UNIT-III

BIOSOLID MECHANICS

Solid mechanics is the branch of mechanics that studies the behavior of solid materials

Solid Mechanics Deals with

• Motion and deformation of material under action of

• Force

• Temperature change

• Phase change

• Other external or internal agents These changes lead us to some properties that are called Mechanical
properties

Mechanical properties

Some of the Mechanical Properties

• Ductility

• Hardness

• Impact resistance

• Fracture toughness

• Elasticity

• Fatigue strength

• Endurance limit

• Creep resistance

• Strength of material

Solid Mechanics:

A force arises from the action (or reaction) of one body on another.

Newton’s third law tells us that the action and reaction forces in this situation (and generally) are equal and
opposite.

The SI unit of force is the newton (N).

The moment of a force about a point is equal to the product of the magnitude of the force and the perpendicular
distance from the point to the line of action of the force.

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Elastic Materials:

Elasticity is the tendency of solid materials to return to their original shape after being forces are applied on
them.

When the forces are removed, the object will return to its original shape and size if the material is elastic

In other words, the deformation disappears completely, after removal of external forces.

Elastin and collagen are the two main components of elastic tissues and provide the tissue with elasticity and
mechanical strength, respectively.

Elastin is an extracellular matrix protein that lends elasticity and resilience to tissues such as the arteries, lungs,
tendons, skin, and ligaments. Elastic fibers have two components, one of which is encoded by the ELN gene.

Whereas collagen is adequately produced in vitro, Collagen is the most abundant protein in the human body,
found in the bones, muscles, skin, and tendons. It is the substance that holds the body together. Collagen forms
a scaffold to provide strength and structure. Production of elastin in tissue-engineered constructs is often
inadequate when engineering elastic tissues. Therefore, elasticity has to be artificially introduced into tissue-
engineered scaffolds. The elasticity of scaffold materials can be attributed to either natural sources, when native
elastin or recombinant techniques are used to provide natural polymers, or synthetic sources, when polymers are
synthesized. While synthetic elastomers often lack the biocompatibility needed for tissue engineering
applications, the production of natural materials in adequate amounts or with proper mechanical strength
remains a challenge. However, combining natural and synthetic materials to create hybrid components could
overcome these issues. This review explains the synthesis, mechanical properties, and structure of native elastin
as well as the theories on how this extracellular matrix component provides elasticity in vivo.

Mechanical Properties

 Ductility: ductility is a solid material's ability to deform under tensile stress.

 Hardness of a material may refer to resistance to bending, scratching, abrasion or cutting.
 Impact resistance is the ability of a material to withstand a high force or shock applied to it over a short
period of time
 Plasticity: ability of a material to deform permanently by the application of force
 Fracture toughness is a property which describes the ability of a material containing a crack to resist
fracture
 Elasticity is the tendency of solid materials to return to their original shape after being deformed
 Endurance strength/ Fatigue strength: The highest stress that a material can withstand for a given
number of cycles without breaking —called also endurance strength
 Endurance limit: In fatigue testing, the maximum stress which can be applied to a material for an infinite
number of stress cycles without resulting in failure of the material is called Endurance limit
 Creep Resistance: It’s the ability of a material not to deform permanently or slowly under the influence
of Mechanical Stress. Creep means Deformation

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Biosolid Mechanics:

In many cases, elastic constitutive models work well when time dependent effects can be neglected. However,
in those cases when time dependent effects cannot be neglected, we will need to utlize different constitutive
models. Basically, time dependent effects indicate that the stress-strain behavior of a material will change with
time. The classic material model for time dependent effects is viscoelasticity. As the name implies,
viscoelasticity incorporates aspects of both fluid behavior (viscous) and solid behavior (elastic).

Characteristics of a Viscoelastic Material:

Just like for elastic models, there are specific characteristics for viscoelastic models. These characteristics set
viscoelastic models distinctly apart from elastic models. Most notably, we know that elastic materials store
100% of the energy due to deformation. However, viscoelastic materials do not store 100% of the energy under
deformation, but actually lose or dissipate some of this energy. This dissipation is also known as hysteresis.
Hysteresis explicitly requires that the loading portion of the stress strain curve must be higher than the
unloading curve. Thus, from a stress-strain curve we can see the hysteresis as the area between the loading and
unloading curve:

The ability to dissipate energy is one of the main reasons for using viscoelastic materials for any application to
cushion shock, from running shoes to packing materials. The two other main characteristics associated with
viscoelastic materials are stress relaxation and creep. Stress relaxation refers to the behavior of stress reaching a
peak and then decreasing or relaxing over time under a fixed level of strain, as shown below:

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Creep is in some sense the inverse of stress relaxation, and refers to the general characteristic of viscoelastic
materials to undergo increased deformation under a constant stress, until an asymptotic level of strain is
reached, as shown below:

Any materials that exhibit hysteresis, creep or stress relaxation can be considered viscoelastic materials. In
comparison, elastic materials do not exhibit energy dissipation or hysteresis as their loading and unloading
curve is the same. Indeed, the fact that all energy due to deformation is stored is a characteristic of elastic
materials. Furthermore, under fixed stress elastic materials will reach a fixed strain and stay at that level. Under
fixed strain, elastic materials will reach a fixed stress and stay at that level with no relaxation.

Mechanical Analogs for Viscoelastic Materials:

The classic description and way to derive viscoelastic consitutive models is through the use of mechanical
analogs. These are simple mechanical models for fluid and solid representations that are put together to produce
viscoelastic effects. The simplest mechanical analog for a linear elastic material is a spring:

The simple constitutive relationship for a spring relates the force (and stress by extension when force is divided
by area) to the elongation or displacement (and strain by extension when displacement is normalized by length
of the spring):

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where Fs is the spring force, E is the elastic modulus of the spring, and us represents the spring displacment.
The mechanical analog for a Newtonian fluid is a dashpot. The simple constitutive relationship for a dashpot
indicates that the force in the fluid depends on the rate the dashpot is displaced, or equivalently the velocity of
the dashpot.

Also, the constitutive parameter that relates force (stress) to displacement rate (strain rate) is viscosity, which we

denote as . Thus, the constitutive equation for a fluid may be written as:

where the dot over the u in the equation indicates differentiation with respect to time and the superscript d
denotes "dashpot".

By making various combinations of spring and dashpot models, we can simulate the behavior of a viscoelastic
material, including stress relaxation and creep.

