Thesis (MMed)--Stellenbosch University, 2014. / No abstract available

Background: In an ongoing study conducted at Karolinska Institutet & Karolinska University Hospital, Positron Emission Tomography (PET)/Computed Tomography (CT) scans are performed on patients with tibia fractures and deformations treated with Taylor Spatial Frames (TSFs) in order to monitor their bone remodeling progress. Each patients receive an administration of approximately 2 MBq/kg bodyweight of Na18F associated with PET scans on two sessions, six and twelve weeks after the attachment of the TSF. These PET/CT scans provide information about the progress of the healing bone and can be used to estimate the optimal time point for de-attachment of the TSF. The Standardized Uptake Value (SUV) is used as a measure of the rate of bone remodeling for these patients, however, there is a need for verification of this practice by a method independent of the PET scanner. Furthermore, information regarding the biodistribution of the Na18F throughout the body of these patients and the effects of the TSF on the CT scan X‑rays is required. Additionally, an investigation of alternative methods that have the potential to provide similar information with a lower absorbed dose to the patients is desirable. Materials and methods: Thermoluminescent Dosimeters (TLDs) were attached on the skin at the position of the heart, urinary bladder, femurs, fracture, and the contralateral tibia of twelve patients during the first one hour and five minutes after the administration of the Na18F. Additional TLD measurements were performed during the CT scan of two of these patients. From the PET scan images, SUVs at the fracture site of these patients were collected. An investigation of the possibility of exploiting the “naturally” occurring bone seeking radionuclide Strontium-90 (90Sr) in the human body to gain information about the fracture site was undertaken. Using a 90Sr source, three different detection techniques were evaluated and a practical methodology for in vivo measurements on the tibia fracture patients was developed. As it was concluded that TLD based measurements were the most suitable technique for this purpose, and it was tested on five patients with tibia fractures. Results: From the collected TLD data, it was concluded that for these patients the urinary bladder is the organ receiving the greatest amount of absorbed dose and the organ most affected as the administered activity exceeds 2 MBq/kg. On average, a three times higher surface dose was measured on the tibia fracture compared to the un-fractured tibia. A linear relationship between the surface dose and SUVmax was shown. A strong positive correlation between the activity concentration at the fracture site and the amount of injected activity was found, and it was demonstrated that this also affects the SUVs. For patients who were administered different amounts of Na18F for the two PET scans, maximum activity concentrationwas less affected than mean activity concentration. It was concluded that TSF’s effect on the scatter of the X-rays to organs higher up in the body is negligible. Regarding “naturally” occurring 90Sr in the human body, no higher activity at the fractured tibia compared to the non‑fractured tibia could be found. Conclusions: This project assessed the accumulation of Na18F in the fracture site of patients treated with TSF by a method independent of the PET scanner. The methodology of using SUVs as an indicator for bone remodeling was verified. It was shown that the uptake of Na18F by the fracture site is strongly correlated to the amount of injected activity. The importance of considering the amount of injected activity when evaluating and comparing SUVs was highlighted. In vivo measurements using LiF:Mn TLDs did not indicate any quantifiable higher concentration of 90Sr at the fracture in the tibia bone.

This thesis is a result of research aimed at analysis of the Taylor Spatial Frames (TSF) in Orthopaedics. The TSF is a ring external fixator, which are used to stabilise a fracture or provide stability during skeletal limb reconstruction procedures. A sound understanding of the mechanics of the fixator is essential, because mechanical stability is a key factor in bone healing. TSF is in fact an adaptation of the hexapod parallel manipulators for dynamisation of the classical ring fixators of Ilizarov type. Therefore, a general solution for Forward kinematics of parallel manipulators was provided and the solution is visualised in real-time. A three-dimensional visualisation tool for TSF, was developed, which offers improvements over the software provided by the manufacturer. Abaqus/CAE programming interfaces were used to develop two separate systems for automatic creation of FEMs of the TSF: one using beam elements and the other using 3D solid elements. The systems were used for a parametric study on axial compression of the TSF. Components of the TSF were also tested and analysed: o TSF rings were studied extensively, which lead to revealing important facts about their role in the TSF. o Fixation bolts in external fixators were studied by FE technique and the results used to relate bolt-load to the bolt-torque applied. o TSF struts were tested in compression and their load-deflection behaviour and the role of universal joints in them were described. TSF and Ilizarov fixators were tested and compared in axial compression. The results highlighted the important role of the pins and wires in deflection of the fixators.

The Taylor Spatial Frame (TSF) is a recently introduced form of a circular external orthopaedic fixator for long bone fracture reduction and deformity correction. The TSF is constructed from two circular rings interconnected with six variable-length struts. Its kinematics are based on the Stewart-Gough platform. The TSF is attached to the patient's anatomy using fine wires and half-pins. In this thesis, three aspects of the TSF are analysed. First, the solution to non-trivial forward and inverse kinematics has been addressed. Second, the mechanical properties of the TSF fixator are investigated. Individual component stiffness is assessed separately and then the complete fixator is modelled. Simple stiffuess models of fine wires and half-pins are derived. Considerations for the use of the TSF for the peri-articular fractures are investigated and potential modifications are proposed. The effect of backlash in the frame components on the accuracy of the fixator has been analysed. Finally, in rder to validate the kinematics solution, to provide a training aid for surgeons and to demonstrate the concept of accurately controlled interfragmentary motion, a prototype of an active TSF was designed and built. Computationally efficient algorithms for solving the forward and inverse kinematics have been developed that require little numerical processing overhead and can be implemented on a mobile computing device. It was found that the TSF fixator has similar axial stiffuess to the circular Ilizarov ring fixator, since wires and half-pins are significantly less stiff than the frames. Furthermore, the TSF exhibits more uniform stiffuess for a range of off-axis loads and is significantly stiffer for torsional loads than the Ilizarov fixator. Slack, in the form of a backlash, can lead to severe strains in the unloaded frames and therefore fractures, and hence precautions are recommended. Finally, considerations and prototype for the automated TSF are presented that can be utilised for demonstration purposes and surgeon training.