Thesis (M.S.)--University of Alabama at Birmingham, 2008. / Description based on contents viewed Oct. 14, 2008; title from PDF t.p. Includes bibliographical references (p. 66-71).

Sexual dimorphism of the distal humerus has been used for the development of morphometric sex estimation methods in human identification. In particular, visual assessment of the olecranon fossa, trochlear shape, and medial epicondyle angle are variably successful in differentiating females and males in African, Asian, and European groups. However, the influence of other factors on the distal humerus has yet to be fully explored. This study utilizes elliptical Fourier analysis (EFA) to examine the shape of these three features for evidence of sexual dimorphism and the effects of age-at-death, stature, and humeral measurements in 261 modern Thai individuals (f=116; m=145), 20-97 years of age. Left humeri were measured, photographed, traced, and analyzed in SHAPE v. 1.3 for EFA. Chi-square, ANOVA, and principal component results indicate sexual dimorphism in the olecranon fossa and trochlear extension shapes, both of which are correlated with epicondylar breadth. Trochlear extension was also found to be correlated with minimum midshaft diameter, vertical head diameter, and stature. The medial epicondyle was not correlated with any of the other factors examined, and age was not correlated with any of the shapes. High rates of intra- and interobserver error were found in the tracings of the three features. While future research should assess methods that better capture the medial epicondyle and improve reliability, features of the distal humerus are sexually dimorphic and somewhat affected by stature and/or body size.

Ökomorphologische Konvergenz tritt auf, wenn Arten mit demselben Lebensstil unabhängig voneinander ähnliche morphologische Merkmale evolvieren. Neue Fallstudien können dabei helfen, die diesem Prozess zugrunde liegenden Mechanismen aufzuklären. Diese Arbeit befasst sich mit einigen konvergent evolvierten, langsamen, baumbewohnenden Säugetieren, d. h. zwei Linien baumlebender Faultieren, dem Zwergameisenbär, den Lorisiden, zwei Kladen ausgestorbener Lemuren, d. h. Paläopropithekiden und Megaladapis, und dem Koala. Es werden funktionsmorphologische Konvergenzen in diesen Taxa erforscht, indem ihr Humerus und ihr Femur sowie jene ihrer nah verwandten, aber ökologisch unterschiedlichen Taxa untersucht werden. Erstmals werden Knochen mittels phylogenetisch vergleichender Methoden auf vier anatomischen Ebenen, d.h. äußere Form, diaphysäre Mikrostruktur und Anatomie sowie epiphysäre Trabekelarchitektur, analysiert. Viele langsame, baumbewohnende Säugetiere teilen eine geringe kortikale Kompaktheit, was wahrscheinlich mit ihrer extrem niedrigen Stoffwechselrate und ihren biomechanischen Anforderungen zusammenhängt. Langsame, arboreale Xenarthra, d. h. baumbewohnende Faultiere und der Zwergameisenbär, weisen ein Muster unvollständiger Konvergenz für eine Reihe äußerer und innerer anatomischer Merkmale auf, was möglicherweise durch die relativ unterschiedliche Ökologie des Zwergameisenbären erklärt wird. Auf einer breiteren Säugetierskala konvergieren andere Merkmale, die möglicherweise mit der Ökologie der langsamen baumbewohnenden Lebensweise in einigen der untersuchten Taxa zusammenhängen, obwohl komplexe Muster auch durch andere evolutionäre Prozesse erklärt werden können. Nur suspensorisch lebende Taxa tragen signifikant zur Konvergenz bei. Diese Arbeit hebt die stärkere Konvergenz hervor, die sich in der inneren Struktur des Knochens widerspiegelt. / Ecomorphological convergence occurs when similar morphological traits are independently evolved by species with the same lifestyle. Novel case studies can help to elucidate the underlying mechanisms of this process. This work addresses some convergent slow arboreal mammals, i.e. two lineages of ‘tree sloths’, the silky anteater, ‘Lorisidae’, two clades of extinct lemurs, i.e. palaeopropithecids and Megaladapis, and the koala. Functional morphological convergences are searched in these taxa, studying their humerus and femur as well as those of their closely related ecologically distinct taxa. For the first time, bones are analyzed at four anatomical levels, i.e. external shape, diaphyseal microstructure and anatomy and epiphyseal trabecular architecture, through phylogenetic comparative methods. Many slow arboreal mammals share a low cortical compactness, probably related to their extremely low metabolic rate and biomechanical demands. Slow arboreal xenarthrans, i.e. ‘tree sloths’ and the silky anteater, exhibit a pattern of incomplete convergence for a set of external and internal anatomical features, possibly explained by the relatively distinct ecology of the silky anteater. On a wider mammalian scale, other traits possibly related to slow arboreal ecology converge in some of the studied taxa, although with complex patterns also explained by other evolutionary processes. Only suspensory taxa significantly contribute to convergence. This thesis highlights the stronger convergence reflected by bone internal structure. By providing potential explanations for convergence in slow arboreal mammals, the inherent complexity of this process is here emphasized.