The simplest combination of the spring and dashpot is to put the spring in series with the dashpot:

This combination is known as the Maxwell model. As we will see, this model actually represents a fluid since it
relaxes completely to zero stress and undergoes creep indefinitely. To derive the constitutive relation, we note
first examine the kinematics of the model. It is clear from the geometry of the model that the total displacement
will be the spring displacement plus the dashpot displacement:

However, the constitutive displacement for the dashpot is written in terms of the dashpot displacement
differentiated with respect to time. Thus, to be consistent, we will differentiate the above expression for the total
displacement with respect to time. This gives:

We need to determine both the displacement rate for the solid and the fluid. For the fluid, we simply rearrange
the fluid constitutive equation:

To get the solid displacement rate, we first rearrange the constitutive equation for the spring:

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we then differentiate this constitutive relationship with respect to time to obtain:

since E does not depend on time. Putting these together we get the total displacement rate as:

By normalizing the force by area and the displacement by length, we can get the analogous stress-strain relation
as:

were the s and d superscripts have been dropped. We also have the following dimensions for the spring constant
E and the viscosity

If we assume constants q1, p0 and p1, we can rewrite the above equation as:

where the constants are defined as:

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Now, let us consider the behavior of a Maxwell material under conditions of both fixed strain and fixed stress.
We assume that strain and stress can be applied instantaneously to a fixed level. In reality, instantaneous stress
or strain cannot be reached, but we assume that in the limit, for example, if the test is run long enough, that the
stress or strain can be considered to be reached instantaneously. We start with the response to an instantaneous
strain that is then held constant over time:

In this case, the rate of change of strain is zero. Thus the equation for the Maxwell material becomes:

To solve for the stress under fixed strain for a Maxwell material, we need to solve the ordinary differential
equation in time. To do this, we can again use the symbolic toolbox in MATLAB. First, we divide through by
p1 to obtain:

We can then use the dsolve option in the MATLAB symbolic toolbox to solve the ordinary differential equation
in time

MATLAB returns a constant C1 which is an integration constant. We can write the equation as:

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To solve for the integration constant C1, we need to determine the initial condition at time t = 0+ on the stress.
To do this, we need to integrate the Maxwell constitutive equation from time t = 0- to some short time t = tn just
after the strain is applied:

The integration gives us:

we know that at t = 0- is 0 and at t = tn is 0. Also, at t = 0- is 0 and at t = tn is 0. For the last

term, we assume that tn is a small number. As we keep ramping up in shorter and shorter times, in the limit we
approach tn = 0+, a nearly instantaneously applied strain. In this case,

This means the last term in the integration is zero and we are left with:

Thus, if we substitute in the initial condition to the solution of the Maxwell model constitutive equation we
obtain the constant C1:

Thus, we have the general solution for the Maxwell model under a step strain as:

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or if we write the constants in terms of the spring modulus and dashpot viscosity:

Now if we divide the stress as a function of time by the initial strain, we obtain the stress relaxation
function G(t) for the Maxwell model:

This is a characteristic function that tells us how the stress relaxes for a given material. If we plot the the stress
relaxation versus time we obtain the general curve:

Note that the stress completely relaxes out over time. This is actually characteristic of a viscoelastic fluid rather
than a viscoelastic solid. Finally, we note that the ratio /E gives us a dimension of time. This is a characteristic
time of the material denoted as the relaxation time, and defined as:

Using the relaxation time, we can rewrite the relaxation function as:

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Now let us consider the response of the Maxwell model to a unit step stress:

In this case, a stress 0 is applied "instantaneously" and then kept constant over time. Thus, the rate of change
of stress is zero and the Maxwell constitutive model becomes:

We can solve the above equation simply by integrating with respect to time. We can also do this in MATLAB

or:

where again C1 is a constant of integration that we need to determine from initial conditions. Given the initial
conditions derived before, we obtain:

This gives the strain versus time under a unit step stress as:

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Similar to the stress relaxation, we can define a creep function J(t) by dividing the strain versus time reponse by
the initial unit step stress. This gives the creep function Jas:

Note that the above equation will give a constantly increasing strain as a function of t:

This is also not characteristic of a viscoelastic solid, since we expect that the creep will reach an asymptotic
level after a certain time.

Although the Maxwell model did not give us a realistic result for a viscoelastic solid (it is more representative
of a viscoelastic fluid) it did allow us to illustrate some important aspects of a viscoelastic material including the
stress relaxation function G(t) and the creep function J(t). We next consider another mechanical analog for a
viscoelastic material, the Voight model, also known as the Kelvin-Voight model. Its geometry is shown below:

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Again, we can make observations based on the geometry of the model. First, we note that the dashpot will
constrain the spring to have the same deformation:

Second, we note that the total force F in the Voight model will be equal to the force in the dashpot plus the force
in the spring:

We can substitute the force-displacement relationship for the spring, and the force displacement relationship for
the dashpot to give:

By analogy, we can write a stress-strain differential equation as:

The above equation again illustrates an important characteristic of viscoelastic materials, namely that the stress
in the material depends not only on the strain, but also on the strain rate.

Let's now see how the Voight model responds to a unit step stress and strain. First, we consider the unit step
strain again:

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For this step strain, we again need to integrate the Voight constitutive equation to obtain the initial conditions:

For the last term in the integral, we have:

For the second term, we have:

If we look at the first term, it will give us the area under the stress versus time curve. This area must have a
limit, otherwise we would have infinite stress. Thus, in the limit as the time becomes very short, the area must
have a finite value. This is given by the delta function (not to be confused with the kronecker delta), which has
the property:

Thus, we have the following initial condition for a step strain test:

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which gives us the following stress versus time response:

This gives a stress relaxation function as:

This gives a stress relaxation function as:

This function gives instantaneous stress relaxation due to the presence of the dashpot.

Next, let us consider the response of the Voight model to a unit step stress:

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We again solve the differential equation in time for the Voight model using MATLAB. To get the equation into
a form we can use for MATLAB, we first divide through by the viscosity and recognize that the stress is
constant 0 to get:

We can then solve this equation in MATLAB:

or, in other words:

where again C1 is a constant of integration. To determine the constant C1, we again need to use the initial
condition. In this case, under an instantaneously applied stress, the dashpot cannot move instantaneously. Thus,
this means that there will be no displacement and therefore the strain at time t = 0 will be zero. Pluggin this
initial condition into the above equation gives:

This give us the solution:

If we divide the above by 0, we obtain the creep function J:

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The above function gives us a strain versus time plot as shown below:

Note that no instantaneous elastic deformation is possible due to the restraint of the dashpot.

