Silicone Encapsulation and the Effect of Primer, Dye and Width of Gap between Conductors, on performance. By Shixin Bickerton (Orthopaedic Science iBSc) 2 ABSTRACT Background and Aims: An instrumented tibial nailed could allow the earlier detection of complications, such as delayed unions. It could also allow a well tailored rehabilitation regime, which could decrease the likelihood of poor outcomes and improve the quality and speed of recovery. The aim was to test 4 possible silicone rubber candidates for the soft encapsulation of strain gauges on an instrumented nail. Attempts were made to assess the effect of rubber type, primer, black pigment, and width of gap between conductors, on leakage currents. Methods: Eight thin film strain gauges and similar thin film structures with different width gaps between conductors, were encapsulated in 4 types of silicone, some of which were primed or included a black pigment. These were tested under electrical bias for leakage currents, over 6 days in water. Results: The use of primer decreased the ability of the MED-6015 silicone encapsulation to protect against leakage currents (p = 0.007). The effect of the black dye, width of gap and rubber type, were not statistically significant, but corroborated with observed macroscopic deterioration. Summary and Conclusions: MED6-161 Primer appears to be detrimental to the encapsulant MED-6015 silicone rubber. Increasing the width of gap between conductors may increase the resilience against current leakage. Tests for the effect of dye and rubber type were inconclusive, but all the rubbers showed promise and more research is needed. Shixin Bickerton SN: 707229 3 CONTENTS Page Abstract 2 Abbreviations 4 Introduction 5 Method 15 Results 25 Discussion 34 Conclusions 45 Appendix 46 References 47 Shixin Bickerton SN: 707229 4 ABBREVIATIONS ADC = Analogue to Digital Converted CB1 = First Test Interface Circuit Board CB2 = Second Test Interface Circuit Board Ch = Channel for Data Collection FDA = Food and Drug Administration IPA = Isopropyl Alcohol (Isopropanol) IM = Intramedullary PGA = Programmable Gain Amplifier PTFE = polytetrafluoroethylene RS232 = Recommended Standard 232 SEM = Scanning Electron Microscope SMD = Strain Measurement Devices Ltd. Shixin Bickerton SN: 707229 5 INTRODUCTION Context An instrumented tibial nail has been proposed with the ability to monitor fracture healing, by using strain gauges to assess loading on the nail. A silicone encapsulant is intended for use to protect the gauges from the destructive effects of body fluids. The encapsulation must be durable enough to survive for up to 9 months after implantation. The strain gauges will be powered periodically, for up to 20 minutes of activity at a time, with the total duration of data collection unlikely to exceed 90 hours over the 9 months. Primer is often used to improve adhesion between silicone rubber and other materials. It may also be advantageous to add black dye to the soft encapsulation. The dye would prevent daylight from temporarily stopping the instrumented implant from working, thus allowing surgeons to check that the implant is functional before it is implanted. The nail will employ thin film strain gauges. Unlike foil gauges, these are not subject to creep, due to the molecular bonding of the gauge to the backing material which eliminates the need for an adhesive layer. They are also capable of higher resistances. It is possible for the strain gauges on the instrumented nail to have different width gaps between adjacent terminal conducting parts. A larger gap may improve the performance of the encapsulation by providing a larger area to which the insulation can adhere, as well as reducing the electric field which the encapsulant must insulate to prevent currents leakage. Tibial Fracture Epidemiology 40% of all long bone open fractures occur in the lower limbs, with the tibial diaphysis being most common (Howard M & Court Brown C M 1997). These tend to be more severe than upper limb fractures, due to increased soft tissue damage and more frequently associated musculoskeletal injuries. For these reasons, the fixation of tibial fractures is both a common Shixin Bickerton SN: 707229 6 and prominent concern in orthopaedics. Although most tibial fractures heal within 24 weeks (Ferguson M et al. 2008), they have the highest non-union rate of all the long bones and a high rate of delayed union or infection. This predisposition is due to the tibia’s anatomy, with little soft tissue coverage to protect against contamination and infection (den Outer A J et al. 1990). Different Fracture Fixation Methods Fixation methods include plates and screws, reamed and unreamed intramedullary (IM) nails and external fixation. Plates are considered by some to be contraindicated in severe open fractures, due to extensive devitalisation caused by disruption of the periosteal blood supply (Gregory P & Sanders R 1995). Compared to external fixation, reamed nailing requires fewer re-operations (Bhandari M et al. 2001). IM nailing is an effective treatment of diaphyseal and metaphyseal fractures and may also be used when a simple fracture extends into the articulation (Nork S E et al. 2005). Reaming increases disruption to the endosteal blood supply, but evidence suggests it reduces the risk of non-union and implant failure (Bhandari M et al. 2000). It also reduced the risk of screws breaking (Blachut P A et al. 1997). IM Nail History and Rationale Many modern nailing techniques owe their origins to Gerhardt Küntscher, who established that “elastic nailing” using a long, metal, tight-fitting intramedullary nail, was a reproducible method of fixating long bone fractures (Küntscher G 1940; Küntscher G & Maatz R 1945). The principles of its use were reported (Allen W C et al. 1968), helping to make it a well recognised and widely accepted method of fracture fixation. Shixin Bickerton SN: 707229 7 IM nailing re-aligns the limb and fracture fragments, yet still allows load transfer across the fracture site during functional activities. It prevents gross movements of the fracture, thus preventing further soft tissue damage and helps decrease the spread of contamination. In comparison to conventional external treatments, such as casting, it permits earlier limb mobilisation, enabling patients to return to normal activities sooner. IM nailing is recognised as a standard treatment for lower limb, diaphyseal long-bone fractures(Zenios H, Malik M H A, & Al-Mesri A R 2004). Different Methods of Monitoring Fracture Healing The complex biomechanics of the musculoskeletal system make it difficult for analytical models to accurately predict forces in bones and joints. Many direct in vivo measurements, have shown previous analytical models to produce too high a value (Brand R et al. 1994). Models are often based on estimations and thus need validation, whereas direct measurements from implants are essentially valid for the site at which they are taken. Radiographs and three or four point bending tests are commonly used to assess fracture healing. Many other alternative methods of monitoring fracture healing exist, including: strain gauges on instrumented implants or external fixators; the measurement of vibrations modes along a fractured long bone (which is compared to the unfractured