An Engineering Approach to Fracture Management

The philosophy underpinning this lecture series is rooted in the confluence of engineering principles and orthopaedic surgery. It emphasizes the necessity of a understanding of mechanics, stress analysis, and material properties to effectively understand and manage fractures. The iterative process of construct design and the application of biomechanical constraints are not merely technical procedures but are seen as an intellectual framework. This approach champions a standardized methodology for analysing complex systems while remaining open to feedback loops, peer collaboration, and innovative technologies. Ultimately, it seeks to refine surgical techniques through a fusion of empirical rigor and creative adaptation, embodying a philosophy that values precision, continuous learning, and the melding of theory with practical application for improved patient outcomes.

The FRACTAL Algorithm

The FRACTAL algorithm is a structured, analytical framework designed to simplify the comprehension and resolution of mechanical challenges encountered in orthopaedic surgery. It delineates a methodical pathway for the visualization, dissection, and strategic management of complex mechanical problems. Below is an summary of each phase:

Frame: Establish a simplified model by delineating the system's boundaries, defining relevant constraints, and selecting an appropriate coordinate system to contextualize forces and moments within a free body diagram.
Resolve: Decompose force vectors into orthogonal components relative to the chosen frame of reference. This facilitates a granular examination of individual force magnitudes and directions, simplifying subsequent analysis.
Anticipate: Employ predictive modeling based on classical mechanics, leveraging Newtonian dynamics and Hookean elasticity, to forecast system behavior under specified loading conditions.
Constrain: Convert mechanical theory into tangible interventions by building mechanical constraints that counteract deforming forces. This involves strategic hardware selection and precise application to stabilize anatomic structures.
Test: Conduct thought experiments to simulate extreme load scenarios. This stress-testing accentuates potential vulnerabilities within the construct, guiding preemptive optimization.
Assess: Critically evaluate the engineered solution against established mechanical principles, scrutinizing stress distribution, material properties, and potential failure modes such as fatigue and crack propagation.
Loop: Re-enter the construct into the FRACTAL cycle for iterative analysis. This recursive process ensures continuous improvement through empirical validation and adaptation to emerging data or clinical outcomes.

ATC Course Format

Commencing it's second season in April 2024, the series is composed of eight 60-minute lectures continuing weekly in an interactive format via Zoom. This 'ATC' Course is specifically designed for Advanced Trainees and Consultants, and assumes a high degree of surgical prerequisite knowledge. Each lecture is designed to be a comprehensive exploration of the themes identified in that week's curriculum. Attendees will have the unique opportunity to participate in these lectures live, fostering real-time engagement and interaction with the presenter and peers. Furthermore, for flexibility, each lecture will be recorded and made available for online streaming for a limited period following the course. This allows participants the option to schedule around work commitments or revisit complex topics at their convenience. To facilitate participant preparedness, pertinent pre-reading and supplementary materials will be made available prior to each session. This ensures everyone arrives with a foundational understanding, ready to engage in the more intricate discussions that form the backbone of the series.

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Overview of Individual Lectures

Lecture 1: Fundamentals of Orthopaedic Mechanics

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• Introduction to biomechanical engineering with a focus on orthopaedic applications.
• Fundamental concepts: force vectors, stress, strain, and material deformation analysis.
• Viscoelastic properties of biological tissues (bone, ligament) and their mechanical implications.
• Microstructural analysis of bone under various loading conditions for predictive modelling.
• Overview of the FRACTAL algorithm as a systematic approach to complex mechanical problem-solving.

Lecture 2: Frame and Resolve - Analytical Tools for Load Analysis

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• Establishing biomechanical frames of reference for structural analysis.
• Vector resolution techniques and their applications in analysing complex force systems.
• Advanced freebody diagram construction tailored to orthopaedic anatomic structures.
• Kinematic principles integration for assessing fracture displacement predictions.
• Case studies on common fractures analysed through freebody diagrams.

Lecture 3: Anticipate - Dynamics and Stability in Fractured Systems

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• Exploration of dynamic systems using Newtonian mechanics in an anatomical context.
• Equilibrium states in fracture mechanics to predict post-fracture kinematics.
• Potential energy concepts applied to stability analyses of orthopaedic constructs.
• Dynamic responses of fractures under varying load conditions examined through case studies.
• Application of equilibrium principles to anticipate fracture movement and deformation.

Lecture 4: Constraint 1 - Mechanical Fasteners and Their Engineering Principles

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• In-depth look at screws, plates, nails, tension bands design and function.
• Classical machines' mechanical advantage adapted for fastener design and function.
• Interaction mechanics between fasteners and parent bone material focusing on load distribution.
• Case studies illustrating diverse hardware configurations in constraint system designs.
• Principles for optimizing mechanical stability through strategic hardware placement.

Lecture 5: Constraint 2 - Practical Application of Hardware Constructs

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• Principles of optimizing mechanical stability through appropriate fastener choice.
• Application-focused discussion on the selection criteria for mechanical fasteners based on fracture specifics.
• Role of fasteners in maintaining mechanical stability during dynamic loading conditions.
• Resolving concepts of mechanical stability with the physiology of bone healing (absolute vs relative stability).
• A special look at Constraint system designs using external fixation constructs.

Lecture 6: Testing - Predictive Stress Testing and Material Limits

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• Review of statics, equilibrium and stability states, and predicted load paths within a static construct.
• Introduce a framework for predicting construct behaviour using a theoretical 'infinity' load state.
• Using material stress and deformation at high load states to predict system behaviour at physiological loads.
• Introduce Finite element analysis (FEA) as a predictive tool and its limitations (GIGO).
• Discussion on safety factors relevant to implant choice and construct design.

Lecture 7: Analysis - Stress Concentration and Failure Analysis

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• Detailed examination of stress concentrations within implants impacting longevity.
• Application of photoelasticity and birefringence techniques to visualize stress distribution.
• Technical assessment of stress concentrations around notches, holes within implants.
• Crack propagation under cyclic loading, and the role of microstructural defects and load redistribution.
• Incorporation of stress analysis into implant design process aiming to improve outcomes.

Lecture 8: Loop - The Iterative Design Process from Personal to Prototypes

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• The iterative design process steps outlined within the FRACTAL algorithm framework
• Feedback loops from personal cases, clinical trials, peer reviews, regulatory bodies
• Continuous improvement strategies for surgical techniques
• Future trends including additive manufacturing and generative design software
• Closing case studies showcasing the application of the iterative design process from concept to clinical practice