Mechanical and morphological properties of parietal bone in patients with sagittal craniosynostosis

Sara Ajami, Naiara Rodriguez-florez, Juling Ong, Noor Ul Owase Jeelani, David Dunaway, Greg James, Freida Angullia, Curtis Budden, Selim Bozkurt, Amel Ibrahim, Patrizia Ferretti, Silvia Schievano, Alessandro Borghi

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Limited information is available on the effect of sagittal craniosynostosis (CS) on morphological and material properties of the parietal bone. Understanding these properties would not only provide an insight into bone response to surgical procedures but also improve the accuracy of computational models simulating these surgeries. The aim of the present study was to characterise the mechanical and microstructural properties of the cortical table and diploe in parietal bone of patients affected by sagittal CS. Twelve samples were collected from pediatric patients (11 males, and 1 female; age 5.2 ± 1.3 months) surgically treated for sagittal CS. Samples were imaged using micro-computed tomography (micro-CT); mechanical properties were extracted by means of micro-CT based finite element modelling (micro-FE) of three-point bending test, calibrated using sample-specific experimental data. Reference point indentation (RPI) was used to validate the micro-FE output. Bone samples were classified based on their macrostructure as unilaminar or trilaminar (sandwich) structure. The elastic moduli obtained using RPI and micro-FE approaches for cortical tables (ERPI 3973.33 ± 268.45 MPa and Emicro-FE 3438.11 ± 387.38 MPa) in the sandwich structure and diploe (ERPI1958.17 ± 563.79 MPa and Emicro-FE 1960.66 ± 492.44 MPa) in unilaminar samples were in strong agreement (r = 0.86, p < 0.01). We found that the elastic modulus of cortical tables and diploe were correlated with bone mineral density. Changes in the microstructure and mechanical properties of bone specimens were found to be irrespective of patients’ age. Although younger patients are reported to benefit more from surgical intervention as skull is more malleable, understanding the material properties is critical to better predict the surgical outcome in patients <1 year old since age-related changes were minimal.
Original languageEnglish
Article number104929
JournalJournal of the Mechanical Behavior of Biomedical Materials
Early online date29 Oct 2021
Publication statusE-pub ahead of print - 29 Oct 2021


  • Craniosynostosis
  • Cranial bone microstructure
  • Biomechanics of cranial bone
  • Pediatric


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