bone on the contralateral side); and assessing the velocity of ultrasound across the fracture (again in comparison to the contralateral side) (Lowet G et al. 1993; Nishimura N 1984). Why use Stain Gauges to Monitor Fracture Healing? The use of strain gauges on implants can provide instant and ongoing monitoring. It allows earlier detection and therefore earlier treatment of delayed unions, mal-unions or non-unions, Shixin Bickerton SN: 707229 8 in comparison to commonly used alternatives, such as radiographs, which are usually taken periodically with long periods between each reading. Strain gauge telemetry systems can use conveniently portable equipment and do not carry the risks associated with X-radiation exposure. Unlike assessing vibrations or the velocity of ultrasound through bones and soft tissues, strain gauges do not require a corresponding healthy bone for comparison. Data from the instrumented implant can also be used to improve post-operative management of the fracture, by tailoring the load-bearing rehabilitation therapy as healing progresses. This helps to maximise the effectiveness and minimise the duration of the recovery. Instrumented Implants in Orthopaedics The first instrumented implant reported, was a hip hemi-arthroplasty (Rydell N W 1966). Strain gauges on the inner surface of a hollowed neck, were used to ascertain the axial force and moments. The gauges were wired to a subcutaneous connector, later exposed by incision. The first reported clinical use of an implant with telemetric data transmission was a hip prosthesis with a battery powered transmitter buried in the patient’s subcutaneous fat, used for 42 days (English T A & Kilvington M 1979). In vivo loads telemetered from nail plates at the hip (Brown R H, Burstein A H, & Frankel V H 1982) produced clinically significant results in three of five implants. Attempts were also made to measure strain along the stem of implants (Barlow J W et al. 1984). Here, the strain gauges were protected only with a layer of silicone rubber. Unsure of the encapsulation’s efficacy, these were not used in vivo. More commonly, studies used gauges placed in a cavity, either welded shut or using a combination of silicone, Teflon™ and Shixin Bickerton SN: 707229 9 epoxy to create a hermetic seal. Longer term instrumentation was developed, with several studies on the force and temperature of hip implants in 7 patients, for a duration of up to 10 years (Bergmann G et al. 1988). Two femoral prostheses were implanted to study the relationship between stress distribution and implant fixation over time (Taylor S J G et al. 1997; Taylor S J G & Walker P S 2001). Recent Progress in Instrumented Implants The progression of electronics has enabled higher performance and more complex circuits to be made with increased efficiency (low power consumption), in an ever decreasing volume of space. Improved integrated circuit technology was one factor at the forefront of developments in modern telemetric implants. However, there has not been a corresponding increase in the longevity of implants encapsulated in soft materials where very low leakage is a necessity, and most implants designed for long term monitoring in vivo are welded. This was not an option here, principally due to cost, as the current study is a precursor for a commercial system. A telemetrised femoral nail was used successfully in 1 human subject, to provide data on load changes during fracture healing, from 2 to 26 weeks post-operatively (Schneider E et al. 2001). A hermetically sealed cavity protected the electronic circuits from body fluids. The loading in the implant, was found to decrease by about 50% as the fracture healed. In addition, the medial–lateral force, anterior–posterior force, and moments about all three of these decreased progressively, as the fracture healed. Shixin Bickerton SN: 707229 10 However, a study in sheep found no clear correlation between implant strain and fracture healing (Wilson D J et al. 2009). Telemetrised femoral nails were used to treat midshaft osteotomies and static strain measurements were taken during leg stance in 11 sheep, for 12 weeks. Although 8 sheep showed evidence of fracture healing (by plain radiographs, microcomputed tomography and histology), only 2 showed decreased loading on the implant. However, a correlation may have been masked by other variables, such as the sheep putting less weight on the injured leg during the early stages of healing. Encapsulation of Electronic devices for Surgical Implantation The primary issue of any implantable (hermetic or nonhermetic) encapsulation is to prevent body fluid ingress damaging the device. In 1973, it was first shown that hermetically sealed cavities may be unnecessary, if soft encapsulation alone could provide sufficient protection (Donaldson P E K 1973). Two mechanisms for protecting devices against moisture were established; an “impermeable envelope,” such as a hermetic packages or a silicon nitride passivating layer, or a “conformal layer,” such as silicone rubber, resin, or tacky wax encapsulation (Donaldson P E K 1976). With implanted devices, the packaging has to be small, biocompatible, protect the electronics from water and ions (largely sodium) and often provide mechanical protection. Current packaging often uses one of three techniques: soft encapsulation with a polymeric material; an outer case made of glass or ceramic with epoxy or metal solder sealing; or metallic flat-packs sealed with resistive electron or laser beam welding, or solder sealing (GülerN F & Übeyl E D 2002). Why Use Soft Encapsulation? Soft encapsulation can provide a viable alternative in implants that lack the space to enclose a cavity, or cannot be hollowed without compromising structural integrity. Since the 1070’s, Shixin Bickerton SN: 707229 11 Nonhermetic conformal encapsulants have been applied in many different fields and have shown that they can be effective (Lin A W & Wong C P 1992). However, where small leakage currents are to be avoided, the encapsulant must be reliable and predictable. Silicone Rubber Silicone rubbers are synthetic polymers with alternating atoms of oxygen and silicon (with or without organic groups attached). They are convenient to apply as 1 or 2 part adhesives, and have a range of material and mechanical properties which make them very suitable for encapsulating electronic assemblies in vivo. There is a growing range of FDA (Food and Drug Administration) unrestricted grade rubbers for long term implantation. They also have advantages in cost, weight and volume, in comparison to welded cavities. The use of silicone resins to encapsulate electronic devices was described by C. P. Wong in two papers. Its electrical performance and correlation to the cure temperature and time were shown (Wong C P 1989) and further explanation was given with regards to understanding its use (Wong C P, Segelken J M, & Balde J W 1989). The properties of silicones make them well suited for the packaging of electronic devices and can improve their reliability, performance and longevity (Vanlathem E & Oellers E 2001). They can encapsulate electronic devices such as integrated circuit devices and hybrid integrated circuits, due to their thermal stability, as well as their dielectric, mechanical and chemical properties (Lin A W & Wong C P 1992). Good compliance of the cured rubber prevents failure due to large interfacial stresses tearing the rubber from the component parts. Silicones have a low order of toxicity to human health and the environment(Joint Assessment of Commodity Chemicals 1994) and do not start to peel, crack, harden or become brittle over time. They are relatively easy to use, containing no flammable or toxic solvents and not requiring any special handling precautions (Mollie J P 1999). Shixin Bickerton SN: 707229 12 Most silicones are very permeable to water vapour (Robb W L 1968), but can adhere well to hydrophilic surfaces, thus preventing water from adsorbing onto the surface and condensing to form a conduction path for leakage (Ko W H & Spear T M 1983). Only highly purified polymers function reliably as encapsulants, because mobile ionic contaminants affect the electrical reliability of encapsulated devices(Smith A L 1974; Wong C P 1988; Wong C P & Looby-Calvert M M 1993). With electric fields and ionic contamination, moisture can cause galvanic and electrolytic corrosion, associated with electro-oxidation and metal migration (Wong C P 1988). Studies have shown that some silicones are viable encapsulants, with the ability to resist moisture ingress and mobile ion permeation (Wu J et al. 2000). Silicones have a low Young’s modulus which can help absorb stresses caused by different coefficients of thermal expansion (such as with silicone on a titanium implant). However, this means the encapsulation may not provide sufficient mechanical protection. If necessary, a harder material can be placed over the silicone to provide additional mechanical stability to withstand, for example, the forceful insertion of an implant. Implantable soft encapsulations have been studied for a number of purposes, such as the implantation of neural microelectrodes. Here, microelectrodes extending from the edge of a MEMS chip into the brain, prevent hermetic sealing. Flexible encapsulations using silicone and parylene is acknowledged by some to be a key component for future of neural prostheses (Stieglitz T, Schuettler M, & Koch K P 2005). In other studies, a composite of nylon and silicone-gel meshes were considered to most successfully meet the requirements for nonhermetic encapsulation (Jackson N et al. 2009). Shixin Bickerton SN: 707229 13 Silicones have been used effectively for short term potting, encapsulation, and sealing of microelectronics (Ko W H & Spear T M 1983). Good results with long term use have also been produced, enabling an implanted radio receiver to work effectively after 11 years, with predictions of efficacy for up to 30 years (Donaldson P E K 1989; Donaldson P E K 1991). Recent studies have added additional evidence in support of these early findings. Investigation Introduction Aim This investigation intends to establish the potential of the following candidate silicone rubbers: MED-6015, MED4-4220, MED3-4013 and EPM-2420, to effectively encapsulate strain gauges under water for extended periods. The first two were chosen for their design as low viscosity, biocompatible, encapsulant materials, MED3-4013 was chosen for its biocompatibility and superior adhesion, and although EPM-2420 was not medically approved, it was investigated for purely scientific purposes, as its properties such as very low viscosity made it an otherwise promising candidate. To be effective, all encapsulants had to adhere sufficiently without voids or deterioration, to protect against water ingress which could cause leakage currents and corrosion. The effects of dye, primer and the width of the gap between adjacent conductors should also be established. My investigation will be comprised of 2 parts; first, preliminary testing of the data collection system using Med-6015 encapsulated strain gauges on titanium beams (Substrates1), and secondly (the primary investigation) testing 4 silicone rubbers (MED6015, MED4-4220, MED3-4014 and EPM-2420) and the effect of primer (MED6-161), dye (MED-4900-2 Pigment) and the width between conductors, on the effectiveness of encapsulation. The primary investigation will use purpose made samples supplied by Strain Measurement Shixin Bickerton SN: 707229 14 Devices Ltd (SMD) (Substrates2). Follow up investigations will be used to assess any voids or failures of adhesion between the rubber and the substrates. Hypotheses for Preliminary Work 1) The data collection system will remain stable and not drift over time. This will be shown by the strain gauges which have not failed and the controls (fixed resistors), maintaining a relatively constant level of current over 7 days under water. 2) Some of the thin film gauges will exhibit leakage currents when immersed in water for 7 days, due to loss of adhesion between the silicone rubber and the gauge. Loss of adhesion will be shown using an Ink test. Hypotheses for Primary Investigation 1) The level of current leakage will be inversely proportional to the size of the gap between conductors. Gaps of 10, 20, 40, 80 and 160µm on similar thin film structures (substrates2) will exhibit progressively better immunity to leakage currents, when tested for 6 days under bias, immersed in water. This will be due to the greater path required for moisture ingress. 2) The use of MED6-161 primer will decrease current leakage, when tested by the same method, due to improved adhesion between the silicone and the surface of the substrate. 3) The addition of 2% MED-4900-2 pigment (black dye) to MED-6015 silicone rubber, will not significantly affect the level of leakage currents, when tested by the same method. 4) Different types of silicone rubbers will perform differently, with different levels of leakage currents, again when tested by the same method. Shixin Bickerton SN: 707229 15 METHOD Preliminary Work: Equipment Stability Tests The purpose of this was to test for drift in the measuring equipment over time, to ensure that any observed drift was due to the test samples and not the instrumentation. It also enabled the encapsulation method to be practised, in order to assess its weaknesses and make amendments for the primary investigation. The stability tests were carried out on 8 thin film strain gauges with 10µm gaps between the adjacent terminal conductor parts. These gauges were situated on two titanium beams (4 on each) and encapsulated in MED-6015 silicone rubber. Primary Investigation: The Effect of Silicone Type, Primer, Dye and Gap-width, on leakage The encapsulation may deteriorate with or without bias, but to be suitable for the intended purpose, any leakage must not be significant enough to cause failure of the strain gauge within 9 months after implantation. However, time constraints prevent intermittent testing of the samples over 9 months, to simulate clinical usage. To test the encapsulation, the current was measured every 5 seconds for 6 days (144 hours), which exceeds the total time the instrumented implant will experience under electrical bias. The current levels were assessed across different width gaps between conductors. Substrates2 consisted of 25x25x1mm polished titanium squares, made by SMD, using the same materials and methods employed to make the thin film strain gauges to be used on the instrumented nail. A layer of glass ceramic (electrical