Bone drilling is a major part of orthopaedic surgery performed during the internal fixation of fractured bones. At present, information related to drilling force, drilling torque, rate of drill bit penetration and drill bit rotational speed is not available to orthopaedic surgeons, clinicians and researchers as bone drilling is performed manually. This research demonstrates that bone drilling force data if recorded in-vivo, during the repair of bone fractures, can provide information about the strength/quality of the bone. Drilling force does not give a direct measure of bone strength; therefore it has been correlated with the shear strength and screw pullout strength to determine the efficacy in estimating the bone strength. Various synthetic bone material densities and animal bones have been tested to demonstrate the use of drilling force data. A novel automated experimental test rig, which enables drilling tests, screw insertion and screw pullout tests to be carried out in a controlled environment, has been developed. Both drilling and screw pullout tests have been carried out in a single setting of the specimen to reduce the experimental errors and increase repeatability of the results. A significantly high value of correlation (r² > 0.99) between drilling force & shear strength and also between drilling force & normalised screw pullout strength in synthetic bone material was found. Furthermore, a high value of correlation (r² = 0.958 for pig bones and r² = 0.901 for lamb bones) between maximum drilling force & normalised screw pullout strength was also found. The result shows that drilling data can be used to predict material strength. Bone screws are extensively used during the internal fixation of fractured bones. The amount of screw been tightened is one of the main factor which affects the bone-screw fixation quality. Over tightening of screw can result into the loss of bone-screw fixation strength, whereas under tightening can result in the screw loosening. Therefore, optimum tightening of the screw is important to achieve the maximum bone-screw fixation strength. At present, optimum tightening of the screw is entirely dependent upon the skill and judgment of the surgeon, which is predominantly based on the feel of the screw tightening torque. Various studies have been reported in the literature to develop an algorithm to set an optimum tightening torque value to be used in surgery. A method which is based on the use of rotation angle of the screw while tightening, rather than using screw insertion/tightening torque, to optimise the bone-screw fixation strength is proposed in this research. The effectiveness of the proposed method has been successfully demonstrated on the synthetic bone material using the designed test rig. The optimum angle for the tested screw was found to be 120° which is equivalent to 33% of the screw pitch.

A qualidade óssea em grandes animais é avaliada pela densidade mineral óssea (DMO) utilizando a técnica de densitometria óptica em imagens radiográficas; o objetivo desse trabalho foi avaliar e comparar a qualidade óssea baseada na microarquitetura de uma forma inédita. Foram selecionados 20 bovinos, 10 da raça Canchim e 10 da raça Nelore, com controle dos processos biológicos e bioquímicos do nascimento até o abate aos 24 meses de idade, antes de entrarem na fase adulta. O osso metatarsal foi escolhido por suportar maior carga e amostras da diáfise do osso cortical seco foram obtidas. A avaliação da estrutura cristalina de ossos metatarsais secos foi realizada utilizando difração de raios X com a aplicação do método de refinamento de Rietveld, avaliando parâmetros de rede, tamanho de cristalito e microdeformação. A técnica de nanoindentação permitiu avaliar os módulos de elasticidade e valores de nanoindentação. A composição química razão cálcio e fósforo do material, resistência à deformação plástica, valores de microdureza, e imagens de microscopia eletrônica de varredura e microscopia óptica foram realizadas. A comparação entre os resultados das duas raças, Canchim e Nelore, dos valores de parâmetros de rede da estrutura cristalina da hidroxiapatita, tamanho de cristalito, microdeformações, relação cálcio e fósforo, microdurezas Vickers/Knoop, nanodureza Vickers e módulo de elasticidade indicaram que a qualidade óssea das raças Canchim e Nelore é estatisticamente semelhante para 30% dos parâmetros estudados e que para os demais 70% dos parâmetros estudados não há semelhança. / The bone quality in large animals is evaluated by bone mineral density (BMD) using the optical densitometry technique in radiographic images; The objective of this study was to evaluate and compare bone quality based on microarchitecture unpublished. Twenty bovines were selected, 10 from the Canchim breed and 10 from the Nelore breed, with control of the biological and biochemical processes from birth to slaughter at 24 months of age, before entering adulthood. The metatarsal bone was chosen because it supported higher load and samples of the diaphysis of the dry cortical bone were obtained. The evaluation of the crystalline structure of dry metatarsal bones was performed using X - ray diffraction with the application of the Rietveld refinement method, evaluating network parameters, crystallite size and microdeformation. The nanoindentation technique allowed to evaluate the modulus of elasticity and nanoindentation values. The chemical composition calcium and phosphorus ratio of the material, resistance to plastic deformation, values of microhardness, and scanning electron microscopy images and optical microscopy were performed. The comparison between the results of the two races, Canchim and Nelore, of the network parameter values of the hydroxyapatite crystal structure, crystallite size, microdeformations, calcium and phosphorus ratio, Vickers/Knoop microhardness, Vickers nanodness and modulus of elasticity indicated that Quality of the Canchim and Nelore races is statistically similar for 30% of the studied parameters and that for the ofter 70% of the studied parameters there is no similarity.