Note that if we rearrange the above equation we can write the strain as a function of time and the initial stress
as:

Note that as mentioned before the dashpot does not allow instantaneous deformation to occur, but overtime the
displacement creeps to an asymptotic level.

Linear elastic:

The simplest approach to elasticity is linear-elasticity. This is a property that means that the relationship
between stress and strain in the material is linear. Before a certain strain level, (sometimes small, sometimes
pretty big) materials tend to “start” their strain-stress behavior win a linear way. Often, it’s only the question at
which strain level materials stop being linearly elastic. When this “limit strain” is reached material will either
break, yield (which means it’s not elastic anymore) or it will start behaving in a nonlinear elastic way.

I think that it’s best to discuss linear elasticity on brittle materials (like glass). Then, the stress-strain relation
looks like this:

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Linear elastic:

Brittle materials are not the only ones you can describe with linear elasticity. However, for the rest, it might be a
bit more tricky! I would say that there is a big group of materials (like metals) that are linear elastics “up to a
point” and then… they start behaving in a nonlinear way!

The classical example for me would be the structural steel.

Note that it has a very long linear elastic part. It ends slightly before yielding starts. Of course, it is often
assumed that it’s linear elastic up to yielding. To me, it’s accurate “enough”! This means that I use the linear
elastic property until the material reaches the yield limit. This is a pretty significant portion of the stress-strain
curve. This means that steel is a nice material to model with linear elasticity, as long as you don’t reach strains
(and stresses) that would cause yielding.

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Not linear… but still elastic!

This is a fun category. I would include plastics and foams here. As I mentioned before, steel has a small section
“just before yielding” where it’s not linearly elastic anymore. But this “spot” is so small that we can easily
ignore it. The similar thing happens with plastics, but there, the zone is so big you just can’t “ignore it”!

You could argue that in the plastics there is no “linear elastic” part but of course, it’s only the problem of
accuracy. After all plastic parts are analyzed using linear elastic parameters as well. It’s clear, that the nonlinear
elastic material should be used, but instead, there are two other possibilities: tangent and secant rigidity.

What you do in this case is pretty simple. You can either assume that at the very beginning the material stiffness
is “ok”. In such a case you will use the tangent stiffness. However, if you expect that the strains will be high
(i.e. close to the start of yielding), then “tangent” stiffness isn’t very accurate. Instead, you could use the secant
stiffness. This one is better for higher strains but shows too soft material behavior beforehand.

All in all both approaches aren’t great, but sometimes they may be sufficient. This is the point where actually
using nonlinear elastic material model may come in handy. Similarly to steel discussed before, yielding will
take place here as well, making the material model pretty interesting… assuming you want to go so far with
stresses and strains in your design.

Nonlinear elastic:

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The previous model may look very complex, but that’s not all. There is another material group I want to
mention here, and those would be foams. There are more interesting, mostly because certain types of foam
never yield. This means that their entire behavior is elastic.

In the above, using tangent or secant stiffness doesn’t look appealing right? I mean sure, if you are somewhere
pretty close to the beginning, maybe there is an argument to be made… but it wouldn’t be the best one!

You see, the foam is elastic. It means that when compressed and then released, will return to its original shape
without any permanent deformations. But it’s not the same “elastic” as in case of the elastic range for steel
element. When the load is taken away from a steel member loaded within the elastic range it behaves differently

Anisotropy:

Anisotropy is the property of substances to exhibit variations in physical properties along different molecular
axes. It is seen in crystals, liquid crystals and, less commonly, in liquids.

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For example, consider the primitive cubic crystal lattice structure shown here. In this instance, all of the atoms
are of the same element.

To recognize this structure's anisotropy, consider the distances A-B, A-C and A-D; they are all different.

If the A-B distance is 1 unit, A-C is √2 units, and A-D is √3 units.

Viewing the structure along an axis following the direction A-B looks different from along an axis following
the directions A-C or A-D. This leads to different physical and mechanical properties in a single crystal along
the different axes: examples are different electrical and thermal conductivity and light polarization.

In amorphous materials, such as glass, no long-range order exists; properties are identical in all directions; these
are isotropic materials.

Anisotrophy in Bones:

The bone tissue is strong and one of the most rigid structures of the body due to its combination of inorganic
and organic elements. The minerals calcium and phosphate, together with collagen, constitute the organic
element of the bone being responsible for approximately 60 to 70% of the bone tissue. Water constitutes
approximately 25 to 30% of the bone tissue weight. The bone tissue is a viscous-elastic material whose
mechanical properties are affected by its deformation grade. The flexibility properties of the bone are provided
by the collagen material of the bone. The collagen content gives the bone the ability to support tense loads. The
bone is also a fragile material and its force depends on the load mechanism. The fragility grade of the bone
depends on the mineral constituents that give it the ability to support compressive loads. Re-absorption and
Bone Deposit - Bone is a highly adaptive material and very sensitive to disuse, immobilization or vigorous
activity and high load levels. The bone tissue can be separated and may change its properties and setting in
response to the mechanical demand.

Bone strength and hardness:

The behavior of any material under different load conditions is determined by its strength and hardness. When
an external force is applied in a bone or in any other material, there is an internal reaction. The strength may be
assessed by checking the relation between the load imposed (external force) and the quantity of deformation
(internal reaction) that takes place in the material, known as load-deformation curve. Anisotropic
Characteristics Bone tissue -Is an anisotropic material, indicating that the bone behavior will change depending

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on the direction of the load application. In general, the bone tissue may lead to higher loads in the longitudinal
direction and a lesser quantity of load when applied over the bone surface. The bone is strong to support loads
in the longitudinal direction because it is used to receive loads in this direction.

Viscoelastic Characteristics - The bone is also viscoelastic, which means that it responds differently depending
on the speed to which the load is applied and the length of the load.

This mean section of the proximal tip of the femur shows both the compact bone and the sponge bone. The
dense compact bone covers the external part of the bone, going downside in order to form the bone body. The
sponge bone is found in the tips and is identified by its truss appearance. Watch for the curvature in the
trabeculae, which is formed to support the stresses.

The bone is considered anisotropic because it responds differently when the forces are applied in different
directions. (A) The bone can lead to great forces applied in the longitudinal direction. (B) The bone is strong
when it leads with forces applied transversally crossing its surface.

The behavior of any material under different load conditions is determined by its strength and hardness. When
an external force is applied in a bone or in any other material, there is an internal reaction. The strength may be
assessed by checking the relation between the load imposed (external force) and the quantity of deformation
(internal reaction) that takes place in the material, known as load-deformation curve.
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In Fig The bone is considered viscoelastic because it responds differently when it receives loads in different
speeds. (A) When it receives the load quickly, the bone responds more rigidly, and may handle a higher load
before it breaks. (B) When it receives the load slowly, the bone is not so rigid or strong, breaking under lesser
loads.