insulator), then nichrome (conductor) was sputtered onto the titanium. On each square, a laser cut the outlines of a 5 rectangles and a strain gauge through the nichrome, exposing the ceramic beneath. The rectangles were cut using 1, 2, 4, 8 and 16 passes of the laser, to create cuts of 10, 20, 40, 80 and 160µm. Exposed triple wire bonds connect the nichrome to soldered pads (lead-free solder 430-20S), which were connected to coloured external wires (500mm 32awg PTFE wires). Shixin Bickerton SN: 707229 16 From left to right, the blue wire was connected to the ‘background’ nichrome (to be grounded), the red, orange, yellow, pink and black wires were connected to the centre of each a. 1cm b. rectangle; and two white wires (one joined to ground) were connected to either end of a strain gauge (Figure 1), Figure 1 – a) Photograph of Substrate2, b) diagram of Substrate2. Section 1: Method For Preliminary work on Substrates1 1.1) Making the Mould A mould was constructed from 2 pieces of Teflon® (PTFE (polytetrafluoroethylene)), to ensure the silicone encased the substrates completely. Two parallel 80x15mm holes were cut through the upper piece, and 4mm into the lower piece using a milling machine (Figure2). A 120x12mm indent was then cut over each of the 2 existing holes, on the upper surface of the lower piece, to a depth of 1.1mm, to accommodate the ends of the beam. The substrates were placed in the mould, with strain gauges facing superiorly and wires exiting through the hole. The mould was held together by 12 screws. Figure2 – Mould for Substrates1 1.2) Cleaning Process The mould (containing the substrates) was immersed in a solution of TEEPOL (½ %) and Na3 PO4 (2 ½ %) for 2 minutes, rinsed under running water for a further 2 minutes, then transferred to a tank with de-ionised water (15MΩ resistance) running through it. The mould was removed when the lyometer testing the water leaving the tank had fallen back down to a Shixin Bickerton SN: 707229 17 normal current level, which indicated the ions from the detergent (initially causing the current to rise) had been largely removed. The mould was then dried in an 80°C oven for 30 minutes. 1.3) Encapsulation Process (Potting) Each beam was encapsulated in 10ml of MED-6015. This 2 part silicone was mixed (10:1) using a DAC150 FVZ-K Speedmixer™, at 2000rpm for 2 minutes, before being injected down one side of each beam, to chase out any air from under it. The rubber was cured in a compression chamber at 2bar on a 45°C hotplate for 24hours, before the substrates were removed from the mould. 1.4) Data Collection System 12 channels for data collection on circuit board 1 (CB1) were connected to multiplexers which sampled each channel in turn. The multiplexers were connected to an AD621 instrumentation amplifier with a fixed gain of 100. The amplifier was connected to a Semtech XE8801A Microcontroller, which had an inbuilt ADC (Analogue to Digital Converter) and PGA (Programmable Gain Amplifier) with a gain set to 10, which brought the total gain to 1000. The PGA also allowed the offsets associated with each signal to be nulled in software, thus allowing each strain gauge signal to occupy the full available range of the amplifier. A second test interface board (CB2), connected CB1 to a computer via an RS232 (Recommended Standard 232) cable. The computer read the information via MK4 (C++ Programme), allowing it to be imported into a LabVIEW programme. CB2 also acted as a voltage reference circuit, to stabilise the voltage at 5V to CB1, as well as containing an oscillator to drive the microcontroller, and acting as a driver for the output RS232 telemetry signal (to convert to standard RS232 voltage levels) (Figure 3). Shixin Bickerton SN: 707229 18 Figure 3 – Photograph of Circuit Boards 1 and 2 (CB1 and CB2) CB2 CB1 10cm The strain gauges were wired into 8 of the 12 channels available for data collection, arranged as quarter bridges, with 20kΩ fixed precision resistors. The 3 remaining channels used two fixed precision resistors each, to function as controls. 1.5) Shielding and Noise reduction Both circuit boards were housed in separate metal boxes to shield against electrical noise. The box for CB1 was grounded to CB1 and the box for CB2 was grounded to the power supply. Aluminium foil was used extensively to shield the surface of the table, the wires extending from CB1 to the substrates, the power supply cable and the water bath. All of these were connected to ground via the metal box of CB1, along with the metal lid of the water bath. 1.6) Other Adjustments Foam attached to the edge of the water bath and its lid, prevented damage to the thin wires exiting the bath. The soldered connections between the strain gauges and the circuit board were covered by heat-shrink wrap and remained outside the water bath, to reduce exposure to humidity, and thus reduce the risk of corrosion. A temperature sensor was attached to CB1. When the substrates were immersed in water, the sensor was placed in a glass test tube full of oil, taped to the inside of the water bath. Oil was used due to its high thermal conductivity and the glass provided good insulation from the oil. Shixin Bickerton SN: 707229 19 1.7) Reprogramming of the Microcontroller Chip The chip was re-wired to power all channels continuously, so that the full number of hours under bias could be achieved in the time available and better electrical shielding was possible. Permanently powering the circuit, more closely reflected the use of the instrumented nail, which would be powered continuously for 20 minutes per session of activity. The ADC output of the Microcontroller had a range of 0 to 215 (32760) counts. Its offset was re-programmed to match the offset of the strain gauges. Firstly, a chip with the PGA set to a gain of 1 ensured that any voltage offset present was within the linear range of the amplifier so that it could be recorded for subsequent nulling. The counts for each channel were recorded and the change required to make them all approximately 14000 counts (roughly the centre of the range) with a gain of 10, was calculated and expressed as a hexadecimal number, using an Excel PGA Offset Calculator Programme. 1.8) LabVIEW Set Up A LabVIEW programme was set up to record various columns of data: the day, hours, minutes and seconds of each reading; the counts and standard deviation for each channel; the temperature (in °C); and the voltage. Readings were set to be taken every 5 seconds and appended to an Excel spreadsheet. 16 points were automatically averaged when taking a reading, to filter out noise. After the data was gathered, every 12 readings were averaged (making each row of data an average of 1 minute or 192 points), to further increase filtering. 1.9) Initial readings The counts (LabVIEW units) were initially recorded when a 33MΩ resistor was joined in parallel to one of the 20kΩ fixed precision resistor on CB1, and the results were used to determine the relationship between counts and microstrain (Appendix 1). Shixin Bickerton SN: 707229 20 1.10) Record Data i) Run the data collection for 3 days in air, to establish the relationship between temperature and counts (Results Figure 6a, Discussion 10). ii) Run the data collection for 6 days under water to gather results and observe for leakage (Results Figure 6b, Discussion 11). 