Bone geometry on the contact stress in the shoulder for evaluation of pressure ulcers: finite element modeling and experimental validation.

This research presents the finite element modeling (FEM) of human-specific computed tomography (CT) data to study the effect of bone prominences on contact stress in the shoulder for prevention of pressure ulcers. The 3D geometry of scapula, skin, and surrounding soft tissues in the shoulder was reconstructed based on the anonymous CT data of a human subject in a prone posture (without loading on the shoulder) for FEM analysis of the contact stress. FEM analysis results show that the maximum stress is located at the prominence of the scapula with sharp bone geometry. This demonstrates that stress concentration at the bone prominence is a significant factor to cause the high contact stress, which is a source for pressure ulcers. For experimental validation, a physical shoulder model manufactured by 3D printing of the bone geometry and the mold for molding of tissue-mimicking silicone was developed. Compression tests of the mattress foam and silicone were conducted to find the nonlinear stress-strain relations as inputs for FEM. Experiments of compressing the shoulder model against the foam were carried out. Three flexible force sensors were embedded inside the model to measure the contact forces and compared to the FEM predictions. Results show that the FEM predicted forces match well with the experimental measurements and demonstrate that FEM can accurately predict the stress distributions in the shoulder to study the effect of bone geometry on the inception of pressure ulcers.