Displaying publications 1 - 20 of 63 in total

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  1. Stability of cervical spine after one-level corpectomy using different numbers of screws and plate systems
    Rosli R, Abdul Kadir MR, Kamarul T
    Proc Inst Mech Eng H, 2014 Apr;228(4):342-9.
    PMID: 24622982 DOI: 10.1177/0954411914527074
    Anterior corpectomy and reconstruction using a plate with locking screws are standard procedures for the treatment of cervical spondylotic myelopathy. Although adding more screws to the construct will normally result in improved fixation stability, several issues need to be considered. Past reports have suggested that increasing the number of screws can result in the increase in spinal rigidity, decreased spine mobility, loss of bone and, possibly, screw loosening. In order to overcome this, options to have constrained, semi-constrained or hybrid screw and plate systems were later introduced. The purpose of this study is to compare the stability achieved by four and two screws using different plate systems after one-level corpectomy with placement of cage. A three-dimensional finite-element model of an intact C1-C7 segment was developed from computer tomography data sets, including the cortical bone, soft tissue and simulated corpectomy fusion at C4-C5. A spinal cage and an anterior cervical plate with different numbers of screws and plate systems were constructed to a fit one-level corpectomy of C5. Moment load of 1.0 N m was applied to the superior surface of C1, with C7 was fixed in all degrees of freedom. The kinematic stability of a two-screw plate was found to be statistically equivalent to a four-screw plate for one-level corpectomy. Thus, it can be a better option of fusion and infers comparable stability after one-level anterior cervical corpectomy, instead of a four-screw plate.
  2. Finite element analysis of idealised unit cell cancellous structure based on morphological indices of cancellous bone
    Kadir MR, Syahrom A, Ochsner A
    Med Biol Eng Comput, 2010 May;48(5):497-505.
    PMID: 20224954 DOI: 10.1007/s11517-010-0593-2
    Human bones can be categorised into one of two types--the compact cortical and the porous cancellous. Whilst the cortical is a solid structure macroscopically, the structure of cancellous bone is highly complex with plate-like and strut-like structures of various sizes and shapes depending on the anatomical site. Reconstructing the actual structure of cancellous bone for defect filling is highly unfeasible. However, the complex structure can be simplified into an idealised structure with similar properties. In this study, two idealised architectures were developed based on morphological indices of cancellous bone: the tetrakaidecahedral and the prismatic. The two architectures were further subdivided into two types of microstructure, the first consists of struts only and the second consists of a combination of plates and struts. The microstructures were transformed into finite element models and displacement boundary condition was applied to all four idealised cancellous models with periodic boundary conditions. Eight unit cells extracted from the actual cancellous bone obtained from micro-computed tomography were also analysed with the same boundary conditions. Young's modulus values were calculated and comparison was made between the idealised and real cancellous structures. Results showed that all models with a combination of plates and struts have higher rigidity compared to the one with struts only. Values of Young's modulus from eight unit cells of cancellous bone varied from 42 to 479 MPa with an average of 234 MPa. The prismatic architecture with plates and rods closely resemble the average stiffness of a unit cell of cancellous bone.
  3. Effects of Blood Flow Restriction Training on Muscle Strength and Pain in Patients With Knee Injuries: A Meta-Analysis
    Li S, Shaharudin S, Abdul Kadir MR
    Am J Phys Med Rehabil, 2021 Apr 01;100(4):337-344.
    PMID: 33727516 DOI: 10.1097/PHM.0000000000001567
    BACKGROUND: Due to the pain caused by knee injuries, low-load resistance training with blood flow restriction (L-BFR) may be a potential adjuvant therapeutic tool in the rehabilitation of knee injuries. This review aimed to analyze the effectiveness of L-BFR training modality in knee rehabilitation.

    DESIGN: A meta-analysis was conducted to determine the potential impact of blood flow restriction on patients with knee injuries. PubMed, EBSCO, and Web of Science databases were searched for eligible studies from January 2000 until January 2020. The mean differences of the data were analyzed using Revman 5.3 software with a 95% confidence interval.