1.11) Ink test The substrates were submersed in a bath of ink to assess adhesion (Discussion 11). Section 2: Method For Primary Investigation on Substrates2 Changes to the encapsulation method for Substrates2 were made, based on the lessons learned from the preliminary work on Substrates1. 2.1) Making the Mould A mould was made with the ability to encapsulate four substrates at once. Two 15cm long L shaped pieces of metal were screwed together to create the base, back and top of the mould. Four 3.2x3cm plastic trays were used to house the substrates, and four longer screws with Teflon® boots would hold the substrates by a corner in the bottom of the trays and packing pieces were placed beneath the trays (Figure 4). Figure 4 – Mould for Substrates2. 2.2) Cleaning Process First, the mould and trays were cleaned with Isopropyl Alcohol (IPA). The substrates were washed in 3M solvent (HFE-72DA), to remove both organic and ionic contaminants, and left vertically for the solvent to run off onto paper. They were then transferred to a tank of deionised water (see Discussion 4), before being dried in an oven, as described for Substrates1, but without the mould. The substrates were then secured into the bottom of the trays. Shixin Bickerton SN: 707229 21 2.3) Encapsulation Process (Potting) One square substrate was encapsulated by a 2mm thick layer of each of the following: - MED-6015 Silicone rubber - MED-6015 Silicone rubber with MED6-161 Primer - MED-6015 Silicone rubber with 2% MED-4900-2 Pigment (Black Dye) - MED-6015 Silicone rubber with MED6-161 Primer and 2% Black Dye - MED4-4220 Silicone rubber (designed as an encapsulants) - MED4-4220 Silicone rubber with MED6-161 Primer - MED3-4013 Silicone rubber (designed as an adhesive) - EPM-2420 Silicone Rubber (Not medical, but chosen for its promising properties) The four MED-6015 encapsulations were completed together, whereas the others were completed at a later date, due to the moulds ability to encapsulate only four substrates at once. Prior to encapsulation, the appropriate substrates were primed with a thin layer of MED6-616 primer, applied with a small clean paintbrush and left to dry in air for 45 minutes. 4cm3 of silicone rubber were mixed for each tray. All rubbers were mixed from 2 parts. MED-6015 was mixed in a ratio of 10:1, EPM-2420 was mixed 1:1, as were MED4-4220 and MED3-4013. The former two were mixed as described for Substrates1, whereas the latter two and could be applied using a 2-cartridge dispensing gun, with a static mixing nozzle attached. The MED-6015 was mixed in 2 syringes (8cm3 in one and 7.84cm3 in the other), then 2% MED-4900-2 Pigment (0.18cm3) was added to the second syringe, before mixing for a further 1 minute in the Speedmixer™, at 2000rpm. Once all the encapsulants had been applied, the mould was placed into a compression chamber at 2bar, heated with heating tape to 70°C, for 24 hours (Figure 5). Figure 5 – Compression chamber with heating tape. Shixin Bickerton SN: 707229 22 Once the rubber had cured, the screws were removed from the top of the mould, allowing the trays to be removed. The encapsulated substrates were not removed from the trays. 2.4) Data Collection System The 12 channels available for data collection were able to accommodate two substrates at a time (each substrate having 5 different width cuts and a strain gauge). A second 20kΩ fixed precision resistor was added as a half-bridge completion resistor to all the channels, with the exception of the channels to be connected to the strain gauges on Substrates2. The resistance of these strain gauges were all different, so the existing resistors were removed from these channels and replaced with resistors made to the specific resistance of the first two substrates. 2.5) 2.6) Shielding and Noise Reduction Measures, and Other Adjustments – No changes. 2.7) Reprogramming of the Microcontroller Chip Each time the substrates were changed over, the microcontroller chip was reprogrammed (as in the method for Substrates1), because the strain gauges on Substrates2 all had slightly different levels of resistance. 2.8) LabVIEW Set Up - No changes. 2.9) Initial readings Prior to each test, the new substrates were run in air for 1 hour (Discussion 9). 2.10) Record Data Tests were run under water for 6 days, for all encapsulated samples. (Results Figures 7(a-d), 8(a-d) and 9, Discussion 13). 2.11) Ink Tests No ink tests were performed with Substrates2, but SEM (Scanning Electron Microscope) Images were taken of the damaged areas (Discussion 11 and 13). Shixin Bickerton SN: 707229 23 2.12) Statistical Analyses Once all the data was gathered, graphs were drawn to enable quick comparisons between the encapsulants. Each of the channels were ranked by their range of the data (rank 1 being smallest and rank30 being the largest) over the 6 days, in order to create a more sensitive measure of outcome than “success” or “failure”. The average level of noise for each channel after filtering was deducted from the range of data prior to statistical analysis (Discussion 13). For the statistical analyses, the strain gauges were not comparable to the other channels, and could not be included. Because there were only 8 strain gauges in total, each with a different encapsulant, they could not produce statistically significant results if analysed for differences caused by any of the factorial comparisons below. Factorial comparisons were made to determine the effect (if any) of primer, dye, width of the gap between conductors, or rubber type on the outcome. Different groups were compared for the effect of primer (Table1), and the effect of dye (Table2). The results from all encapsulations could be used for the comparison between gap widths, because each gap width was covered by every encapsulant. Table1 – The primed substrates (left) were compared to unprimed substrates (right). MED-6015 with primer MED-6015 MED-6015 with primer and dye MED-6015 with dye MED4-4220 with primer MED4-4220 Table2 – The substrates with dye (left) were compared to substrates without dye (right). MED-6015 with dye MED-6015 MED-6015 with primer and dye MED-6015 with primer Shixin Bickerton SN: 707229 24 Because there cannot be a normal distribution with so few results, non-parametric tests were used to determine the p-value. The Mann–Whitney U Test was used for the effect of primer or dye (comparing 2 independent samples) and the Kruskal-Wallis Test was used for the effect of gap-width or rubber type (comparing 5 and 4 independent samples respectively). This test showed whether or not there was a significant difference between each of the groups (it did not test for correlation between increasing gap width and current leakage). Because MED-6015 and MED4-4220 encapsulants were both tested with and without primer, a separate comparison between these two rubbers could be made, with more statistical significance than the comparison between all the different rubber types, where dyed or primed samples were excluded. Shixin Bickerton SN: 707229 25 RESULTS During the investigation, all substrates were placed in the bottom half of the bridge, so an increase in currents (as caused by leakage currents) was presented as a decrease in counts on the graphs. A change of 16.51 counts equated to a change of 1 microstrain (Appendix 1). Preliminary Work Results Figure 6 – Graphs for preliminary work, showing Substrates1, encapsulated in MED-6015, a) run in air and b) run in water. 