Ziel der Studie war die Evaluation des biomechanischen Effekts einer medialen Unterstützung bei proximalen Humerusfrakturen. An 32 unfixierten humanen Humeri, aufgeteilt in vier Plattenosteosynthesegruppen, wurde der Einfluss von inferomedialen Schrauben, dynamischen Verriegelungsschrauben und medialer Knochenspanaugmentation vom Femurkopf, im Vergleich zu einer Gruppe ohne mediale Unterstützung, getestet. Die Steifigkeit der Proben wurde bei Torsion, axialer Ausrichtung, 20° Abduktion und 20° Adduktion geprüft. Anschließend wurde über 5000 Zyklen und bis zum Versagen belastet. Verglichen wurden Steifigkeiten, interfragmentäre Bewegungen, Maximalbelastungen und Versagensursachen. Ausschließlich für die Gruppe mit Knochenspanaugmentation konnten signifikante Unterschiede, im Vergleich zu den anderen Gruppen, nachgewiesen werden. Eine Knochenspanaugmentation, mittels kortikospongiösem Span vom Hüpftkopf, bot biomechanisch eine signifikante Unterstützung der medialen Säule. Klinisch könnte das Auftreten von sekundären Repositionsverlusten möglicherweise reduziert werden. Für die Verwendung von inferomedialen oder dynamischen Schrauben ließen sich bei 2-Segmentfrakturen im biomechanischen Modell keine signifikanten Vorteile nachweisen.

Proximal humerus fractures are the third most common fractures in the over-65 patient population and their stable fixation remains a key challenge in orthopaedic and trauma surgery. While Open Reduction Internal Fixation by plate has become a well-known treatment modality in the last few decades, clinical studies associate high complication rate with its use. The overall aim of this project was to create a computer-aided design framework for proximal humerus plates using a validated subject-specific humerus-plate finite element model. The framework consisted of three stages: (1) reverse engineering of bone and plate geometry, (2) creation and validation of a finite element model simulating the in vitro testing of the bone-implant construct and (3) parametric optimisation study of implant design using this model. In vitro biomechanical tests were conducted to not only compare the mechanical performance of three key commercially available proximal humerus plates (S3-, Fx- and PHILOS plate) but also the effect of different screw zones. Sixty-five humeri specimens with two-part surgical neck fractures were treated and grouped based on their different screw configurations. Extension, flexion, varus and valgus bending were applied in the cantilever fashion in the elastic tests whereas only varus bending was applied in the plastic tests. The load required to apply 5 mm displacement was measured to determine bone-plate construct stiffness. The S3 plate yielded the stiffest constructs and while the removal of the inferomedial support had the most impact on varus bending stiffness, type of medial support was important: inferomedial screws in the Fx plate achieved higher bending stiffness than blade insertion. Stability of constructs treated with the plate was an interplay of factors such as the plate’s and screws' number, orientation and position. Next, a subject-specific finite element model of the humerus-plate construct was successfully developed that simulated the stiffest of the constructs from the in vitro varus bending tests conducted in this project. The model was validated against the in vitro results. The validated model was then used to perform a parametric optimisation study where the combination of design parameters (height and divergence angle of S3 plate’s inferomedial screws) was determined that achieved optimum bone-plate construct stability (minimum fracture gap change). Out of the 538 designs tested, the optimum design (16o divergence angle and 33o height angle) yielded the lowest fracture gap change (0.156 mm) which was 4.686% lower than the standard finite element model while achieving 5.707% higher varus bending load (54.753 N). The validated model was also used to investigate the issue of using smooth pegs and threaded screws. Twenty-six models with different percentages of screw threading were run to compare their bone-plate construct stiffness. While threading the smooth pegs was found to increase the varus bending stiffness by up to 4.546%, it did not affect all screws equally. Finally, the successful completion of the optimisation study of screw orientation and the clinical investigation promises the implementation of the computational framework for a range of future multi-objective optimisation studies of multiple design parameters especially for the design of implants for other parts of the human body and also for investigations into other clinically relevant questions.