    RESULTS: Nine studies fulfilled the inclusion criteria. These studies involved 179 patients who received L-BFR, 96 patients who underwent high-load resistance training, and another 94 patients who underwent low-load resistance training. The analysis of pooled data showed that patients in both the L-BFR (standardized mean difference, 0.83 [0.53, 1.14], P < 0.01) and high-load resistance training (standardized mean difference, -0.09 [-0.43, 0.24], P = 0.58) groups experienced an increase in muscle strength after the training. In addition, pain score was significantly reduced in the L-BFR group compared with the other two groups (standardized mean difference, -0.61 [-1.19, -0.03], P = 0.04).

    CONCLUSIONS: Muscle strength increased after L-BFR and high-load resistance training compared with low-load resistance training. Furthermore, pain score was significantly reduced after L-BFR. Hence, L-BFR is a potential intervention to be applied in rehabilitation of knee injuries.

  4. Age estimation based on bone length using 12 regression models of left hand X-ray images for Asian children below 19 years old
    Darmawan MF, Yusuf SM, Abdul Kadir MR, Haron H
    Leg Med (Tokyo), 2015 Mar;17(2):71-8.
    PMID: 25456051 DOI: 10.1016/j.legalmed.2014.09.006
    Age estimation was used in forensic anthropology to help in the identification of individual remains and living person. However, the estimation methods tend to be unique and applicable only to a certain population. This paper analyzed age estimation using twelve regression models carried out on X-ray images of the left hand taken from an Asian data set for subjects under the age of 19. All the nineteen bones of the left hand were measured using free image software and the statistical analysis were performed using SPSS. There are two methods to determine age in this study which are single bone method and all bones method. For single bone method, S-curve regression model was found to have the highest R-square value using second metacarpal for males, and third proximal phalanx for females. For age estimation using single bone, fifth metacarpal from males and fifth proximal phalanx from females can be used due to the lowest mean square error (MSE) value. To conclude, multiple linear regressions is the best techniques for age estimation in cases where all bones are available, but if not, S-curve regression can be used using single bone method.
  5. Comparison on three classification techniques for sex estimation from the bone length of Asian children below 19 years old: an analysis using different group of ages
    Darmawan MF, Yusuf SM, Kadir MR, Haron H
    Forensic Sci Int, 2015 Feb;247:130.e1-11.
    PMID: 25540897 DOI: 10.1016/j.forsciint.2014.11.007
    Sex estimation is used in forensic anthropology to assist the identification of individual remains. However, the estimation techniques tend to be unique and applicable only to a certain population. This paper analyzed sex estimation on living individual child below 19 years old using the length of 19 bones of left hand applied for three classification techniques, which were Discriminant Function Analysis (DFA), Support Vector Machine (SVM) and Artificial Neural Network (ANN) multilayer perceptron. These techniques were carried out on X-ray images of the left hand taken from an Asian population data set. All the 19 bones of the left hand were measured using Free Image software, and all the techniques were performed using MATLAB. The group of age "16-19" years old and "7-9" years old were the groups that could be used for sex estimation with as their average of accuracy percentage was above 80%. ANN model was the best classification technique with the highest average of accuracy percentage in the two groups of age compared to other classification techniques. The results show that each classification technique has the best accuracy percentage on each different group of age.
  6. The influence of experimental silane primers on dentin bond strength and morphology: a laboratory and finite element analysis study
    Mustafa AA, Matinlinna JP, Saidin S, Kadir MR
    J Prosthet Dent, 2014 Dec;112(6):1498-506.
    PMID: 24993375 DOI: 10.1016/j.prosdent.2014.05.011
    STATEMENT OF PROBLEM: The inconsistency of dentin bonding affects retention and microleakage.