6a) Graph to show Substrates1, Encapsulated in MED- 6015, in Air 6b) Graph to show Substrates1, Encapsulated in MED- 6015, in Water Water Bath Topped up Strain Gauge Counts Temperature (°C) 18000 38 16000 37 14000 36 12000 10000 35 8000 34 6000 33 4000 32 2000 0 0 12 24 36 48 60 72 84 96 108 120 132 31 144 Time (hours) Ch = Channel for Data Collection Shixin Bickerton SN: 707229 Ch 8 Gauge Ch 7 Gauge Ch 6 Gauge Ch 5 Gauge Ch 4 Gauge Ch 3 Gauge Ch 2 Gauge Ch 1 Gauge Temperature (°C) 26 Preliminary work Results (Method 1.10.i and ii) In air, the strain gauge counts correlated (inversely) with temperature. A 1°C increase caused a decrease of 100 counts, which was equivalent to a change in 6.06 microstrain (Figure 6a). The water-bath maintained the temperature at 37-37.5°C, except when it was topped up at 117 hours. It was decided the water bath would not be topped up during the primary investigation, because it would cause large errors in the statistical analyses based on the range of counts. The strain gauge on the first channel for data collection (Ch1, blue), began to fail at 50 hours, from which point, it exhibited increasing leakage currents until it fell below the observable range, at 130 hours. Channel 9 (Ch9, pale green) appeared to be severely unstable between the periods 0-3hours, and 46-51hours, yet it remained stable at an appropriate count after this point, suggesting a poor connection, as opposed to a fault with the sample or encapsulant. The remaining 6 strain gauges remained relatively constant. After Substrates1 had been tested, it was revealed that the strain gauges were covered by SMD’s conformal silicone coating, prior to the encapsulation with MED-6015, and therefore it was probably the conformal coating that was being tested. However, these results still showed that silicone could be an effective encapsulant, and that the measuring equipment was not subject to drift. Shixin Bickerton SN: 707229 27 Primary Investigation Results Figure 7 - Graphs showing the current across the different width gaps, on Substrates2, encapsulated in: a) MED-6015 alone, b) MED-6015 with primer, c) MED-6015 with 2% MED-4900-2 Pigment (Black Dye), and d) MED-6015 with primer and Black Dye. Key The count for all lines have been adjusted to start at zero, to aid comparisons between the different width gaps. Strain Gauges are not shown. 7a) MED-6015 7b) MED-6015 with Primer Counts Temperature (°C) Counts Time (hours) Time (hours) 7c) MED-6015 with Dye Counts 7d) MED-6015 with Primer and Dye Temperature (°C) Time (hours) Shixin Bickerton SN: 707229 Temperature (°C) Counts Temperature (°C) Time (hours) 28 Figure 8 - Graphs showing the current across different width gaps, on Substrates2, encapsulated in: a) MED4-4220 alone, b) MED4-4220 with primer, c) MED3-4013, and d) EPM-2420. Key The count for all lines have been adjusted to start at zero, to aid comparisons between the different width gaps. Strain Gauges are not shown. 8a) MED4-4220 8b) MED4-4220 with Primer Counts Temperature (°C) Counts Time (hours) Temperature (°C) Time (hours) 8c) MED3-4013 8d) EPM-2420 Counts Temperature (°C) Time (hours) Shixin Bickerton SN: 707229 Counts Temperature (°C) Time (hours) 29 Figure 9 – Graph showing the strain gauges on Substrates2, in all the different encapsulants. All Strain Gauges on Substrates2, in Water Strain Gauge Counts 31000 26000 EPM-2420 MED3-4013 MED4-4220 with Primer MED4-4220 MED-6015 with Primer and Dye MED-6015 with Dye MED-6015 with Primer MED-6015 21000 16000 11000 Results of Statistical Analyses The channels were ranked from 1 to 30, based on their range of data over the 6 days (Method 2.21). A lower rank number indicates a more successful encapsulation. Table 1a: Effect of Primer – Mean and sum of ranked data for primed (1) and unprimed (0) substrates (encapsulated in MED-6015 and MED4-4220), Mann-Whitney U Test P-value = 0.101 Table 1b: Effect of Primer on MED-6015 – Mean and sum of ranked data for primed (1) and unprimed (0) substrates (encapsulated with MED-6015_ Mann-Whitney U Test Shixin Bickerton SN: 707229 P-value = 0.007 30 Table 2: Effect of Black Dye – Mean and sum of ranked data for the comparison of substrates with dye (1) and without dye (0). Mann-Whitney U Test P-value = 0.112 Table 3: Effect of Width of Gap – Mean of ranked data for the comparison of gap width. (in µm) Kruskal-Wallis Test P value = 0.115 Table 4: Comparison between all 4 Different Rubber Types – Mean and sum of ranked data for the comparison of MED-6015 (Rubber1), MED4-4220 (Rubber2), MED3-4013 (Rubber3) and EPM-2420 (Rubber4). Only samples without dye and without primer used. Kruskal-Wallis Test P value = 0.395 Table 5: Comparison between MED-6015 and MED4-4220 – Mean and sum of ranked data for the comparison of MED-6015 (Rubber1) withMED4-4220 (Rubber2). Mann-Whitney U Test Shixin Bickerton SN: 707229 P-value = 0.070 31 Primary Investigation Results (Method 2.10, Results Figures 7(a-d), 8(a-d) and 9, Discussion 14) For clinical use, the encapsulant on the instrumented nail would be considered successful if a change of 1-2 microstrain (16.5 – 33 counts) was not compromised by leakage, corrosion or drift. The length of the perimeter of each rectangle on Substrates2 (5cm) was approximately 50 times the distance between the pads (1mm) of the nail’s thin film strain gauges (where leakage is most important). The strain gauges on Substrates2 were also at least 4 times larger than those on the instrumented nail. This was done in order to amplify any differences in performance between the encapsulants, by simulating a worse-case-scenario in vivo. When examining the graphs, it should be noted that the level of leakage was amplified by the increased length over which leakage could occur. Parameter Specific Investigations 1) Primer When comparing the graphs for the encapsulations in MED-6015 (Figure 7a-d), the most prominent feature was the negative effect of primer. Without primer (Figure 7a), the counts remained relatively constant across all the different width gaps, with an average range of 34.6 counts. In contrast, the substrate encapsulated with primer (Figure 7b) showed much greater current leakage, with an average range of 1965 counts. However, the MED4-4220 encapsulation did not show this effect when primed. The statistical analysis of the effect of primer using both rubbers (Table 1a) produced statistically insignificant results with a p-value of 0.101. A second analysis was carried out comparing the effect of primer on the MED-6015 encapsulation alone. These result showed that the primer caused significant deterioration of the encapsulant (p-value = 0.007) and it corroborated with the appearance of the graphs and the appearance of the encapsulation. With MED-6015 and primer, voids were seen prior to Shixin Bickerton SN: 707229 32 encapsulation (Discussion 7, Figure 12) and brown patches of corrosion were observed after testing (Discussion 12, Figure 17). 