The bone fails more quickly when exposed to a shear strength rather than a compressive or tensive strength.
This is because the bone is anisotropic and responds differently when it receives loads of different directions.
The shear strengths are responsible for problems in the vertebral discs. A shear strength may produce
spondylolisthesis, in which one vertebra slips over another previously. In the lumbar spine, shear strength by
vertebrae, increases with increasing lordosis and with hyperlordosis. The pull of muscle on the lumbar vertebrae
also creates an increasing shear strength on the vertebrae.

Examples of fractures due to shear strengths are frequently found in the femoral condyles or tibial plateau. The
injury mechanism of both is usually a hyperextension of the knee with some fixing of the foot and a valgus
strength or medial on the thigh or shin. In adults, this shear strength may create a fracture or injury in the
collateral or crossed ligaments. In the developing child, this shear strength may create epiphyseal fractures, such
as the distal femoral epiphysis. The mechanism of injury and resultant epiphyses injury. An epiphyseal fracture
of the distal epiphysis is usually created by a shearing strength. A strength applied in valgus on the thigh or shin
with the foot fixed and hyperextended knee is commonly produced. The effects of such a fracture can be quite
significant since that epiphysis is the fastest growing in the body and is responsible for approximately 37% of
bone growth in the leg.

Hard Tissue:

Hard tissue (also termed calcified tissue) is tissue which is mineralized and has a firm intercellular matrix. The
hard tissues of humans are bone, tooth enamel, dentin, and cementum. The term is in contrast to soft tissue.

Bone:

Bone is a rigid organ that constitutes part of the vertebral skeleton. Bones support and protect the various organs
of the body, produce red and white blood cells, store minerals and also enable mobility. Bone tissue is a type of
dense connective tissue. Bones come in a variety of shapes and sizes and have a complex internal and external
structure. They are lightweight yet strong and hard, and serve multiple functions. Mineralized osseous tissue or
bone tissue, is of two types – cortical and cancellous and gives it rigidity and a coral-like three-dimensional
internal structure. Other types of tissue found in bones include marrow, endosteum, periosteum, nerves, blood
vessels and cartilage.
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Bone is an active tissue composed of different cells. Osteoblasts are involved in the creation and mineralisation
of bone; osteocytes and osteoclasts are involved in the reabsorption of bone tissue. The mineralised matrix of
bone tissue has an organic component mainly of collagen and an inorganic component of bone mineral made up
of various salts.

Enamel

Enamel is the hardest substance in the human body and contains the highest percentage of minerals, 96%, with
water and organic material composing the rest. The primary mineral is hydroxyapatite, which is a crystalline
calcium phosphate. Enamel is formed on the tooth while the tooth is developing within the gum, before it
erupts into the mouth. Once fully formed, it does not contain blood vessels or nerves. Remineralisation of teeth
can repair damage to the tooth to a certain degree but damage beyond that cannot be repaired by the body. The
maintenance and repair of human tooth enamel is one of the primary concerns of dentistry.

In humans, enamel varies in thickness over the surface of the tooth, often thickest at the cusp, up to 2.5 mm, and
thinnest at its border with the cementum at the cementoenamel junction (CEJ).

The normal color of enamel varies from light yellow to grayish (bluish) white. At the edges of teeth where there
is no dentin underlying the enamel, the color sometimes has a slightly blue tone. Since enamel is
semitranslucent, the color of dentin and any material underneath the enamel strongly affects the appearance of a
tooth. The enamel on primary teeth has a more opaque crystalline form and thus appears whiter than on
permanent teeth.

The large amount of mineral in enamel accounts not only for its strength but also for its brittleness. Tooth
enamel ranks 5 on Mohs hardness scale and has a Young's modulus of 83 GPa. Dentin, less mineralized and less
brittle, 3–4 in hardness, compensates for enamel and is necessary as a support. On radiographs, the differences
in the mineralization of different portions of the tooth and surrounding periodontium can be noted; enamel
appears lighter than dentin or pulp since it is denser than both and more radiopaque.

Enamel does not contain collagen, as found in other hard tissues such as dentin and bone, but it does contain
two unique classes of proteins: amelogenins and enamelins. While the role of these proteins is not fully
understood, it is believed that they aid in the development of enamel by serving as a framework for minerals to
form on, among other functions. Once it is mature, enamel is almost totally without the softer organic matter.
Enamel is avascular and has no nerve supply within it and is not renewed, however, it is not a static tissue as it
can undergo mineralization changes.

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Dentin

By weight, 70% of dentin consists of the mineral hydroxyapatite, 20% is organic material, and 10% is water.
Yellow in appearance, it greatly affects the color of a tooth due to the translucency of enamel. Dentin, which is
less mineralized and less brittle than enamel, is necessary for the support of enamel. Dentin rates approximately
3 on the Mohs scale of mineral hardness.

Cementum

Cementum is slightly softer than dentin and consists of about 45% to 50% inorganic material (hydroxyapatite)
by weight and 50% to 55% organic matter and water by weight. The organic portion is composed primarily of
collagen and proteoglycans. Cementum is avascular, receiving its nutrition through its own imbedded cells from
the surrounding vascular periodontal ligament.

The cementum is light yellow and slightly lighter in color than dentin. It has the highest fluoride content of all
mineralized tissue. Cementum also is permeable to a variety of materials. It is formed continuously throughout
life because a new layer of cementum is deposited to keep the attachment intact as the superficial layer of
cementum ages. Cementum on the root ends surrounds the apical foramen and may extend slightly onto the
inner wall of the pulp canal.

Blood circulation:

The importance of the vascular supply for bone is well-known to orthopaedists but is still rather overlooked
within the wider field of skeletal research. Blood supplies oxygen, nutrients and regulatory factors to tissues, as
well as removing metabolic waste products such as carbon dioxide and acid. Bone receives up to about 10% of
cardiac output, and this blood supply permits a much higher degree of cellularity, remodelling and repair than is
possible in cartilage, which is avascular. The role of the blood supply in the pathophysiology of bone deserves
wider attention outside the orthopaedic community. This brief review focuses on selected topics of particular
current interest.