    PURPOSE: The purpose of this laboratory and finite element analysis study was to investigate the effects on the formation of a hybrid layer of an experimental silane coupling agent containing primer solutions composed of different percentages of hydroxyethyl methacrylate.

    MATERIAL AND METHODS: A total of 125 sound human premolars were restored in vitro. Simple class I cavities were formed on each tooth, followed by the application of different compositions of experimental silane primers (0%, 5%, 25%, and 50% of hydroxyethyl methacrylate), bonding agents, and dental composite resins. Bond strength tests and scanning electron microscopy analyses were performed. The laboratory experimental results were validated with finite element analysis to determine the pattern of stress distribution. Simulations were conducted by placing the restorative composite resin in a premolar tooth by imitating simple class I cavities. The laboratory and finite element analysis data were significantly different from each other, as determined by 1-way ANOVA. A post hoc analysis was conducted on the bond strength data to further clarify the effects of silane primers.

    RESULTS: The strongest bond of hybrid layer (16.96 MPa) was found in the primer with 25% hydroxyethyl methacrylate, suggesting a barely visible hybrid layer barrier. The control specimens without the application of the primer and the primer specimens with no hydroxyethyl methacrylate exhibited the lowest strength values (8.30 MPa and 11.78 MPa) with intermittent and low visibility of the hybrid layer. These results were supported by finite element analysis that suggested an evenly distributed stress on the model with 25% hydroxyethyl methacrylate.

    CONCLUSIONS: Different compositions of experimental silane primers affected the formation of the hybrid layer and its resulting bond strength.

  7. Triple-layered PLGA/nanoapatite/lauric acid graded composite membrane for periodontal guided bone regeneration
    Jamuna-Thevi K, Saarani NN, Abdul Kadir MR, Hermawan H
    Mater Sci Eng C Mater Biol Appl, 2014 Oct;43:253-63.
    PMID: 25175212 DOI: 10.1016/j.msec.2014.07.028
    This paper discusses the successful fabrication of a novel triple-layered poly(lactic-co-glycolic acid) (PLGA)-based composite membrane using only a single step that combines the techniques of solvent casting and thermally induced phase separation/solvent leaching. The resulting graded membrane consists of a small pore size layer-1 containing 10 wt% non-stoichiometric nanoapatite (NAp)+1-3 wt% lauric acid (LA) for fibroblastic cell and bacterial inhibition, an intermediate layer-2 with 20-50 wt% NAp+1 wt% LA, and a large pore size layer-3 containing 30-100 wt% NAp without LA to allow bone cell growth. The synergic effects of 10-30 wt% NAp and 1 wt% LA in the membrane demonstrated higher tensile strength (0.61 MPa) and a more elastic behavior (16.1% elongation at break) in 3 wt% LA added membrane compared with the pure PLGA (0.49 MPa, 9.1%). The addition of LA resulted in a remarkable plasticizing effect on PLGA at 3 wt% due to weak intermolecular interactions in PLGA. The pure and composite PLGA membranes had good cell viability toward human skin fibroblast, regardless of LA and NAp contents.
  8. Geometric variable designs of cam/post mechanisms influence the kinematics of knee implants
    Fallahiarezoodar A, Abdul Kadir MR, Alizadeh M, Naveen SV, Kamarul T
    Knee Surg Sports Traumatol Arthrosc, 2014 Dec;22(12):3019-27.
    PMID: 25149643 DOI: 10.1007/s00167-014-3227-7
    PURPOSE: Reproducing the femoral rollback through specially designed mechanism in knee implants is required to achieve full knee function in total knee arthroplasty. Most contemporary implants use cam/post mechanism to replace the function of Posterior Cruciate Ligament. This study was aimed to determine the most appropriate cam and post designs to produce normal femoral rollback of the knee.

    METHODS: Three different cams (triangle, ellipse, and circle) and three different posts (straight, convex, concave) geometries were considered in this study and were analysed using kinematic analyses. Femoral rollback did not occur until reaching 50° of knee flexion. Beyond this angle, two of the nine combinations demonstrate poor knee flexion and were eliminated from the study.

