Numerical analysis of gait load distribution in the human pelvis and design of a biomechanical testing device: experimental assessment of two implants for anterior fragility fractures

Field: Engineering (Physical Sciences)

The current project research was conducted at the University of Luxembourg in cooperation with orthopaedic surgeons from the Centre Hospitalier de Luxembourg and the Universitätsklinikum des Saarlandes. The main objective was to investigate the gait load distribution in the human pelvis and the influence of the stiffness of the pubic symphysis and the sacroiliac joints on this force transmission in order to numerically and experimentally assess the stability provided by two reconstruction systems for anterior fragility fractures. To begin with, the global approach consisted in combining inverse dynamics and finite element methods to investigate physiological loadings applied to the pelvis during the gait cycle. Then, an experimental test bench was designed to reproduce those gait conditions on artificial pelvises for biomechanical assessment of different systems used for fragility fractures of the pelvis. At first, muscles forces and joint contact forces from the gait applied to the pelvis were calculated by inverse dynamics with an experimentally validated musculoskeletal model. Implementation in a finite element model including bones and joints of the pelvis highlighted that superior rami experience the highest stresses. Fracture of a superior ramus changed the initial load distribution by increasing the stresses at the inferior ramus and on the posterior structures. Combination of superior and inferior rami fractures on the same side redirected the forces backwards and showed high stresses on the sacral alae where compression fractures are commonly seen clinically. Reconstruction devices showed differences in stability at early stage of healing with benefits provided by the iliopubic subcutaneous plate. No noticeable differences compared to the Supra-Acetabular External Fixator were seen during later healing. Regarding the influence of the joint stiffness on the load distribution in a healthy pelvis, an increase of PS stiffness redirected loads to the anterior pelvis whereas an increase of PS laxity redirected loads to the posterior structures. A fusion of the sacroiliac joints did not show noticeable changes in the normal load distribution. Following the computational investigation, an experimental test bench was designed with numerical engineering tools. The biomechanical setup aimed at reproducing loadings observed during previously studied moments of the gait on artificial pelvises with fused joints. Static loadings and cyclic loadings were performed on artificial pelvises with and without reconstruction devices: first with a superior ramus fracture only and then with superior and inferior rami fractures. The Supra-Acetabular External Fixator and the iliopubic subcutaneous plate did not show any significant stability difference when a superior ramus fracture is considered. When including the inferior ramus fracture on the same side, the iliopubic subcutaneous plate significantly improved the stability of the reconstructed pelvis by reducing IV the displacement of the superior fracture, contrary to the Supra-Acetabular External Fixator that did not show any improvement. For both configurations, no fatigue phenomenon was observed during cyclic loadings simulating four days of walking for a patient (5 000 cycles). There is no conflict of interest related to this work.