracy renders CBCT a promising technique for high-resolution clinical scanning

Augmented screwdrivers can increase the performance of orthopaedic surgeons compared with use of normal screwdrivers

Orthopaedic screws insertion can be trivialised as a simple procedure, however it is frequently performed poorly. Limited work exists defining how well surgeons insert screws or whether augmented screwdrivers can aid surgeons to reduce stripping rates and optimise tightness. We aimed to establish the performance of surgeons inserting screws and whether this be improved with screwdriver augmentation. 302 orthopaedic surgeons tightened 10 non-locking screws to what they determined to be optimum tightness into artificial bone sheets. The confidence in the screw purchase was given (1–10). A further 10 screws were tightened, using an augmented screwdriver that indicated when a predetermined optimum tightness was reached. The tightness for unstripped insertions under normal conditions and with the augmented screwdriver were 81% (95% CI 79–82%)(n = 1275) and 70% (95% CI 69–72%)(n = 2577) (p < 0.001). The stripping rates were 58% (95% CI 54–61%) and 15% (95% CI 12–17%) respectively (p < 0.001). The confidences when using the normal and augmented screwdrivers respectively were 7.2 and 7.1 in unstripped insertions and 6.2 and 6.5 in stripped insertions. Performance improved with an augmented screwdriver, both in reduced stripping rates and greater accuracy in detecting stripping. Augmenting screwdrivers to indicate optimum tightness offer potentially enormous clinical benefits by improving screw fixation

Cone-beam Computed Tomography is a Fast and Promising Technique for Microstructural Imaging in Clinical Practice

Due to the rising life expectancy, bone and joint diseases (e.g., osteoporosis, osteoarthritis and rheumatoid arthritis) have become an important socioeconomic burden. For these diseases, the importance of assessing the bone's microarchitecture make-up in clinical practice has been emphasized in basic science. However, it remains challenging to assess it in clinical practice. High-resolution in vivo imaging became possible with the advent of a highresolution peripheral computed tomography (HR-pQCT) scanner. Two systems are currently on the market, XTremeCT-I and XTremeCT-II (Scanco Medical AG, Switzerland) which provide a voxel size of down to 82µm and down to 60.7µm, respectively. So far, a breakthrough of the scanner for widespread clinical applications is still lacking. The two main disadvantages of the scanner are the slow scanning time (2 à 3min. for a stack of 0.9 à 1cm), which makes scanning of a large volume of interest challenging in vivo, and the dedicated nature of the scanner which does not allow routine clinical use for standard musculoskeletal diagnostics. A promising alternative is high-resolution cone-beam computed tomography (CBCT), which is already the gold standard in many dental and maxillofacial applications. The top high-resolution CBCT scanners on the market, e.g. CBCT Newtom 5G (Cefla, Italy), feature a fast scanning time (18 à 31s.), a large field of view (12x12x8cm3) and a low radiation dosage, in addition to a high resolution (voxel size down to 75µm). Yet, CBCT is impaired by the presence of image artefacts that reduce image contrast, leading to it being currently used for qualitative evaluation only. The overarching aim of this PhD is to determine whether CBCT can be enhanced by means of artefact correction algorithms and advanced segmentation techniques in order to be used to visualize and quantify bone microstructure and to quantify bone mechanical parameters in clinical practice. To attain this main aim, four sub aims were formulated and worked out in this thesis. The first sub aim was to identify CBCT artefacts and to enhance CBCT images. In literature, scattering is addressed as the main detrimental factor in CBCT imaging and beam hardening is another often mentioned important artefact. To address these artefacts, a Monte Carlo simulation, as well as a C++ program was developed. In contrast to what is often assumed in literature, our simulations demonstrated that scattering is limited when scanning a wrist with a normal gantry and that the impact of beam hardening, rather than scattering, is more pronounced in CBCT images. The development of a beam hardening correction technique, which took into account the high bone content of extremities, was able to enhance the images significantly. Next to beam hardening correction, an in-house reconstruction and projection processing program was developed which enhanced the images already significantly, compared to the standard reconstruction of the scanner. The second sub aim of this thesis was to evaluate the accuracy of CBCT images in quantifying bone microstructural parameters. To enable quantification of the bone microstructural parameters, the images had to be segmented and a trabecular volume of interest had to be selected. For the segmentation, an adaptive segmentation technique was proposed in this thesis. This adaptive segmentation technique was a key element to enhance accuracy of the quantified bone microstructural parameters, because it enabled segmentation of not completely homogeneous images. To select the trabecular volume of interest automatically, the technique of Buie et al. was extended. Two ex vivo validations were performed in this thesis, one on 19 trapezia and another on 19 distal radii. Both validations demonstrated that our enhanced CBCT images were able to quantify bone microstructural parameters with high accuracy. The third sub aim was to evaluate the accuracy of CBCT images in quantifying bone mechanical parameters. Thus far, simple-flat surface boundary conditions have been mostly applied on sections of a bone, such as a section of the distal radius. To apply boundary conditions on entire bones or multiple bones, more advanced boundary conditions are needed. Therefore, a software technique was developed to apply more general loading conditions. Afterwards, the accuracy of CBCT to quantify bone mechanical parameters was tested on the previously mentioned 19 trapezia and 19 distal radii. Both validations demonstrated that the enhanced CBCT images had an adequate accuracy even when quantifying bone mechanical parameters. The last sub aim was to compare the accuracy of CBCT to HRpQCT, the current standard for in vivo high-resolution scanning of extremities. Although CBCT is visually less sharp, it provides a very similar, albeit slightly lower, accuracy in quantifying bone microstructural and mechanical parameters when compared with XTremeCT-II, the newest generation HR-pQCT scanner. In conclusion, it can be stated that our enhanced CBCT images are able to quantify bone microstructural and mechanical parameters with high accuracy. Hence, high-resolution CBCT, which features fast scanning of large FOV at high resolution and low radiation dosage, is a promising scanner for high-resolution imaging in clinical practice.status: publishe