    RESULTS: The combination of circle cam with concave post, straight post and convex post showed 15.6, 15.9 and 16.1 mm posterior translation of the femur, respectively. The use of ellipse cam with convex post and straight post demonstrated a 15.3 and 14.9 mm femoral rollback, whilst the combination of triangle cam with convex post and straight post showed 16.1 and 15.8 mm femoral rollback, respectively.

    CONCLUSION: The present study demonstrates that the use of circle cam and convex post created the best femoral rollback effect which in turn produces the highest amount of knee flexion. The findings of the study suggest that if the design is applied for knee implants, superior knee flexion may be possible for future patients.

    LEVEL OF EVIDENCE: IV.

  9. Polydopamine as an intermediate layer for silver and hydroxyapatite immobilisation on metallic biomaterials surface
    Saidin S, Chevallier P, Abdul Kadir MR, Hermawan H, Mantovani D
    Mater Sci Eng C Mater Biol Appl, 2013 Dec 1;33(8):4715-24.
    PMID: 24094179 DOI: 10.1016/j.msec.2013.07.026
    Hydroxyapatite (HA) coated implant is more susceptible to bacterial infection as the micro-structure surface which is beneficial for osseointegration, could also become a reservoir for bacterial colonisation. The aim of this study was to introduce the antibacterial effect of silver (Ag) to the biomineralised HA by utilising a polydopamine film as an intermediate layer for Ag and HA immobilisation. Sufficient catechol groups in polydopamine were required to bind chemically stainless steel 316 L, Ag and HA elements. Different amounts of Ag nanoparticles were metallised on the polydopamine grafted stainless steel by varying the immersion time in silver nitrate solution from 12 to 24 h. Another polydopamine layer was then formed on the metallised film, followed by surface biomineralisation in 1.5 Simulated Body Fluid (SBF) solution for 3 days. Several characterisation techniques including X-Ray Photoelectron Spectroscopy, Atomic Force Microscopy, Scanning Electron Microscopy and Contact Angle showed that Ag nanoparticles and HA agglomerations were successfully immobilised on the polydopamine film through an element reduction process. The Ag metallisation at 24 h has killed the viable bacteria with 97.88% of bactericidal ratio. The Ag was ionised up to 7 days which is crucial to prevent bacterial infection during the first stage of implant restoration. The aged functionalised films were considered stable due to less alteration of its chemical composition, surface roughness and wettability properties. The ability of the functionalised film to coat complex and micro scale metal make it suitable for dental and orthopaedic implants application.
  10. Finite element analysis of zygomatic implants in intrasinus and extramaxillary approaches for prosthetic rehabilitation in severely atrophic maxillae
    Ishak MI, Kadir MR, Sulaiman E, Kasim NH
    Int J Oral Maxillofac Implants, 2013 May-Jun;28(3):e151-60.
    PMID: 23748334 DOI: 10.11607/jomi.2304
    To compare the extramaxillary approach with the widely used intrasinus approach via finite element method.
  11. Fulltext Mechanical, rheological, and bioactivity properties of ultra high-molecular-weight polyethylene bioactive composites containing polyethylene glycol and hydroxyapatite
    Ahmad M, Uzir Wahit M, Abdul Kadir MR, Mohd Dahlan KZ
    ScientificWorldJournal, 2012;2012:474851.
    PMID: 22666129 DOI: 10.1100/2012/474851
    Ultrahigh-molecular-weight polyethylene/high-density polyethylene (UHMWPE/HDPE) blends prepared using polyethylene glycol PEG as the processing aid and hydroxyapatite (HA) as the reinforcing filler were found to be highly processable using conventional melt blending technique. It was demonstrated that PEG reduced the melt viscosity of UHMWPE/HDPE blend significantly, thus improving the extrudability. The mechanical and bioactive properties were improved with incorporation of HA. Inclusion of HA from 10 to 50 phr resulted in a progressive increase in flexural strength and modulus of the composites. The strength increment is due to the improvement on surface contact between the irregular shape of HA and polymer matrix by formation of mechanical interlock. The HA particles were homogenously distributed even at higher percentage showed improvement in wetting ability between the polymer matrix and HA. The inclusion of HA enhanced the bioactivity properties of the composite by the formation of calcium phosphate (Ca-P) precipitates on the composite surface as proven from SEM and XRD analysis.