2) Width of Gap between Conductors On the primed MED-6015 encapsulation graph (Figure 7b), the level of leakage decreased as the width of the gap between conductors increased. The statistical analysis comparing the different width gaps appeared to show differences which corroborated with this hypothesis, with a smaller mean rank for each larger width (with the exception of the 80µm gap) (Table 3). However, these results was not statistically significant (p = 0.115) and no obvious explanation was found for the slight anomaly of the 80µm gap. 3) Black Dye The analysis of the effect of 2% MED-4900-2 black dye (Table 2) appeared to suggest a possible detrimental effect, but once again, this result was not significant (p = 0.112). 4) Comparison between Silicone Rubber Types The comparison between all 4 rubber types showed that MED3-4013 had a mean rank about half that of the others (Table 4), but these results were very dubious with a p-value of 0.395. The comparison between MED-6015 and MED4-4220 suggested the former was not as effective as the latter and due to the higher number of samples used, this result was closer to being significant (p = 0.070) (Discussion 14.d). 5) Dendrite Formation Some of the graphs with discernible current leakage (in particular Figure 7d), had a particular shape dissimilar to that of the strain gauge failure observed in the preliminary work (Figure 6b). The characteristic of a sudden, yet short lived increase in current (decrease in counts), may have represented a dendritic growth across the gaps between adjacent conducting parts. Shixin Bickerton SN: 707229 33 The electric field could have caused metal ions on one side of the gap (anode) to move to the opposite side (cathode) where the field strength was highest. The metal ions could then have been deposited, forming a thin strand of metal (dendrite). When a dendrite spanned the full width of the gap, it could have caused a momentary short circuit, before it broke, causing the distinctive graph shape. 6) Strain Gauges Only the strain gauge encapsulated in MED-6015 with primer failed completely. However, this was not due to leakage currents, because the counts increased until they fell above of the observable range. This meant that the current was decreasing with failure, indicating an increase in resistance. The failure was caused by corrosion of the thin film gauge, which had an appearance similar to that seen in Figure 17d (Discussion 12). All the others strain gauges showed relatively little current leakage or drift with time. Shixin Bickerton SN: 707229 34 DISCUSSION 1) Gas bubbles during the Encapsulation of Substrates1 Initially, the silicone was placed in a vacuum-jar after mixing in the Speedmixer™ for deaeration (to extract excess gas). However, the bubbles which formed would not burst and were reabsorbed once the vacuum was removed. The silicone was cured in a pressure chamber to eliminate bubbles as the rubber cured. On the first attempt to remove the substrates1 from their mould, bubbles appeared at the interface between the polished titanium and the silicone, at the ends of the beams. To ensure the rubber had cured completely, the mould was placed in a 70°C oven for a further 2 hours. Afterwards, the bubbles still appeared, suggesting insufficient adhesion between the rubber and the titanium. For the purpose of rubber adhesion, it may be more desirable to have a matt or roughened titanium surface, however, the instrumented nails must have a polished surface for strain gauges to be sputtered on. To avoid this problem, Substrates2 were placed in individual trays and not removed. To ensure adequate curing, a thinner (2mm) layer of silicone was used and the substrates were placed in a compression chamber heated with heating tape to 70°C to accelerate the process. 2) Excess Noise on Particular Channels of Data Collection The shielding described in the method successfully reduced noise to an acceptable level (below 20 counts) on all except the last three channels (Ch 10, 11 and 12), which remained high (70-80 counts). All shielding and ground connections were checked, and the external wires and substrates for the noisy channels were switched with those of low noise. This did not affect the outcome, therefore the noise was not due to a component outside CB1. The circuit board was cleaned with IPA (Isopropyl Alcohol), its joints were re-soldered, old Shixin Bickerton SN: 707229 35 unused temperature sensors were removed from the board, and the fixed resistors, multiplexers and microcontroller chip were replaced. When these all proved ineffective, an Oscilloscope showed noise on the last three channels at the amplifier, which identified a problem between there and where the channels exited the board. Examining the circuit diagram revealed that capacitive coupling may have been occurring, where two digital traces for unused temperature sensors ran close to a resistors and analogue trace for the affected channels. These traces were cut near the microcontroller and grounded to increase shielding between the last three channels and the rest of the board. 3) Scanning Electron Micrograph (SEM) images of Substrates2 Prior to Encapsulation The widths of the gaps cut by the laser may not have been exact if subsequent passes of the laser overlapped the adjacent cuts. SEM (Scanning Electron Micrograph) images were taken to assess the accuracy of the gap widths and examine their appearance (Figure 10). Figure 10 – SEM Images of a) a 40µm gap, b) a 80µm gap, and c) a 160µm and 80µm gap. This substrate was not encapsulated. a) b) c) Although the accuracy of the widths was acceptable, some unexpected features were observed. Firstly, a significant amount of debris (probably nichrome left behind by the laser), remained within the gaps. Secondly, the edges of the gaps appeared scalloped. Some of these ‘defects’ extended more than 10µm into the gap, so increased failures of the 10µm and 20µm gaps might have been expected. However, the scanning process affected the substrates. The laser cuts initially appeared dark, but became lighter under the SEM scan. The SEM worked Shixin Bickerton SN: 707229 36 well on the metallic surfaces, but the electrons disrupted the ceramic insulation exposed. The scalloped edges may have been an artefact produced by the scanning process and not an accurate representation of the edge of the gap. Due to the permanent change to the surface of the gap, the substrate used to take these images was not tested. 4) Cleaning of Substrates2 Prior to the encapsulation of Substrates2 with MED-6015, the water deioniser broke. Due to time constraints, store-bought deionised water was fed into the water tank, via a peristaltic pump. The pump ran for 20 minutes before the substrates were immersed, but the lyometer continued to read high levels of ionic contamination, probably <1% of ultimate purity (Appendix 2). The deioniser was functional for all other encapsulations, but the impurity of the water used for cleaning substrates encapsulated with MED-6015 may have biased these results (Discussion 14d). 5) Encapsulation of Substrates2 A mould with 4 trays (to hold 4 substrates at once) was made to enable an efficient, yet manageable encapsulation process. The Teflon® boots held the substrates down by a corner, within the 6mm blank space below the upper edge (the wires were attached 8mm below this edge), so the encapsulation of the strain gauges and rectangular cuts were not obstructed. 