PurposeSpinopelvic fixations involving the S2-alar-iliac (S2AI) and iliac screws are commonly used in various spinal fusion surgeries. This study aimed to compare the biomechanical characteristics, specifically the risk of screw and adjacent bone failures of S2AI screw fixation with those of iliac screw fixation using a finite element analysis (FEA).MethodsA three-dimensional finite element (FE) model of a healthy spinopelvis was generated. The pedicle screws were placed on the L3-S1 with three different lengths of the S2AI and iliac screws (60 mm, 75 mm, and 90 mm). In particular, two types of the S2AI screw, 15°- and 30°-angled polyaxial screw, were adopted. Physiological loads, such as a combination of compression, torsion, and flexion/extension loads, were applied to the spinopelvic FE model, and the stress distribution as well as the maximum von Mises equivalent stress values were calculated.ResultsFor the iliac screw, the highest stress on the screw was observed with the 75-mm screw, rather than the 60-mm screw. The bones around the iliac screw indicated that the maximum equivalent stress decreased as the screw length increased. For the S2AI screw, the lowest stress was observed in the 90-mm screw length with a 30° head angle. The bones around the S2AI screw indicated that the lowest stress was observed in the 90-mm screw length and a 15° head angle.ConclusionsIt was found that the S2AI screw, rather than the iliac screw, reduced the risk of implant failure for the spinopelvic fixation technique, and the 90-mm screw length with a 15° head angle for the S2AI screw could be biomechanically advantageous.

It is now common to perform the Nuss procedure as a surgical treatment for pectus excavatum. As several types of detailed surgical methods exist as part of the Nuss procedure, studies are currently being conducted to verify their relative superiority via computerized biomechanical methods. However, no studies have considered the influence of sternoclavicular joints on the simulations of the Nuss procedure. Accordingly, this study aims to demonstrate the influence of these joints by comparing the clinical data with the finite element analysis data. Scenarios were set by classifying the movement of the joints based on the constraints of translation and rotation in the coordinate plane. The analyses were performed by applying the set scenarios to the constructed finite element model of a chest wall. The sternal displacement, Haller index, and equivalent stress were obtained from the analysis, and the data were compared with the data of the postoperative patient. When the translation of the anterior direction on the chest wall was constrained, the result obtained thereof was found to be similar to those obtained in the actual surgery. It is suggested that more accurate results can be obtained if the influence of the sternoclavicular joints is considered.

The Nuss procedure is one of the most widely used operation techniques for pectus excavatum (PE) patients. It attains the normal shape of the chest wall by lifting the patient’s chest wall with the Nuss bar. However, the Nuss bar is for the most part bent by a hand bender according to the patient’s chest wall, and this procedure causes various problems such as the failure of the operation and a decreased satisfaction of the surgeon and patient about the operation. To solve this problem, we proposed a method for deriving the optimal operation result by designing patient-specific Nuss bars through computer-aided design (CAD) and computer-aided manufacturing (CAM), and by performing auto bending based on the design. In other words, a three-dimensional chest wall model was generated using the computed tomography (CT) image of a pectus excavatum patient, and an operation scenario was selected considering the Nuss bar insertion point and the post-operative chest wall shape. Then, a design drawing of the Nuss bar that could produce the optimal operation result was derived from the operation scenario. Furthermore, after a computerized numerical control (CNC) bending machine for the Nuss bar bending was constructed, the Nuss bar prototype was manufactured based on the derived design drawing of the Nuss bar. The Nuss bar designed and manufactured with the proposed method has been found to improve the Haller index (HI) of the pectus excavatum patient by approximately 37% (3.14 before to 1.98 after operation). Moreover, the machining error in the manufacturing was within ±5% compared to the design drawing. The method proposed and verified in this study is expected to reduce the failure rate of the Nuss procedure and significantly improve the satisfaction of the surgeon and patient about the operation.

Syndesmosis injuries account for approximately 20% of ankle fractures that require surgery. Although multiple surgical options are available, all of them are based on metal screws. Serious complications that arise when applying metal screws include screw loosening or breakage. To prevent such complications, we applied a simulation method using a finite element (FE) analysis. We created a 3D FE model of an ankle joint and conducted an FE analysis focusing on syndesmosis in terms of the level, material, and diameter of the syndesmotic screw and the number of penetrated cortical bones. The magnitude and direction of the force applied to the tibia in the midstance state were considered for simulating the model. The maximum von-Mises stress and syndesmosis widening were analyzed in terms of different biomechanical parameters. We identified the characteristics of the most biomechanically stable syndesmotic screw and its fixation point on the basis of the two parameters. We demonstrated that the ideal syndesmotic screw fixation should be fixed at a level 20 to 25 mm above the ankle using a 4.5 mm titanium screw.

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The purpose of this study is to suggest a novel in silico Nuss procedure that can predict the results of chest wall deformity correction. 3D geometric and finite element model of the chest wall were built from the 15-year-old male adolescent patient’s CT image with pectus excavatum of the mild deformity. A simulation of anterior translating the metal bar (T) and a simulation of maintaining equilibrium after 180-degree rotation (RE) were performed respectively. A RE simulation using the chest wall finite element model with intercostal muscles (REM) was also performed. Finally, the quantitative results of each in silico Nuss procedure were compared with those of postoperative patient. Furthermore, various mechanical indicators were compared between simulations. This confirmed that the REM simulation results were most similar to the actual patient's results. Through two clinical indicators that can be compared with postoperative patient and mechanical indicators, the authors consider that the REM of silico Nuss procedure proposed in this study is best simulated the actual surgery.

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Purpose: Spinopelvic fixations involving the S2-alar-iliac (S2AI) and iliac screws are commonly used in various spinal fusion surgeries. This study aimed to compare the biomechanical characteristics, specifically the risk of screw and adjacent bone failures of S2AI screw fixation with those of iliac screw fixation using a finite element analysis (FEA). Methods: A three-dimensional finite element (FE) model of a healthy spinopelvis was generated. The pedicle screws were placed on the L3-S1 with three different lengths of the S2AI and iliac screws (60 mm, 75 mm, and 90 mm). In particular, two types of the S2AI screw, 15°- and 30°-angled polyaxial screw, were adopted. Physiological loads, such as a combination of compression, torsion, and flexion/extension loads, were applied to the spinopelvic FE model, and the stress distribution as well as the maximum von Mises equivalent stress values were calculated. Results: For the iliac screw, the highest stress on the screw was observed with the 75-mm screw, rather than the 60-mm screw. The bones around the iliac screw indicated that the maximum equivalent stress decreased as the screw length increased. For the S2AI screw, the lowest stress was observed in the 90-mm screw length with a 30° head angle. The bones around the S2AI screw indicated that the lowest stress was observed in the 90-mm screw length and a 15° head angle. Conclusions: It was found that the S2AI screw, rather than the iliac screw, reduced the risk of implant failure for the spinopelvic fixation technique, and the 90-mm screw length with a 15° head angle for the S2AI screw could be biomechanically advantageous.