A qualidade óssea em grandes animais é avaliada pela densidade mineral óssea (DMO) utilizando a técnica de densitometria óptica em imagens radiográficas; o objetivo desse trabalho foi avaliar e comparar a qualidade óssea baseada na microarquitetura de uma forma inédita. Foram selecionados 20 bovinos, 10 da raça Canchim e 10 da raça Nelore, com controle dos processos biológicos e bioquímicos do nascimento até o abate aos 24 meses de idade, antes de entrarem na fase adulta. O osso metatarsal foi escolhido por suportar maior carga e amostras da diáfise do osso cortical seco foram obtidas. A avaliação da estrutura cristalina de ossos metatarsais secos foi realizada utilizando difração de raios X com a aplicação do método de refinamento de Rietveld, avaliando parâmetros de rede, tamanho de cristalito e microdeformação. A técnica de nanoindentação permitiu avaliar os módulos de elasticidade e valores de nanoindentação. A composição química razão cálcio e fósforo do material, resistência à deformação plástica, valores de microdureza, e imagens de microscopia eletrônica de varredura e microscopia óptica foram realizadas. A comparação entre os resultados das duas raças, Canchim e Nelore, dos valores de parâmetros de rede da estrutura cristalina da hidroxiapatita, tamanho de cristalito, microdeformações, relação cálcio e fósforo, microdurezas Vickers/Knoop, nanodureza Vickers e módulo de elasticidade indicaram que a qualidade óssea das raças Canchim e Nelore é estatisticamente semelhante para 30% dos parâmetros estudados e que para os demais 70% dos parâmetros estudados não há semelhança. / The bone quality in large animals is evaluated by bone mineral density (BMD) using the optical densitometry technique in radiographic images; The objective of this study was to evaluate and compare bone quality based on microarchitecture unpublished. Twenty bovines were selected, 10 from the Canchim breed and 10 from the Nelore breed, with control of the biological and biochemical processes from birth to slaughter at 24 months of age, before entering adulthood. The metatarsal bone was chosen because it supported higher load and samples of the diaphysis of the dry cortical bone were obtained. The evaluation of the crystalline structure of dry metatarsal bones was performed using X - ray diffraction with the application of the Rietveld refinement method, evaluating network parameters, crystallite size and microdeformation. The nanoindentation technique allowed to evaluate the modulus of elasticity and nanoindentation values. The chemical composition calcium and phosphorus ratio of the material, resistance to plastic deformation, values of microhardness, and scanning electron microscopy images and optical microscopy were performed. The comparison between the results of the two races, Canchim and Nelore, of the network parameter values of the hydroxyapatite crystal structure, crystallite size, microdeformations, calcium and phosphorus ratio, Vickers/Knoop microhardness, Vickers nanodness and modulus of elasticity indicated that Quality of the Canchim and Nelore races is statistically similar for 30% of the studied parameters and that for the ofter 70% of the studied parameters there is no similarity.