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Schematic diagram showing general arrangement of the vascular supply to healthy adult bone. The main blood
supply is derived from one or more nutrient arteries, which penetrate to the medulla and connect to the smaller
periosteal arterial supply to enable perfusion of cortical bone. The arterial branches drain into arterio-venous
sinuses in the medulla that support hematopoietic and stromal cells. Blood exits the medullary cavity via
multiple small veins that penetrate the cortex. Thus, perfusion is predominantly centrifugal, at least in young
adult bone.

Healthy bone requires a substantial blood flow to supply the requisite oxygen and nutrients, and to eliminate
carbon dioxide, acid and other metabolic waste products. Estimates of the proportion of the cardiac output
received directly by the skeleton range from about 5.5% to 11%.

Effect of oxygen on bone cell function:

It has long been recognized that bone growth (including endochondral ossification during development) and
repair occur in association with a rich vascular supply. Conversely, impairment of the blood supply is well-
known to reduce growth and repair, cause bone loss and, ultimately, necrosis. These observations are clearly
consistent with the role of the vasculature in supplying nutrients, minerals and regulatory factors to bone. In
recent years the influence of oxygen tension and hypoxia on bone function has become a major research focus.

Hypoxia occurs when the blood supply to tissues is reduced or disrupted. Oxygen tension (pO2) in arterial blood
is about 12.64 kPa (12%); in venous and capillary blood it is about 5.32 kPa (5%), approximately a quarter of
that in atmospheric air. In normal tissues, median interstitial pO 2 values range from about 3–9%.

Elasticity:
Bone mineral is a ceramic material and exhibits normal Hookean elastic behaviour, i.e. a linear stress-strain
relationship. In contrast, collagen is a polymer that exhibits a J-shaped stress-strain curve. Typical stress-strain
curves for compact bone, tested in tension or compression in the wet condition, are approximately a straight
line. Bone generally has a maximum total elongation of only 0.5 - 3%, and therefore is classified as a brittle
rather than a ductile solid.

Bones serve a variety of mechanical functions. Together the bones in the body form the skeleton. They provide
a frame to keep the body supported, and an attachment point for skeletal muscles, tendons, ligaments and joints,
which function together to generate and transfer forces so that individual body parts or the whole body can be
manipulated in three-dimensional space (the interaction between bone and muscle is studied in biomechanics).

Bones serve a variety of mechanical functions. Together the bones in the body form the skeleton. They provide
a frame to keep the body supported, and an attachment point for skeletal muscles, tendons, ligaments and joints,
which function together to generate and transfer forces so that individual body parts or the whole body can be
manipulated in three-dimensional space (the interaction between bone and muscle is studied in biomechanics).

Tensile and Compressive Strength:

As mentioned previously, bones such as the femur are subjected to bending moments during normal loading.
These create both tensile and compressive stresses in different regions of the bone.

There is a large variation in measured values of both the tensile and compressive strength of bone. Different
bones in the body need to support different forces, so there is a large variation in strength between them.
Additionally, age is an important factor, with strength often decreasing as a person gets older.

25 | k r i p a ’ s n o t e s . .
Viscosity:

Bone is a viscoelastic material, that exhibits both creep and stress relaxation. The ultimate strength, energy to
failure and fracture toughness of bone tissue are rate dependent. The fatigue life of bone is also frequency
dependent, and crack growth is both cycle and frequency dependent at high stress intensity. As such, the
viscoelastic properties of bone may play a role in fracture. However, bone is a hierarchical composite, and the
viscoelastic properties may differ between microstructural and macroscopic levels.

Porosity plays a major role in the macroscopic strength and viscoelasticity of bone. The relaxation time constant
is positively correlated to water content in torsion, and hydrated bone exhibits greater viscoelastic damping than
dry bone over a broad range of frequencies. At low frequencies, viscoelasticity was attributed to viscous-like
motion at the cement lines.

Microdamage occurs at scales below the macroscopic porosity. As such, the intrinsic viscoelasticity at length
scales on the order of size of a microcrack may be important. Measurements of the viscoelasticity of bone at the
microstructural level have become more common with the availability of nanoindentation.

Microdamage is more common in the femoral cortical bone of females than males, and increases with age. As
fatigue crack propagation is sensitive to viscoelastic behavior, we hypothesized that the microstructural level
viscoelasticity of female cortical bone differs from males. Moreover, we hypothesized that differences in
viscoelasticity are due to differences in bone composition.

Specifically, we 1) measured the elastic modulus and creep time constant of human cortical bone in both
osteons and interstitial tissue; 2) measured tissue composition including mineralization, collagen content, and
collagen cross-link content; and 3) investigated the dependence of the viscoelastic properties on age, gender,
microstructural location, and tissue composition.

Functional Adaptation Of Bone:

During life, bone is continually optimized for its loadbearing role by a process of functionally adaptive
(re)modelling. This process, which is more active in growing bone, is dominated by high-magnitude, high-rate
strains, presented in an unusual distribution. Adaptation occurs at an organ level, involving changes in whole
bone architecture and bone mass . The repetitive coordinated bone loading associated with habitual activity may
have little role in the preservation of bone mass, and may even reduce the osteogenic potential of an otherwise
highly osteogenic stimulus. Cells of the osteocyte/osteoblast network are best placed to appreciate mechanical
strain. Among the strain-related responses they show, is a reduced rate of apoptosis. This may serve to regulate
and target osteoclast activity. A more complete understanding of the stimuli and pathways involved in both the
physiology and pathology of this structural homeostatic mechanism will allow the design of more appropriate
exercise regi regimens and targeted pharmacological interventions to limit morbidity and mortality by reducing
bone fragility.

Bone continually remodels - growth, reinforcement, resorption- depends on stress and strain.

There is an optimal range of stress for maximum strength

under stressed or overstressed bone can weaken

26 | k r i p a ’ s n o t e s . .
stresses on fractured bone affect healing

stress-dependent remodeling affects surgical implant and prosthesis design, e.g. fracture fixation plates, surgical
screws, artificial joints.

Stress-Dependent Remodeling

Osteoclasts - cells responsible for resorption

Osteoblasts - cells responsible for growth (hypertrophy)

compressive stress stimulates formation of new bone and is important for fracture healing

loss of calcium and reduced bone densityloss of normal stress

Time scales:remodeling - months/yearsfastest remodeling is due to change in mineral contenthealing -

weeksgrowth/maturation - years

Types of Bone Remodeling

Two types of remodeling in bone:

1. surface (external) remodeling

change in bone shape and dimensions
deposition on to or resorption of bone material from inner or outer surfaces
2. internal remodelingchange in: bulk density, trabecular size, orientation, osteon size, etc.