  12. Effects of different implant-abutment connections on micromotion and stress distribution: prediction of microgap formation
    Saidin S, Abdul Kadir MR, Sulaiman E, Abu Kasim NH
    J Dent, 2012 Jun;40(6):467-74.
    PMID: 22366313 DOI: 10.1016/j.jdent.2012.02.009
    The aim of this study was to analyse micromotion and stress distribution at the connections of implants and four types of abutments: internal hexagonal, internal octagonal, internal conical and trilobe.
  13. Biomechanical analysis of the wrist arthroplasty in rheumatoid arthritis: a finite element analysis
    Bajuri MN, Abdul Kadir MR, Murali MR, Kamarul T
    Med Biol Eng Comput, 2013 Feb;51(1-2):175-86.
    PMID: 23124814 DOI: 10.1007/s11517-012-0982-9
    The total replacement of wrists affected by rheumatoid arthritis (RA) has had mixed outcomes in terms of failure rates. This study was therefore conducted to analyse the biomechanics of wrist arthroplasty using recently reported implants that have shown encouraging results with the aim of providing some insights for the future development of wrist implants. A model of a healthy wrist was developed using computed tomography images from a healthy volunteer. An RA model was simulated based on all ten general characteristics of the disease. The ReMotion ™ total wrist system was then modelled to simulate total wrist arthroplasty (TWA). Finite element analysis was performed with loads simulating the static hand grip action. The results show that the RA model produced distorted patterns of stress distribution with tenfold higher contact pressure than the healthy model. For the TWA model, contact pressure was found to be approximately fivefold lower than the RA model. Compared to the healthy model, significant improvements were observed for the TWA model with minor variations in the stress distribution. In conclusion, the modelled TWA reduced contact pressure between bones but did not restore the stress distribution to the normal healthy condition.
  14. Biomechanical analysis of rheumatoid arthritis of the wrist joint
    Bajuri MN, Kadir MR, Amin IM, Ochsner A
    Proc Inst Mech Eng H, 2012 Jul;226(7):510-20.
    PMID: 22913098 DOI: 10.1177/0954411912445846
    The wrist is the most complex joint for virtual three-dimensional simulations, and the complexity is even more pronounced when dealing with skeletal disorders of the joint such, as rheumatoid arthritis (RA). In order to analyse the biomechanical difference between healthy and diseased joints, three-dimensional models of these two wrist conditions were developed from computed tomography images. These images consist of eight carpal bones, five metacarpal bones, the distal radius and ulna. The cartilages were developed based on the shape of the available articulations and ligaments were simulated via mechanical links. The RA model was developed accurately by simulating all ten common criteria of the disease related to the wrist. Results from the finite element (FE) analyses showed that the RA model produced three times higher contact pressure at the articulations compared to the healthy model. Normal physiological load transfer also changed from predominantly through the radial side to an increased load transfer approximately 5% towards the ulnar. Based on an extensive literature search, this is the first ever reported work that simulates the pathological conditions of the rheumatoid arthritis of the wrist joint.
  15. Finite element analysis of different surgical approaches in various occlusal loading locations for zygomatic implant placement for the treatment of atrophic maxillae
    Ishak MI, Abdul Kadir MR, Sulaiman E, Abu Kasim NH
    Int J Oral Maxillofac Surg, 2012 Sep;41(9):1077-89.
    PMID: 22575179 DOI: 10.1016/j.ijom.2012.04.010