Correlation Between Cone-Beam Computed Tomography and High-Resolution Peripheral Computed Tomography for Assessment of Wrist Bone Microstructure

High-resolution peripheral quantitative computed tomography (HR-pQCT) is considered as the best technique to measure bone microarchitecture in vivo. However, a breakthrough for medical applications is inhibited because of the restricted field of view (∼9 mm) and a relatively long acquisition time (∼3 minutes). The goal of this study was to compare the accuracy of cone-beam computed tomography (CBCT) and HR-pQCT and to determine the agreement between CBCT and HR-pQCT in quantifying bone structural parameters. Nineteen trapezia of arthritic patients were scanned four times ex vivo: 1) CBCT (NewTom 5G, Cefla, at 75 μm); 2) HR-pQCT (XTremeCT-I, Scanco, at 82 μm); 3) HR-pQCT (XTremeCT-II, Scanco, at 60.7 μm); and 4) microCT (SkyScan1172, Bruker, at 19.84 μm). XTremeCT-I and XtremeCT-II were reconstructed, segmented, and analyzed following the manufacturer's guidelines. CBCT was reconstructed with in-house developed software and analyzed twice: once with an adaptive segmentation technique combined with a direct analysis method (AT-DM) and once with a Laplace-Hamming filtering technique combined with an indirect analysis method (LH-IM). Parameters of interest included bone volume fraction (BV/TV) and trabecular thickness (Tb.Th), separation (Tb.Sp), and number (Tb.N). The analyses of the CBCT data showed that the AT-DM analysis correlated better with microCT for BV/TV, Tb.Sp, and Tb.N, whereas the LH-IM technique correlated better for Tb.Th. Evaluated over all parameters, the coefficient of determination for XtremeCT-I, XtremeCT-II, and CBCT were higher as R2  = 0.68, 0.72, and 0.67, respectively. For CBCT, the correlations improved when three samples with very thin trabeculae close to each other were excluded and became similar to those for XtremeCT-I and XtremeCT-II. Interesting for clinical practice is that those bones could be identified automatically with the CBCT scanner. We conclude that CBCT produced similar accuracy as HR-pQCT in bone morphometric analyses of trapezia. The broader range of application, larger field of view, and shorter acquisition time make CBCT a valuable alternative to HR-pQCT. © 2019 American Society for Bone and Mineral Research.status: publishe

Surgical Technique and Comparison of Autologous Cancellous Bone Grafts from Various Donor Sites in Rats.