Functional Adaptation

Principal of Functional Adaptation, Roux (1895):"the ability of organs (and cells, tissues and organisms) to
adapt their capacity to function in response to altered demands by practice”

Functional adaptation in bone is remodeling of structure, geometry and mechanical properties in response to
altered loading

Related to the engineering concept of optimal design

Theories of Stress-Adaptive Bone Remodeling

Two main analytical models of bone adaptation to stress:

1. The theory of surface bone remodeling

2. The theory of internal bone remodeling

Hill’s Model:

27 | k r i p a ’ s n o t e s . .
Muscles and nerve fibers allow us to move our bodies. They enable our internal organs to function. The human
body has over 600 muscles, which make up around 40 percent of our bodyweight. Each muscle consists of
thousands, or tens of thousands, of muscle Smaller sections. muscle is a hierarchical structure, composed of a
core of force generating sarcomeres arranged in bundles of myofibrils, fibers and fascicles that together form a
complete muscle. Fibers, fascicles and muscles are surrounded by a matrix of connective tissues.

Types of muscle

There are three types of muscle found in the human body:

• Skeletal (muscles that move voluntarily)

• Smooth (involuntary muscles in organs)

• Cardiac (only found in the heart)

Muscle model:

To study the behavior of a modeling system is a suitable method. In other words, one of the best ways of
understanding a given physiological system is to model it. The muscle model allows a better understanding of
muscle function without the need to know its details. Also, with the aid of the model, we can study the effect of
various factors on the system.

Hill’s Model
Hill-type muscle model is one of the most used models to describe the mechanism of force production. It is
composed by different elements that describe the behaviour of the muscle (contractile, series elastic and parallel
elastic element) and tendon.

– The three element Hill-type model (Figure 6) provides the simplest and arguably the most widely
implemented model of muscle function that can characterize interaction between contractile and elastic
elements. The model includes a contractile element (CE) that represents the fundamental mechanical behavior
of the sarcomere, governed by activation kinetics, force-length properties, and force-velocity properties derived
from isolated muscle studies. Springs in parallel with the CE and in series will influence the force, length and
speed of the entire unit. This model is useful for exploring and describing the significance of the interaction
between these different elements, and is commonly implemented in forward-dynamic simulations of movement.

Muscle model of Hill (A Hill-type model of muscle with a contractile element (CE) arranged alongside a
parallel elastic element (PEE) and in series with a series elastic element (SEE). Force development within the
28 | k r i p a ’ s n o t e s . .
CE is a function of activation kinetics (a), force-length (f-l) properties, and force-velocity (f-v) properties. Force
developed by the PEE depends on the CE length, while force in the SEE is equal to the sum of PEE and CE
forces).

Figure illustrates the schematic of the Hill model.

Schematic of the Hill-type muscle fiber (contractile element (CE), a parallel element (PE), and a series element
(SE)).

Three element model – Contractile Component (CC) – Series Elastic Component (SEC) – Parallel Elastic
Component (PEC)

If we want to introduce the Hill model as a block diagram, the Figure will show it well.

Hill’s Model (Hill equation):

Hill model includes 2 parts:

1. A maximal F versus v relationship for quick release from isometric contraction with isotonic force.

2. Lumped parameter model to phenomenologically represent elastic stiffness component of muscle.

• Hill model was developed from energy balance concepts.

Hill showed:

• Muscle produced heat in isometric contraction.

• When isometrically contracted, muscle was released under an isotonic load that

allowed muscle shortening.

29 | k r i p a ’ s n o t e s . .
where H is shortening heat and x is distance shortened

where a is constant of proportionality and is function of level of action.

• Hill also showed:

where F0 is max isometric force.

During shortening contacting muscle produces extra heat (greater than isometric) and mechanical work

Total energy in excess of isometric contraction then is

Therefore, the rate of extra energy liberation is:

where v is the speed of shortening

Hill showed that rate of extra energy liberation was inversely proportional to load F applied to muscles in
shorting experiments.
For isometric experiments

For contracting muscle experiments

30 | k r i p a ’ s n o t e s . .
where b is a constant associated with the rate of energy liberatio.
If v0 is the maximum velocity of contraction at F = 0
Then Hill showed that parameter was related to v0 by

Rewriting equation 1 yields

Rearranging terms produces the Hill equation

Skeletal muscle:

Skeletal muscle is one of three major muscle types, the others being cardiac muscle and smooth muscle. It is a
form of striated muscle tissue which is under the voluntary control of the somatic nervous system. Most skeletal
muscles are attached to bones by bundles of collagen fibers known as tendons.

A skeletal muscle refers to multiple bundles (fascicles) of cells joined together called muscle fibers. The fibers
and muscles are surrounded by connective tissue layers called fasciae. Muscle fibers, or muscle cells, are
formed from the fusion of developmental myoblasts in a process known as myogenesis. Muscle fibers are
cylindrical and have more than one nucleus. They also have multiple mitochondria to meet energy needs.

Muscle fibers are in turn composed of myofibrils. The myofibrils are composed of actin and myosin filaments,
repeated in units called sarcomeres, which are the basic functional units of the muscle fiber. The sarcomere is
responsible for the striated appearance of skeletal muscle and forms the basic machinery necessary for muscle
contraction.

Muscle fibers:

Muscle fibers are the individual contractile units within a muscle. A single muscle such as the biceps brachii
contains many muscle fibers.

31 | k r i p a ’ s n o t e s . .
Another group of cells, the myosatellite cells are found between the basement membrane and the sarcolemma of
muscle fibers. These cells are normally quiescent but can be activated by exercise or pathology to provide
additional myonuclei for muscle growth or repair.

Individual muscle fibers are formed during development from the fusion of several undifferentiated immature
cells known as myoblasts into long, cylindrical, multi-nucleated cells. Differentiation into this state is primarily
completed before birth with the cells continuing to grow in size thereafter.

Arrangement of muscle fibers:

Inside each skeletal muscle, muscle fibers are organized into individual bundles, each called a fascicle, by a
middle layer of connective tissue called the perimysium. This fascicular organization is common in muscles of
the limbs; it allows the nervous system to trigger a specific movement of a muscle by activating a subset of
muscle fibers within a bundle, or fascicle of the muscle. Inside each fascicle, each muscle fiber is encased in a
thin connective tissue layer of collagen and reticular fibers called the endomysium. The endomysium contains
the extracellular fluid and nutrients to support the muscle fiber. These nutrients are supplied via blood to the
muscle tissue.