    The aim of this study was to compare two different types of surgical approaches, intrasinus and extramaxillary, for the placement of zygomatic implants to treat atrophic maxillae. A computational finite element simulation was used to analyze the strength of implant anchorage for both approaches in various occlusal loading locations. Three-dimensional models of the craniofacial structures surrounding a region of interest, soft tissue and framework were developed using computed tomography image datasets. The implants were modelled using computer-aided design software. The bone was assumed to be linear isotropic with a stiffness of 13.4 GPa, and the implants were assumed to be made of titanium with a stiffness of 110 GPa. Masseter forces of 300 N were applied at the zygomatic arch, and occlusal loads of 150 N were applied vertically onto the framework surface at different locations. The intrasinus approach demonstrated more satisfactory results and could be a viable treatment option. The extramaxillary approach could also be recommended as a reasonable treatment option, provided some improvements are made to address the cantilever effects seen with that approach.
  16. Mechanical and microarchitectural analyses of cancellous bone through experiment and computer simulation
    Syahrom A, Abdul Kadir MR, Abdullah J, Öchsner A
    Med Biol Eng Comput, 2011 Dec;49(12):1393-403.
    PMID: 21947767 DOI: 10.1007/s11517-011-0833-0
    The relationship between microarchitecture to the failure mechanism and mechanical properties can be assessed through experimental and computational methods. In this study, both methods were utilised using bovine cadavers. Twenty four samples of cancellous bone were extracted from fresh bovine and the samples were cleaned from excessive marrow. Uniaxial compression testing was performed with displacement control. After mechanical testing, each specimen was ashed in a furnace. Four of the samples were exemplarily scanned using micro-computed tomography (μCT) and three dimensional models of the cancellous bones were reconstructed for finite element simulation. The mechanical properties and the failure modes obtained from numerical simulations were then compared to the experiments. Correlations between microarchitectural parameters to the mechanical properties and failure modes were then made. The Young's modulus correlates well with the bone volume fraction with R² = 0.615 and P value 0.013. Three different types of failure modes of cancellous bone were observed: oblique fracture (21.7%), perpendicular global fracture (47.8%), and scattered localised fracture (30.4%). However, no correlations were found between the failure modes to the morphological parameters. The percentage of error between computer predictions and the actual experimental test was from 6 to 12%. These mechanical properties and information on failure modes can be used for the development of synthetic cancellous bone.
  17. Biomechanical and bioactivity concepts of polyetheretherketone composites for use in orthopedic implants-a review
    Abdullah MR, Goharian A, Abdul Kadir MR, Wahit MU
    J Biomed Mater Res A, 2015 Nov;103(11):3689-702.
    PMID: 25856801 DOI: 10.1002/jbm.a.35480
    The use of polyetheretherketone (PEEK) composites in the trauma plating system, total replacement implants, and tissue scaffolds has found great interest among researchers. In recent years (2008 afterward), this type of composites has been examined for suitability as substitute material over stainless steel, titanium alloys, ultra high molecular weight polyethylene, or even biodegradable materials in orthopedic implant applications. Biomechanical and bioactivity concepts were contemplated for the development of PEEK orthopedic implants and a few primary clinical studies reported the clinical outcomes of PEEK-based orthopedic implants. This study aims to review and discuss the recent concepts and contribute further concepts in terms of biomechanical and bioactivity challenges for the development of PEEK and PEEK composites in orthopedic implants.
  18. Fulltext In vitro evaluation of bioactivity of chemically deposited hydroxyapatite on polyether ether ketone
    Almasi D, Izman S, Sadeghi M, Iqbal N, Roozbahani F, Krishnamurithy G, et al.
    Int J Biomater, 2015;2015:475435.
    PMID: 25838826 DOI: 10.1155/2015/475435