<p>The risk of fracture is higher in adults with type 2 diabetes compared to controls without type 2 diabetes, despite normal or higher than normal bone mineral density (BMD). In addition to BMD, bone strength depends on other factors such as structural and material <em>bone qualities</em>, which are not accounted for in BMD measurements. The objective was to determine whether structural and material <em>bone qualities</em> are different in adults with type 2 diabetes compared to controls without type 2 diabetes. First, a cross-sectional study was undertaken using MRI to investigate distal radius trabecular bone microarchitecture, a structural <em>bone quality.</em> In women with type 2 diabetes, trabecular bone holes were larger compared to controls, which is important because greater trabecular bone hole size is related to reduced bone strength. Next, a two year prospective study was conducted with the participants involved in the cross-sectional study to determine whether changes in trabecular bone microarchitecture are different in women with type 2 diabetes compared to controls. There was a greater increase in the number of trabecular bone holes in women with type 2 diabetes compared to controls, which provides early evidence of trabecularization of cortical bone in women with type 2 diabetes. In the third study, quantitative backscattered electron imaging (qBEI) was used to derive bone mineralization density distribution (BMDD) outcomes for bone samples from adults with and without type 2 diabetes to compare material <em>bone quality. </em>There was evidence of elevated bone calcium concentration and reduced mineralization heterogeneity in bone samples from adults with type 2 diabetes compared to controls, which may contribute to bone brittleness. In summary, differences in structural and material <em>bone qualities </em>identified in this body of work provide explanations for elevated fracture risk in adults with type 2 diabetes.</p> / Doctor of Science (PhD)

<p>Pod pojmom politraume se podrazumeva te&scaron;ka istovremena povreda najmanje dve regije tela sa anatomskom težinom povrede AIS koja je jednaka ili veća od tri kao i ukupna izračunata anatomska težina povreda izražena ISS zbirom mora da bude veća od 15. Cilj istraživanja je da se primenom upitnika (SF36, PTSD&ndash;testa i Glazgov skale ishoda) proceni kvalitet života između politraumatizovanih pacijenata sa prelomomima dugih kostiju i politraumatizovanih bez preloma duge kosti kao i da se uoče rani pokazatelji lo&scaron;e prognoze kvaliteta života nakon zavr&scaron;etka lečenja. Istraživanje je prospektivnog karaktera i obuhvatilo je 202 politraumatizovana pacijenta koji su bili povređeni u periodu 2010-2014 godine i bili lečeni u Urgentnom Centu Kliničkog Centra Vojvodine. Od 202 politraumatizovana pacijenta na kontrolne preglede se odazvalo ukupno 72 pacijenta, 37 sa prelomima dugih kostiju - ispitivana grupa i 35 politraumatizovanih pacijenata bez preloma duge kosti koji su činili kontrolnu gupu. Godinu dana nakon zavr&scaron;etka hospitalizacije svaki ispitanik je popunjavao upitnik( SF36, PTSD test i Glazgov skala ishoda ), načinjen je klinički pregled i standardna radiografija predela preloma duge kosti. Rezultati ukazuju da ukupni kvalitet života nakon zavr&scaron;etka lečenja se ne razlikuje značajno između ispitivanih grupa, iako politraumatizovani sa prelomima dugih kostiju imaju niži kvalitet života, odnosno značajno lo&scaron;ije fizički funkcioni&scaron;u i imaju značajno če&scaron;će psihičke poremećaje (postraumatski stresni poremećaj, depresija) u odnosu na kontrolnu grupu. Tip preloma duge kosti nije uticao na krajnji kvalitet života politraumatizovanih, dok su oni sa dva i vi&scaron;e preloma imali značajno lo&scaron;iji kvalitet života. Na osnovu dobijenih rezultata konstatovali smo da veću &scaron;ansu za bolji kvalitet života imaju pacijenti mlađi od 44 godine, ukoliko su inicjalno imali vrednost ISS skora manji od 30,5 bodova, vrednosti sistolnog i dijastolnog arterijskog pritiska u referentnim vrednostima, kao i broja eritrocita i trombocita, i ukoliko su primili manje od 4 jedinica transfuzije krvi u prva 24 časa.</p> / <p>The term of polytrauma means, a patient with multiple severe injuries in at least two regions of the body with anatomical severity of trauma AIS equal or greater than three and the total calculated weight anatomical injuries expressed by ISS score must be greater than 15. The aim of our study is early estimate of quality of life in polytrauma patients with multiple fractures of the long bones and polytrauma patients without fractures of long bones as well as to detect early indicators of poor prognosis of quality of life after treatment, using questionnaires (SF 36, PTSD test and Glasgow Outcome Scale). This was prospective study and included 202 polytrauma patients who were injured during the period 2010-2014 and were treated in the Emergency Center of Clinical Center of Vojvodina. From 202 polytrauma patients, on control examinations responded 72 