Autologous cancellous bone graft is the gold standard in large bone defect repair. However, studies using autologous bone grafting in rats are rare. To determine the feasibility of autologous cancellous bone graft harvest from different anatomical donor sites (humerus, ilium, femur, tibia, tail vertebrae) in rats and compare their suitability as donor sites, a total of 13 freshly euthanized rats were used to describe the surgical technique, determine the cancellous bone volume and microstructure, and compare the cancellous bone collected quantitatively and qualitatively. It was feasible to harvest cancellous bone graft from all 5 anatomical sites with the humerus and tail being more surgically challenging. The microstructural analysis using µCT showed a significantly lower bone volume fraction, bone mineral density, and trabecular thickness of the humerus and iliac crest compared to the femur, tibia, and tail vertebrae. The harvested weight and volume did not differ between the donor sites. All donor sites apart from the femur yielded primary osteogenic cells confirmed by the presence of Alkaline phosphatase and Alizarin Red S stain. Bone samples from the iliac crest showed the most consistent outgrowth of osteoprogenitor cells. In conclusion, the tibia and iliac crest may be the most favourable donor sites considering the surgical approach. However, due to the differences in microstructure of the cancellous bone and the consistency of outgrowth of osteoprogenitor cells, the donor sites may have different healing properties, that need further investigation in an in vivo study. This article is protected by copyright. All rights reserved

The absence of immediate stimulation delays bone healing

Aim: Secondary bone healing requires an adequate level of mechanical stimulation expressed by the extent of interfragmentary motion in the fracture. However, there is no consensus about when the mechanical stimulation should be initiated to ensure a timely healing response. Therefore, this study aims to compare the effect of the immediate and delayed application of mechanical stimulation in a large animal model. Methods: Twelve Swiss White Alpine sheep underwent partial osteotomy of a tibia that was stabilised with an active fixator inducing well-controlled mechanical stimulation. Animals were randomly assigned into two groups with different stimulation protocols. The immediate group received daily stimulation (1000 cycles/day) from the first day post-operation, while in the delayed group, stimulation began only on the 22nd day post-operation. Healing progression was evaluated daily by measuring the in vivo stiffness of the repair tissue and by quantifying callus area on weekly radiographs. All animals were euthanised five weeks post-op. Post-mortem callus volume was determined from high-resolution computer tomography (HRCT). Results: Fracture stiffness (p < 0.05) and callus area (p < 0.01) were significantly larger for the immediate group compared to the delayed stimulation group. In addition, the callus volume measured on the post-mortem HRCT showed 319 % greater callus volume for the immediate stimulation group (p < 0.01). Conclusions: This study demonstrates that a delay in the onset of mechanical stimulation retards fracture callus development and that mechanical stimulation already applied in the early post-op phase promotes bone healing.</p

Advanced CT visualization improves the accuracy of orthopaedic trauma surgeons and residents in classifying proximal humeral fractures: a feasibility study

PURPOSE: Osteosynthesis of proximal humeral fractures remains challenging with high reported failure rates. Understanding the fracture type is mandatory in surgical treatment to achieve an optimal anatomical reduction. Therefore, a better classification ability resulting in improved understanding of the fracture pattern is important for preoperative planning. The purpose was to investigate the feasibility and added value of advanced visualization of segmented 3D computed tomography (CT) images in fracture classification. METHODS: Seventeen patients treated with either plate-screw-osteosynthesis or shoulder hemi-prosthesis between 2015 and 2019 were included. All preoperative CT scans were segmented to indicate every fracture fragment in a different color. Classification ability was tested in 21 orthopaedic residents and 12 shoulder surgeons. Both groups were asked to classify fractures using three different modalities (standard CT scan, 3D reconstruction model, and 3D segmented model) into three different classification systems (Neer, AO/OTA and LEGO). RESULTS: All participants were able to classify the fractures more accurately into all three classification systems after evaluating the segmented three-dimensional (3D) models compared to both 2D slice-wise evaluation and 3D reconstruction model. This finding was significant (p < 0.005) with an average success rate of 94%. The participants experienced significantly more difficulties classifying fractures according to the LEGO system than the other two classifications. CONCLUSION: Segmentation of CT scans added value to the proximal humeral fracture classification, since orthopaedic surgeons were able to classify fractures significantly better into the AO/OTA, Neer, and LEGO classification systems compared to both standard 2D slice-wise evaluation and 3D reconstruction model.status: publishe