    Polyether ether ketone (PEEK) is considered the best alternative material for titanium for spinal fusion cage implants due to its low elasticity modulus and radiolucent property. The main problem of PEEK is its bioinert properties. Coating with hydroxyapatite (HA) showed very good improvement in bioactivity of the PEEK implants. However the existing methods for deposition of HA have some disadvantages and damage the PEEK substrate. In our previous study a new method for deposition of HA on PEEK was presented. In this study cell proliferation of mesenchymal stem cell and apatite formation in simulated body fluid (SBF) tests were conducted to probe the effect of this new method in improvement of the bioactivity of PEEK. The mesenchymal stem cell proliferation result showed better cells proliferation on the treated layer in comparison with untreated PEEK. The apatite formation results showed the growth of the HA on the treated PEEK but there was not any sight of the growth of HA on the untreated PEEK even after 2 weeks. The results showed the new method of the HA deposition improved the bioactivity of the treated PEEK in comparison with the bare PEEK.
  19. The effects of additional hollow cylinder coated to external fixator screws for treating pilon fracture: A biomechanical perspective
    Ramlee MH, Seng GH, Ros Felip A, Abdul Kadir MR
    Injury, 2021 Aug;52(8):2131-2141.
    PMID: 33745700 DOI: 10.1016/j.injury.2021.03.017
    An external fixator is a promising medical device that could provide optimum stability and reduce the rate of complications in treating bone fracture during intervention period. It is noted that the biomechanics behaviour of device can be altered by introducing more features such as material suitability and additional components. Therefore, this study was conducted via finite element method to investigate the effects of additional hollow cylinder coated with external fixator screws in treating Type III pilon fracture. Finite element models which have been validated with experimental data were used to simulate stresses at the pin-bone interface and relative micromovement at interfragmentary fractures during swing (70 N load) and stance phases (350 N load). All bones and external fixators were assigned with isotropic material properties while the cartilages were simulated with hyper-elastic. For the hollow cylinder, polyethylene was assigned due to its properties which are equivalent to the bone. From the results, it is found that stresses at the pin-bone interface for the coated screws were reduced to 54% as compared to the conventional fixator. For the micromovement, there was no difference between both models, whereby the value was 0.03 mm. The results supported previously published literature, in which high stresses are unavoidable at the interface, fortunately, those stresses did not exceed the ultimate strength of bone, which is safe for treating patients. In conclusion, if patients are allowed to bear weight bearing, the external fixator with coated screws is a more favourable option to be fixed into the bone to avoid complications at the interface.
  20. Finite element analysis of the wrist in stroke patients: the effects of hand grip
    Ramlee MH, Beng GK, Bajuri N, Abdul Kadir MR
    Med Biol Eng Comput, 2018 Jul;56(7):1161-1171.
    PMID: 29209961 DOI: 10.1007/s11517-017-1762-3
    The provision of the most suitable rehabilitation treatment for stroke patient remains an ongoing challenge for clinicians. Fully understanding the pathomechanics of the upper limb will allow doctors to assist patients with physiotherapy treatment that will aid in full arm recovery. A biomechanical study was therefore conducted using the finite element (FE) method. A three-dimensional (3D) model of the human wrist was reconstructed using computed tomography (CT)-scanned images. A stroke model was constructed based on pathological problems, i.e. bone density reductions, cartilage wane, and spasticity. The cartilages were reconstructed as per the articulation shapes in the joint, while the ligaments were modelled using linear links. The hand grip condition was mimicked, and the resulting biomechanical characteristics of the stroke and healthy models were compared. Due to the lower thickness of the cartilages, the stroke model reported a higher contact pressure (305 MPa), specifically at the MC1-trapezium. Contrarily, a healthy model reported a contact pressure of 228 MPa. In the context of wrist extension and displacement, the stroke model (0.68° and 5.54 mm, respectively) reported a lower magnitude than the healthy model (0.98° and 9.43 mm, respectively), which agrees with previously reported works. It was therefore concluded that clinicians should take extra care in rehabilitation treatment of wrist movement in order to prevent the occurrence of other complications. Graphical abstract ᅟ.
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