L'enrichissement des modèles numériques de l'être humain est un enjeu majeur dans la recherche en biomécanique des chocs. Dans le cas des os longs, les propriétés mécaniques sont le plus souvent déterminées à partir de caractéristiques macroscopiques sans prendre en compte l'influence de l'architecture du tissu. Ce manque de considération explique les limites de la biofidélité des modèles proposés actuellement. Fort de ce constat, une approche multi-échelle semble être pertinente pour une amélioration des prédictions obtenues. Cette thèse s'intéresse plus particulièrement au comportement de l'humérus humain dans le cadre de sollicitations dynamiques et propose le développement d'une loi micromécanique pour le décrire. Cette loi est un couplage entre le schéma d'homogénéisation linéaire de Mori-Tanaka pour l'estimation des propriétés mécaniques apparentes de l'humérus avec un raisonnement thermodynamique décrivant la progression de l'endommagement au sein de l'os cortical à l'aide d'une loi de croissance des porosités. La validité de ce modèle a été faite à travers l'estimation de l'effort ultime lors d'essais de type impacts. Pour ce faire, cette étude repose sur les résultats de campagnes expérimentales explorant à différentes échelles les propriétés mécaniques de 13 humérus prélevés de 10 sujets humains post-mortem. Ainsi des essais d'impact ont été réalisés sur pièces anatomiques, les propriétés élastiques mésoscopiques et l'influence de l'endommagement sur ces dernières ont été caractérisées à travers des tests de traction/compression ou de flexion sur éprouvettes et les propriétés microscopiques de la matrice osseuse ont été mesurées par nanoindentation. / The relevant of the human numerical models is a major issue in biomechanical researches. The long bones' mechanical properties are often identified from macro-scale characteristics without taking account of bone structure. This lack of consideration explains the limit of the proposed models biofidelity. A multi-scale approach seems to be relevant for the prediction's improvement, in light of this. This thesis studied the human humerus behavior during dynamical solicitations and propose a micromechanical law to describe it. This law is coupling the linear homogenization scheme of Mori-Tanaka to evaluate the apparent mechanical properties of humerus with a thermo dynamical reasoning to describe the cortical bone damaging by porosities growing. The model validity has been established by the estimation of the maximal load during a impact test. This study is based on the results from multi-scale experimental campaigns exploring the mechanicals properties of 13 humerus from 10 post-mortem human cadavers. So impacts tests have been realized on anatomical specimens, the mesoscopic elastic properties and the damaging influence on them have been characterized by traction, compression or flexion tests and the microscopic properties of bone matrix have been measured by nanoindentation.