In skeletal muscles that work with tendons to pull on bones, the collagen in the three tissue layers (the mysia)
intertwines with the collagen of a tendon. At the other end of the tendon, it fuses with the periosteum coating
the bone. The tension created by contraction of the muscle fibers is then transferred though the mysia, to the
tendon, and then to the periosteum to pull on the bone for movement of the skeleton. In other places, the mysia
may fuse with a broad, tendon-like sheet called an aponeurosis, or to fascia, the connective tissue between skin
and bones. The broad sheet of connective tissue in the lower back that the latissimus dorsi muscles (the “lats”)
fuse into is an example of an aponeurosis.

Every skeletal muscle is also richly supplied by blood vessels for nourishment, oxygen delivery, and waste
removal. In addition, every muscle fiber in a skeletal muscle is supplied by the axon branch of a somatic motor
neuron, which signals the fiber to contract. Unlike cardiac and smooth muscle, the only way to functionally
contract a skeletal muscle is through signaling from the nervous system.

Skeletal Muscle Fibers

Because skeletal muscle cells are long and cylindrical, they are commonly referred to as muscle fibers. Skeletal
muscle fibers can be quite large for human cells, with diameters up to 100 μm and lengths up to 30 cm (7.6 in)
in the Sartorius of the upper leg. During early development, embryonic myoblasts, each with its own nucleus,
fuse with up to hundreds of other myoblasts to form the multinucleated skeletal muscle fibers. Multiple nuclei
mean multiple copies of genes, permitting the production of the large amounts of proteins and enzymes needed
for muscle contraction.

Some other terminology associated with muscle fibers is rooted in the Greek sarco, which means “flesh.” The
plasma membrane of muscle fibers is called the sarcolemma, the cytoplasm is referred to as sarcoplasm, and the
specialized smooth endoplasmic reticulum, which stores, releases, and retrieves calcium ions (Ca++) is called
the sarcoplasmic reticulum (SR) (Figure 7.6). As will soon be described, the functional unit of a skeletal muscle
fiber is the sarcomere, a highly organized arrangement of the contractile myofilaments actin (thin filament) and
myosin (thick filament), along with other support proteins

32 | k r i p a ’ s n o t e s . .
 A skeletal muscle fiber is surrounded by a plasma
membrane called the sarcolemma, which contains sarcoplasm, the cytoplasm of muscle cells. A muscle fiber is
composed of many fibrils, which give the cell its striated appearance.

Skeletal Muscle Actions

Knowing the muscular organization of each region of the body is crucial in anatomy. With an understanding of
where a muscle originates and inserts, you can calculate the movements that will occur at a joint when these two
points are brought together following an isotonic muscular contraction. The orientation, placement, and
coordination of these muscles allow the human body to produce a wide range of voluntary movements.

The muscular system consists of skeletal muscles and their associated connective tissues. It does not include
cardiac muscle and smooth muscle, which are associated with the systems in which they are found, such as the
cardiovascular, digestive, urinary, or other organ systems.

A skeletal muscle is attached to one bone and extends across a joint to attach to another bone. A muscle can also
attach a bone to another structure, such as skin. When the muscle contracts, one of the structures usually
remains stationary, while the other moves. The following terms refer to this characteristic of muscle
contraction:

 The origin of the muscle is the muscle end that attaches to the stationary structure, usually a bone or a
bony structure.
 The insertion of the muscle is the muscle end that attaches to the moving structure.
 The belly of the muscle is that part of the muscle between the origin and insertion.

Several muscles usually influence a particular body movement:

 The prime mover is the muscle that is most responsible for the movement.
 Synergists are other muscles that assist the prime mover. Synergists may stabilize nearby bones or
refine the movement of the prime mover.
 Antagonists are muscles that cause a movement opposite to that of the prime mover. For example, if the
prime mover raises an arm, its antagonist pulls the arm down. An antagonist is generally attached to the
opposite side of the joint to which the prime mover is attached.

33 | k r i p a ’ s n o t e s . .
Key Terms

 Bone replacement involves the osteoclasts which break down bone and the osteoblasts which make new
bone.
 Bone turnover rates differ depending on the bone and the area within the bone.
 There are four stages in the repair of a broken bone: 1) the formation of hematoma at the break, 2) the
formation of a fibrocartilaginous callus, 3) the formation of a bony callus, and 4) remodeling and
addition of compact bone.
 Proper bone growth and maintenance requires many vitamins (D, C, and A), minerals (calcium,
phosphorous, and magnesium), and hormones ( parathyroid hormone, growth hormone, and calcitonin ).
 callus: the material of repair in fractures of bone which is at first soft or cartilaginous in consistency, but
is ultimately converted into true bone and unites the fragments into a single piece
 spicule: a sharp, needle-like piece
 fibroblast: a cell found in connective tissue that produces fibers, such as collagen

Bone Remodeling and Repair

Bone renewal continues after birth into adulthood. Bone remodeling is the replacement of old bone tissue by
new bone tissue. It involves the processes of bone deposition or bone production done by osteoblasts and bone
resorption done by osteoclasts, which break down old bone. Normal bone growth requires vitamins D, C, and A,
plus minerals such as calcium, phosphorous, and magnesium. Hormones such as parathyroid hormone, growth
hormone, and calcitonin are also required for proper bone growth and maintenance.

Bone turnover rates, the rates at which old bone is replaced by new bone, are quite high, with five to seven
percent of bone mass being recycled every week. Differences in turnover rates exist in different areas of the
skeleton and in different areas of a bone. For example, the bone in the head of the femur may be fully replaced
every six months, whereas the bone along the shaft is altered much more slowly.

Bone remodeling allows bones to adapt to stresses by becoming thicker and stronger when subjected to stress.
Bones that are not subject to normal everyday stress (for example, when a limb is in a cast) will begin to lose
mass.

34 | k r i p a ’ s n o t e s . .
 Stages of fracture repair: The healing of a bone fracture follows a series of progressive steps: (a) A fracture
hematoma forms. (b) Internal and external calli form. (c) Cartilage of the calli is replaced by trabecular bone.
(d) Remodeling occurs.

