Abstract
Pressure ulcers are mainly caused by prolonged pressure on local tissues. The current method of preventing pressure ulcers is mainly to change the patient's position by turning, so it is significant to study the biomechanics of the typical site of pressure ulcers. Based on anatomical theory, a three-dimensional model of the shoulder and hip was established, and the theoretical contact pressure between the body and the bed was calculated by force analysis. Then, finite element models of typical parts of pressure ulcers were established, and the maximum stresses under different boundary conditions were obtained by finite element analysis. Finally, a human body turning experiment was conducted using a pressure distribution sensor, and the pressure distribution clouds and maximum contact pressure curves under different turning angles were obtained. The results show that the extreme point of maximum stress occurs at \(90^{ \circ }\), producing a stress concentration phenomenon; the peak stresses at the shoulder and hip are more balanced in the angular threshold range of \(30^{ \circ }\) to \(45^{ \circ }\), the stresses are more dispersed, and there exists an angular threshold for optimal integrated pressure, which can improve the efficiency of the use of assisted turning equipment. The relevant results help to explain the causes of pressure ulcer disease and can provide clinical references to improve the effectiveness of care.
Similar content being viewed by others
References
Ahir, S. P., P. S. Walker, C. J. Squire-Taylor, G. W. Blunn, and J. Bayley. Analysis of glenoid fixation for a reversed anatomy fixed-fulcrum shoulder replacement. J Biomech. 37(11):1699–1708, 2004.
Brem, H., J. Maggi, and D. Nierman. High cost of stage IV pressure ulcers. Am J Surg. 200(4):473–477, 2010.
Bhattacharya, S., and R. K. Mishra. Pressure ulcers: current understanding and newer modalities of treatment. Indian J Plast Surg. 48(1):4–16, 2015.
Edsberg, L. E., J. M. Black, M. Goldberg, L. Mcnichol, L. Moore, and M. Sieggreen. Revised national pressure ulcer advisory panel pressure injury staging system revised pressure injury staging system. J Wound Ostomy Continence Nurs. 43(6):585–597, 2016.
Gefen, A., D. M. Brienza, J. Cuddigan, E. Haesler, and J. Kottner. Our contemporary understanding of the aetiology of pressure ulcers/pressure injuries. Int Wound J. 11:2021, 2021.
Ingram, D. Musculoskeletal model of the human shoulder for joint force estimation. Epfl. 2015. https://doi.org/10.5075/epfl-thesis-6497.
Joshua, S., T. Mervis, and J. Phillips. Pressure ulcers: prevention and management. J Am Acad Dermatol. 81(4):893–902, 2019.
Kottner, J., J. Cuddigan, K. Carville, K. Balzer, D. Berlowitz, S. Law, M. Litchford, P. Mitchell, Z. Moore, J. Pittman, D. Sigaudo-Roussel, C. Y. Yee, and E. Haesler. Prevention and treatment of pressure ulcers/injuries: the protocol for the second update of the international Clinical Practice Guideline 2019. J Tissue Viability. 28(2):51–58, 2019.
Kumari, S., D. Sharma, A. Rana, R. Pathak, R. Lal, and A. Kumar. Risk assessment tool for pressure ulcers development in Indian surgical wards. Indian J Surg. 77(3):206–212, 2015.
Lustig, M., and A. Gefen. Computational studies of the biomechanical efficacy of a minimum tissue deformation mattress in protecting from sacral pressure ulcers in a supine position. Int Wound J. 1:2021, 2021.
Luo, Y., Y. Wang, B. L. Tai, R. K. Chen, and A. J. Shih. Bone geometry on the contact stress in the shoulder for evaluation of pressure ulcers: finite element modeling and experimental validation. Med Eng Phys. 37(2):187–194, 2015.
Luboz, V., A. Perrier, M. Bucki, B. Diot, F. Cannard, N. Vuillerme, and Y. Payan. Influence of the calcaneus shape on the risk of posterior heel ulcers using 3D patient-specific biomechanical modeling. Ann Biomed Eng. 43(2):325–335, 2015.
Li, N., Y. Tie, P. Yu, J. Chang, L. Zhao, X. Zhao, H. ElhajjImad, N. Xi, and L. Liu. Bio-inspired upper limb soft exoskeleton to reduce stroke-induced complications. Bioinspir Biomim. 13(6):2018, 2018.
Mcginnis, E., M. Briggs, M. Collinson, L. Wilson, and J. Nixon. Pressure ulcers related pain in community populations: a prevalence survey. BMC Nurs. 13(1):16, 2014.
Mo, F., F. Li, M. Behr, Z. Xiao, G. Zhang, and X. Du. A lower limb-pelvis finite element model with 3D active muscles. Ann Biomed Eng. 46(1):86–96, 2018.