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Pre-publication drafts are reproduced with permission and copyright © 2013 of the Journal of Orthopaedic Trauma [Mutch J, Rouleau DM, Laflamme GY, Hagemeister N. Accurate Measurement of Greater Tuberosity Displacement without Computed Tomography: Validation of a method on Plain Radiography to guide Surgical Treatment. J Orthop Trauma. 2013 Nov 21: Epub ahead of print.] and copyright © 2014 of the British Editorial Society of Bone and Joint Surgery [Mutch JAJ, Laflamme GY, Hagemeister N, Cikes A, Rouleau DM. A new morphologic classification for greater tuberosity fractures of the proximal humerus: validation and clinical Implications. Bone Joint J 2014;96-B:In press.] / Les fractures isolées de la Grosse Tubérosité (GT) de l’humerus proximal sont rares et peu étudiées. Trois problèmes importants existent: 1: Même si 5mm + de déplacement supérieur du GT est cité comme indication chirurgicale, les mesures basées sur radiographie peuvent errer de plus que 10mm. 2: Les classifications de Neer et l’AO décrivent seulement un type de fracture de GT (gros fragment, ligne de fracture verticale). Deux autres types de fracture existent: type fracture-avulsion avec petit fragment osseux et type Hill-Sachs très latéral. 3: On manque d’études de pronostic ou de traitement des fractures de GT selon la morphologie. Article 1 montre et évalue une méthode simple de mesurer le déplacement supérieur de la GT (le GT ratio) sur les radiographies standard; ceci corrèle très bien avec tomographie (CT). Article 2 introduit une méthode de classification Morphologique des fractures de GT (Avulsion, Split, Dépression) qui a une fiabilité de bonne à excellente. Les données échographiques, radiologiques, et cliniques de 54 patients porteurs de fracture de GT (suivie moyenne 2.5 années) sont aussi incluses. Les patients <50 ans ont eu plus de déchirures de la coiffe et ceux avec fractures déplacées (≥ 5mm) avaient plus d’atrophie du susépineux. Les déchirures complètes de la coiffe et l’atrophie du susépineux augmentaient l’atteinte permanente. La morphologie des fractures de GT n’a pas eu un impact significatif sur le pronostic. Cependant, l’âge, le sexe, et le taux de luxation glénohumérale étaient différents selon le type de fracture et ceci pourrait refléter la pathophysiologie. Une évaluation plus précise de l’impact de la Morphologie des fractures de GT sur le pronostic et traitement nécessitera une étude prospective multicentrique. / Isolated fractures of the Greater Tuberosity (GT) of the proximal humerus are rare and a challenge to study. Three main problems arise: 1: Though 5mm+ superior GT displacement is often a surgical indication, measurement errors on radiographs may surpass 10mm. 2: The Neer and AO classifications describe only one type of GT fracture (large fragment, vertical fracture line). Two other fracture types have been described: an avulsion-type (small fragment), and a very lateral Hill-Sachs-type. 3: There are no studies on the treatment or prognosis of GT fractures according to fracture morphology. Article 1 introduces and tests a simple method to measure superior GT displacement (the GT ratio) using standard radiographs; this correlates very well with computed tomography (CT). Article 2 presents the Morphologic classification for GT fractures. It describes three fracture types (Avulsion, Split, Depression) and has good to excellent reliability. The ultrasonographic, radiologic, and clinical results of 54 patients (average follow-up 2.5 years) with isolated GT fractures are then described. Patients <50 years had higher rates of rotator cuff tears and displaced (≥ 5mm) GT fractures were associated with supraspinatus atrophy. Both full rotator cuff tears and supraspinatus atrophy resulted in poor outcomes. The impact of fracture morphology on prognosis was not significant. However, age, sex, and associated glenohumeral dislocation differed by fracture type and this may reflect their pathophysiology. A more thorough evaluation of the prognosis and treatment of GT fractures by morphologic type would require a prospective multicenter study.