patients, 37 with fractures of long bones - study group and 35 polytrauma patients without fractures of long bones and they were control group. One year after the end of hospitalization each patient filled out a questionnaire (SF36, PTSD test and Glasgow Outcome Scale), made a clinical examination and standard X-rays of long bone fractures. Our results indicate that the overall quality of life after treatment is not significantly different between the groups, although polytraumatized patients with fractures have a lower quality of life and significantly worse physical functioning and have significantly more mental disorders (post-traumatic stress disorder, depression) compared to the control group. Type of long bone fractures did not affect on the final quality of life, while those patients with two or more fractures had a significantly poorer quality of life. Based on these results we concluded that greater chance for a better quality of life have patients younger than 44 years, unless they had initially ISS score less than 30.5 points, systolic and diastolic blood pressure in the reference values as well as the number of red blood cells and platelets, and if they received less than 4 units of blood transfusions in the first 24 hours.</p>

Osteoporose und gestörte Heilungsverläufe von Knochenbrüchen verursachen immer noch beachtliche klinische Komplikationen. Ein vielversprechender Ansatz für die nichtinvasive und nichtionisierende Abschätzung des Frakturrisikos und der Bildgebung von Frakturheilung ist quantitativer Ultraschall (QUS). Dennoch liegt die derzeitige Akzeptanz für die Knochenqualitätsabschätzung noch weit hinter herkömmlichen röntgenbasierten Anwendungen. Es wurden akustische Mikroskopie und Synchrotronstrahlen-Mikrotomographie für die Anatomie und altersabhängige Erfassung von strukturellen und elastischen Variationen auf der mikroskopischen Ebene von humanen Femora verwendet. Die gewonnenen Daten dienten als Grundlage für die Erstellung mikromechanischer Modelle von Knochen für numerische Simulationen der Schallausbreitung im humanen Femurhals. Dabei wurde der Aufbau eines US-basierten Femur-Scanners in transversaler Transmission (TT) nachempfunden. Im letzten Abschnitt der Arbeit wurde QUS in TT in in vitro Experimenten am Rattenfrakturmodell auf eine Anwendung für die Bildgebung der Frakturheilung getestet. Die Studien konnten zeigen, dass ein Großteil der adaptiven Fähigkeiten von Knochen auf mikroskopischer Ebene auf eine Kombination von extrazellulärer Matrixelastizität und Gewebeporosität zurückzuführen ist. Die Simulationen des zweiten Teils konnten die Existenz von geführten Wellen im humanen Femurhals bestätigen. Die sensitive Abhängigkeit von US-parametern von frakturrelevanten Knocheneigenschaften zeigt das hohe Potential von QUS für die Frakturrisikoabschätzung. Der zweite Teil der Arbeit konnte erfolgreich die Möglichkeit von QUS in TT zur Diskriminierung von zeitigen Heilungsstadien demonstrieren. Zusammenfassend bestätigt die Studie das hohe Potential von QUS für die Frakturrisikoabschätzung und die Bildgebung der Frakturheilung. / Osteoporosis and impaired bone healing are of high relevance. A promising non-invasive, non-ionizing candidate for fracture risk prediction and monitoring fracture healing is quantitative ultrasound (QUS). However, the acceptance of QUS for bone quality assessment is still not comparable to X-ray based methods. Scanning acoustic microscopy (SAM) and Synchrotron Radiation micro-computer tomography (SRµCT) has been used to investigate anatomical and age dependent variations of micro elastic, structural and mineralization parameters at the tissue level of human femoral bone. Femoral neck models were created based on these data for numerical sound propagation simulations emulating a transverse transmission (TT) setup of an in vivo QUS prototype. In the last part of the project the TT approach has been tested in ex vivo experiments in a rat healing model. The power of QUS, to discriminate two early healing stages has been compared to µCT measurements at the same specimens. It was found that the major contributor to bone adaptation is related to a combination of extracellular matrix elasticity and tissue porosity. It is hypothesized that these parameters are likely to have a considerable impact on the reliability of in silico models. The simulations of the second part confirmed the existence of guided wave propagation in the cortical shell and a high dependency of US parameters on fracture relevant bone properties. The results demonstrate the high potential for bone fracture risk prediction at the femoral neck using QUS. Finally, it was successfully demonstrated that early healing stage discrimination of QUS in TT was superior compared to µCT. In summary these investigations not only show the importance for a precise estimation of micro mechanical properties for numerical modelling but also demonstrate the feasibility and high potential of QUS for bone quality assessment and monitoring of fracture healing.