Martelli, S., F. Taddei, and L. Cristofolini. Extensive risk analysis of mechanical failure for an epiphyseal hip prosthesis: a combined numerical-experimental approach. Proc Inst Mech Eng H. 225(2):126–140, 2011.
Nakhli, Z., B. Hatira, M. Pithioux, P. Chabrand, and K. Saanouni. On prediction of the compressive strength and failure patterns of human vertebrae using a quasi-brittle continuum damage finite element model. Acta Bioeng Biomech. 21(2):143–151, 2019.
Nageswaran, S., R. Vijayakumar, and S. Sivarasu. Design of mechanical interface to re-distribute excess pressure to prevent the formation of decubitus ulcers in bed ridden patients. Annu Int Conf IEEE Eng Med Biol Soc. 1021–4:2015, 2015.
Oomens, C. W., O. F. Bressers, E. M. Bosboom, C. V. Bouten, and D. L. Blader. Can loaded interface characteristics influence strain distributions in muscle adjacent to bony prominences? Comput Methods Biomech Biomed Eng. 6(3):171–180, 2003.
Oomens, C. W. J., M. Broek, and B. Hemmes. How does lateral tilting affect the internal strains in the sacral region of bed ridden patients? A contribution to pressure ulcer prevention. Clin Biomech. 35:7–13, 2016.
Pickham, D., B. Ballew, K. Ebong, J. Shinn, M. E. Lough, and B. Mayer. Evaluating optimal patient-turning procedures for reducing hospital-acquired pressure ulcers (LS-HAPU): study protocol for a randomized controlled trial. Trials. 17(1):190, 2016.
Polikeit, A., L. P. Nolte, and S. J. Ferguson. The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine. 28(10):991–996, 2003.
Pickenbrock, H., V. U. Ludwig, and A. Zapf. Support pressure distribution for positioning in neutral versus conventional positioning in the prevention of decubitus ulcers: a pilot study in healthy participants. BMC Nurs. 16:16–60, 2017.
Santamaria, N., M. Gerdtz, S. Sage, J. McCann, A. Freeman, T. Vassiliou, S. De Vincentis, A. W. Ng, E. Manias, W. Liu, and J. Knott. A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial. Int Wound J. 12(3):302–308, 2015.
Suzie, C. Science and practice of pressure ulcer management. Int Wound J. 3(2):99–100, 2006.
Sumarno, A. S. Pressure ulcers: the core, care and cure approach. Br J Community Nurs. 24(Sup12):S38–S42, 2019.
Seo, K. H., T. Y. Choi, and C. Oh. Development of a robotic system for the bed-ridden. Mechatronics. 21(1):227–238, 2011.
Schnackenburg, K. E., H. M. Macdonald, R. Ferber, J. P. Wiley, and S. K. Boyd. Bone quality and muscle strength in female athletes with lower limb stress fractures. Med Sci Sports Exerc. 43(11):2110–2119, 2011.
Ostomy Wound and Continence Nurses Society-Wound Guidelines Task Force. WOCN 2016 Guideline for Prevention and Management of Pressure Injuries (Ulcers): an executive summary. J Wound Ostomy Continence Nurs. 44(3):241–246, 2017.
Yusuf, S., M. Okuwa, and Y. Shigeta. Microclimate and development of pressure ulcers and superficial skin changes. Int Wound J. 12(1):40–46, 2015.
Zhong, W., M. Q. Malcolm, Q. Xing, and N. Pan. Textiles and human skin, microclimate, cutaneous reactions: an overview. Cutan Ocul Toxicol. 25(1):23–39, 2006.
Zhang, L., M. Zhu, L. Shen, and F. Zheng. Finite element analysis of the contact interface between trans-femoral stump and prosthetic socket. Annu Int Conf IEEE Eng Med Biol Soc. 1270–3:2013, 2013.
Acknowledgments
The author wishes to thank National Natural Science Foundation of China (Grant No. 52005045), and National Key R&D Program of China (Grant No. 2019YFC0119200), and Natural Science Foundation of Beijing Municipality (Grant Nos. 19L2018 and 3202003) that supported this work.
Funding
This study was funded by National Natural Science Foundation of China (Grant No. 52005045), and National Key R&D Program of China (Grant No. 2019YFC0119200), and Natural Science Foundation of Beijing Municipality (Grant Nos. 19L2018 and 3202003).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There are no conflicts of interest in this study.
Consent for Publication
Consent for publication of individual data has been obtained from all the participants of the study.
Additional information
Associate Editor Ender A. Finol oversaw the review of this article.
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Su, P., Lun, Q., Lu, D. et al. Biomechanical Changes on the Typical Sites of Pressure Ulcers in the Process of Turning Over from Supine Position: Theoretical Analysis, Simulation, and Experiment. Ann Biomed Eng 50, 654–665 (2022). https://doi.org/10.1007/s10439-022-02938-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10439-022-02938-9