Objetivo: Comparar o comprimento do úmero em fetos portadores de síndrome de Down (T21) com o comprimento do úmero em fetos normais, utilizando instrumentos de referência da população local. Método: Estudo caso-controle retrospectivo que comparou o comprimento do úmero de fetos normais com os fetos com T21, entre 18 semanas e 23 semanas e 6 dias. Os exames dos fetos com T21 foram realizados entre 1994 e 2012. Os controles normais foram avaliados entre 2007 e 2009. Foram analisadas as médias, medianas e desvios-padrão da idade materna, idade gestacional e medida do úmero. Posteriormente, foi feita análise da correlação entre as medidas dos úmeros e a idade gestacional, sendo seus valores expressos em múltiplos da mediana (MoMs). O comprimento do úmero dos fetos com T21 foram confrontados com os fetos normais utilizando o teste t-Student. A medida do úmero foi avaliada considerando-se os níveis de corte abaixo do percentil 10, 5 e 2,5 a fim de obter as respectivas taxas de sensibilidade. Calculou-se, ainda, a razão de verossimilhança (RV). A seguir, foi utilizado um modelo linear geral tendo a idade materna como covariável para controlar na comparação. Comparou-se, também, a medida do comprimento do úmero dos fetos normais da população local com o comprimento do úmero esperado baseado na curva de Jeanty. Os testes foram realizados com nível de significância de 5%. Resultados: Foram incluídos 58 casos com T21 e 1888 controles normais. A sensibilidade do comprimento do úmero para a detecção da T21 utilizando o nível de corte abaixo do percentil 10 foi de 44,8 % com RV de 4,4, abaixo do percentil 5 foi de 34,4 % com RV de 6,9 e abaixo do percentil 2,5 foi de 31,0 % com RV de 12. O valor médio dos úmeros, em MoMs, de fetos com T21 é estatisticamente inferior ao dos fetos normais (p < 0,001), utilizando o teste t-Student. Quando controlada a idade materna na comparação entre os grupos, a diferença permaneceu estatisticamente significativa (p < 0,001). Fez-se uma análise para comparar o comprimento do úmero nos fetos normais da população local com o comprimento do úmero esperado para a curva de Jeanty, e viu-se que os fetos normais locais têm comprimento do úmero estatisticamente significante menor. Conclusões: Existe diferença estatisticamente significante entre o comprimento do úmero de fetos normais e de fetos com T21 na população local (p < 0,001). A sensibilidade para detecção de T21 foi de 44,8%, 34,4% e 31%, para o úmero abaixo do percentil 10, 5 e 2,5, respectivamente. A curva de Jeanty não tem rendimento adequado para uso como controle do crescimento umeral em fetos normais locais, acarretando com seu uso o inevitável aumento da taxa de falsos positivos de úmeros curtos / Objective: This study aimed to compare the humeral length (HL) in fetuses with Down syndrome (T21) with HL in normal fetuses, by using instruments of reference of the local population. Method: A case-control study was conducted comparing HL in normal fetuses with HL in fetuses with T21, aged between 18 weeks and 23 weeks and 6 days. Fetuses with T21 who were examined between 1994 and 2012 were included. The normal controls were evaluated between 2007 and 2009. The averages, medians, and standard deviations were obtained for maternal age, gestational age, and HL. Afterwards, we analyzed the correlation between the HL and the gestational age, with values expressed as multiples of the median (MoMs). The HLs of fetuses with T21 were compared with the HLs in normal fetuses by using Student\'s t-test. The humeri were evaluated considering the cut-off levels below the 10th, 5th, and 2,5th percentiles to obtain the sensitivity. The likelihood ratios (LR) were also calculated. Next, a general linear model was used with maternal age as a covariate to control for comparison of the groups. Comparison was also made between the HL of fetuses in the local population and the expected HL, based on the Jeanty curve. The tests were performed with a significance level of 5%. Results: The study included 58 cases with T21 and 1888 normal controls. The sensitivity of the HL to detect T21 by using a cut-off level below the 10th percentile was 44.8% with a LR of 4.4; below the 5th percentile, the sensitivity was 34.4% with a LR of 6.9; and below the 2.5th percentile, the sensitivity was 31.0% with a LR of 12. The average value of the humerus, in MoMs, of fetuses with T21 is statistically lower than that of normal fetuses (p < 0.001), as measured by using Student\'s t-test. When maternal age was controlled as a covariant in the comparison between groups, the difference remained statistically significant (p < 0.001). An analysis to compare the HL in normal fetuses of the local population with expected HL based on the Jeanty curve concluded that the HL in normal fetuses of the local population is lower than expected. Conclusions: There is a statistically significant difference between the HL of normal fetuses and HL of fetuses with T21 in the local population (p < 0.001). The sensitivity for detection of T21 was 44.8%, 34.4%, and 31% for the humerus below the 10th, 5th and 2.5th percentile, respectively. The Jeanty curve is not adequate to use as growth control for humeri in local normal fetuses, as its use leads to an increase in false positive rates when measuring the proportion of short humeri