A fractured or broken bone undergoes repair through four stages:

1. Hematoma formation: Blood vessels in the broken bone tear and hemorrhage, resulting in the formation
of clotted blood, or a hematoma, at the site of the break. The severed blood vessels at the broken ends of
the bone are sealed by the clotting process. Bone cells deprived of nutrients begin to die.
2. Bone generation: Within days of the fracture, capillaries grow into the hematoma, while phagocytic cells
begin to clear away the dead cells. Though fragments of the blood clot may remain, fibroblasts and
osteoblasts enter the area and begin to reform bone. Fibroblasts produce collagen fibers that connect the
broken bone ends, while osteoblasts start to form spongy bone. The repair tissue between the broken
bone ends, the fibrocartilaginous callus, is composed of both hyaline and fibrocartilage. Some bone
spicules may also appear at this point.
3. Bony callous formation: The fibrocartilaginous callus is converted into a bony callus of spongy bone. It
takes about two months for the broken bone ends to be firmly joined together after the fracture. This is
similar to the endochondral formation of bone when cartilage becomes ossified; osteoblasts, osteoclasts,
and bone matrix are present.
4. Bone remodeling: The bony callus is then remodelled by osteoclasts and osteoblasts, with excess
material on the exterior of the bone and within the medullary cavity being removed. Compact bone is
added to create bone tissue that is similar to the original, unbroken bone. This remodeling can take many
months; the bone may remain uneven for years.

Kinds of Broken Bones

Types of bone fractures include:

 A greenstick fracture: a break on one side of the bone only

 A buckle or torus fracture: an outward bend on one side of the bone without breaking the other side
 An avulsion fracture: when a tendon or ligament pulls off of a tiny piece of bone
 A growth plate fracture: a break in the area of a child or teen's growing bone
 A stress fracture: a tiny crack in the bone
 A comminuted fracture: a bone breaks into more than two pieces
 A compression fracture: a collapsing of the bone
Signs of a Broken Bone:

It always hurts to break a bone. There also might be swelling and bruising. The injured area may be hard to
move and use.

Sometimes the body part looks crooked or different than it did before the injury.

Fracture Names Fixators

35 | k r i p a ’ s n o t e s . .
Site

Head Skull Fracture Wires, pins, and plates

Craniofacial Fracture Wires, screws, and plates

Trunk Clavicle Fracture Intramedullary nails and plates

Scapular Fracture Screws and plates
Pelvic Fracture Screws, plates, and external fixators
Spinal Fracture Fixation device consists of rods, pedicle screws, and plates

Upper Limb Humeral Fracture Open reduction with plate and screws
Fracture Radius, Ulnar Fracture Close reduction with intramedullary nail
Metacarpal and Open reduction with plate and screws
Phalangeal Fracture Close reduction with intramedullary nail
Open reduction with intramedullary nail, screws and plates
Close reduction with external fixators

Lower Femoral Fracture Open reduction with plate and screws

Limb Tibial and Fibular Close reduction with intramedullary nail
Fracture Fracture Open reduction with plate and screws and intramedullary nails
Metatarsus Fracture Open reduction with plate and screws and intramedullary nails
Calcaneal Fracture Close reduction with screws or wires

Fracture fixation materials and devices:

Biomaterials used for internal fracture fixation are confined to those that are able to withstand cyclic loads,
allowing for the intrinsic functionality of the skeletal system. Metals, polymers, and ceramics have all been used
as orthopedic biomaterials, but metals supply the most desirable properties that are needed. Furthermore, metals
are the most common class of biomaterials used for fracture fixation, owing to their mechanical properties that
lend to the stabilization required; although, polymers and ceramics have also been used to fixate fractures. The
three most common metals used as biomaterials are titanium alloys, cobalt- chromium alloys, and stainless
steel. Of these, titanium alloys and electro polished stainless steel are most commonly used for fracture fixation,
as the cobalt-chromium alloys are more difficult to fabricate and have a high production cost.

Metals

36 | k r i p a ’ s n o t e s . .
Both titanium and its alloys and stainless steel can be manufactured under different conditions to produce
different mechanical properties for different orthopedic applications. Despite these tunable quali- ties, stainless
steel is stiffer, denser, and more ductile and has a greater elastic modulus and yield strength than titanium.
Meanwhile, tita- nium has a greater maximum torque and greater fatigue resistance. Additionally, the
intrinsically microrough structure of titanium provides a surface allowing for osseointegration whereas
electropolished stainless steel does not. The magnetism of stainless steel produces distortions in imaging while
titanium does not. Titanium has a thicker oxide layer and regenerates its oxide layer faster than stainless steel,
which alto- gether means titanium implants are better protected from corrosion by the body.

Polymers

Polymer based composite materials have a greater fatigue resistance than other materials, in addition to having a
high strength and low stiffness. Clinical trials with unidirectional laminate composites of carbon fiber
reinforced epoxy resin showed that polymeric composites are potentially viable options for fracture fixation.

composite bone plates composed of biocompatible thermoplastic polyether ether ketone (PEEK) and carbon
fibers as reinforcement that were braided together to form a single layer, and these layers were placed on top of
each other and pressed together to create the plates. This braided plate allowed for a thinner plate with greater
stiffness than other composite plates, such as unidirectional laminates or discontinuous short fibers.

Bioceramics

Bioceramics are a good material for bone tissue engineering because the mineral phase of the extracellular
matrix (ECM) of bone is itself com- posed of hydroxyapatite, but bioceramics on their own are not widely used
as internal fixation devices. Work has been done to potentially use pure ceramics for fixating anterior cruciate
ligament (ACL) injuries. Composites composed of polymer and bioceramics have been developed for
interference screws, which are mainly used for ACL fixation but can also be used for fracture fixations.

Biodegradable materials

An ideal internal fixation device would be one that is biodegradable or, in other words, one that decreases in
stiffness over time as the frac- ture heals and does not require a second surgery for removal. There are currently
many commercially available biodegradable polymers used in fixation in craniofacial and maxillofacial
applications. For example, Inion implants are biodegradable polymers used for the fixation of craniofacial
fractures that are composed of a combination of trimethylene carbonate, L-lactide, D, L-lactide, and
polyglycolide, and they have a comparable performance to titanium. Magnesium has been incorporated in
systems with other materials to make use of their degradability. For example, a hybrid metal system with
magnesium and titanium, controlling the electrolytic corrosion with a polymeric coating on the surface of the
magnesium, and the finite element model showed desirable results. The fracture would be supported well with
the titanium and initially by the magnesium, and the gradual degradation of the magnesium would help promote
fracture healing.

Smart materials

Smart materials are materials that have properties that respond to external stimuli, such as pH, temperature, and
light. They are beneficial for use in bone fixation as they would make the implant easier to handle by the
orthopedic surgeon and would be able to conform to the fracture requirements. For example a pedicle screw

37 | k r i p a ’ s n o t e s . .
used in spinal fusion surgery containing the shape memory alloy, nitinol, to expand and retract with temperature
changes to allow an easy insertion and removal of the screw.

38 | k r i p a ’ s n o t e s . .