6) Silicone Rubber Types Differences between the silicones became apparent with encapsulation. MED-6015 was designed as an encapsulant and is essentially the same (materially and electrically) as the biocompatible, clinical grade MED-6215 silicone proposed for use in the instrumented nail. Its viscosity was low enough to enable easy application and although many bubbles appeared as it was applied, these were eliminated by the compression chamber (Figure 11a). Shixin Bickerton SN: 707229 37 MED4-4220 cured very quickly before it even entered the compression chamber. It formed fewer bubbles than MED-6015 during its application, but those which were formed were never removed, due to its rapid curing. Fortunately, none of the bubbles disrupted adhesion between the rubber and the substrate, so should not have affected the results (Figure 11b). MED3-4013 was designed as an adhesive. Its high viscosity made it difficult to force through the end of the syringe, and it formed a snake-like mass as opposed to flowing onto the surface of the substrate. It had to be spread out manually once dispensed, to ensure adequate coverage of the substrate. Prior to curing, it appeared to have several bubbles, although observations were hindered by its milky appearance and uneven surface. However, it cured less rapidly than MED4-4220, allowing the bubbles to be eliminated by the compression chamber (Figure 11c). Although this method of application was troublesome, better results may be possible using high pressure injection into a mould; the method by which the instrumented nails will be encapsulated. EPM-2420 is not a medically approved silicone, so its testing was for scientific purposes only. However, its properties made it a promising candidate for soft encapsulation and the mixing and encapsulation process was very successful. Its low viscosity enabled it to flow into the tray with ease and it did not form any bubbles (Figure 11d). Figure 11 – Photograph of Substrates2 (all without primer or dye), encapsulated in: a) MED-6015, b) MED4-4220, c) MED3-4013, and d) EPM-2420. a. b. c. d. Shixin Bickerton SN: 707229 38 7) Encapsulations with Primer The primer caused large voids at the interface between the silicone and the substrate, for encapsulations with MED-6015 (Figure 11). Figure 12 (right) – Photograph of Substrates2 encapsulated in MED-6015, a) alone, and b) primed. a. b. 8) Low Miscibility of MED-6015 and MED-4900-2 Pigment (Black Dye) When 2% black dye was mixed into MED-6015, the mixture initially appeared homogenous, but separated upon injection over the substrate (Figure 13a). A 2mm thick sample of MED6015 with 5% black dye showed similar separations (Figure 13b). With 10% dye, the rubber had the desired dark homogenous appearance. Figure 13– Photograph of MED-6015 mixed with black dye, a) at 2% (over Substrates2), and b) at 5% in an aluminium tray. a) b) Although MED4-4220 and MED3-4013 encapsulations were not tested with dye, samples with 2% and 5% dye all appeared black and homogenous with good miscibility (Figure 14). Figure 14–Photograph of MED4-4220 with dye at 2% and 5%, and MED3-4013 with dye at 2% and 5% (from left to right) 2% MED4-4220 5% MED4-4220 Shixin Bickerton SN: 707229 2% MED3-4013 5% MED3-4013 5cm 39 These tests also showed that if MED4-4220 was placed into the pressure oven before it cured, the bubbles would be removed and a perfect finish could be achieved on its lower surface, where it would contact the substrate (Figure 15). Figure 15–Photograph of a) the upper surface and b) the lower surface, MED4-4220 with dye at 2%. The small indents in the upper surface remained after the bubbles had burst, but no defects were present on the lower surface. a. b. 9) Initial Readings in Air for Substrates2 (Method 2.9) In every case, the readings taken for one hour before the substrates were immersed in water, did not drift and were the same as the initial starting values of the tests under water. Interestingly, when substrates were dried at room temperature and humidity after testing, the values of some channels returned to the values observed at the start of the tests under water. This showed that some of the disruptions caused by water ingress were reversible. 10) Preliminary Work (Substrates1) in Air (Method 1.10.i) The initial intention was for LabVIEW to record a reading every 5 seconds and start a new file at midnight every night. However, on the first data-gathering attempt, the system ran until midnight, when a LabVIEW error prevented the creation of a new file. LabVIEW was then set to run continuously. With one reading every 5 seconds, 17280 rows of data were collected every 24 hours. Excel could hold 65000 rows of data, so as long as a new file was started manually every 3½ days, no issues arose. Shixin Bickerton SN: 707229 40 Before the test was re-started, different correlations were observed between some of the channels and temperature. The gauges fluctuated by up to 200 counts, 5 of which correlated directly with temperature (current decreased with decreasing temperature) and 3 of which correlated inversely with temperature (current decreased with increasing temperature). Possible explanations included: variation due to the coefficient of thermal expansion of the titanium beams; variation due to the temperature coefficient of the fixed precision resistors; or variation due the temperature coefficient of the strain gauges themselves. A change due to the expansion coefficient of titanium would be expected to cause the longitudinal strain gauges to change in the opposite direction to the perpendicular gauges. However, no correlation to the strain gauge orientation was found. In addition, the expansion coefficient was < 9ppm, which was insufficient to account for the changes observed. The temperature coefficient of the strain gauges was < 20ppm (nichrome). This corresponded to a change of 10microstrain/°C (20 ÷ Gauge factor of 2) or 165.1counts/°C, which was large enough to account for the changes observed. The 20kΩ fixed precision resistors had a temperature coefficient of <15ppm and could also have accounted for these changes. To test if it was due to the fixed precision resistors, a resistor known to correlate directly with temperature, was switched with one known to correlate inversely. The resultant graphs switched in response, identifying the resistors as the primary cause of change. To reduce the fluctuations with temperature, the <15ppm 20kΩ fixed precision resistors were replaced with <5ppm resistors. Before the test was re-started, two of these resistors were also wired into each of the spare channels (10, 11, 12) to function as controls. Variations seen in these channels, could not be influenced by the substrates. Shixin Bickerton SN: 707229 41 11) Ink Test (Method 1.11) The ink test showed a failure of adhesion primarily at the end nearest to the channel that had failed. However, the defect did not extend over the strain gauge and was therefore unlikely to affect the results (Figure 16). 1cm Figure 16 – Substrates1 (titanium beams) encapsulated in MED-6015, then immersed in blue ink. Failure of adhesion occurred primarily on the right hand side of the top beam. This test was only sensitive to large failures of adhesion that extended inwards from the rubber’s edge, making it unsuitable for Substrates 2, which were not removed from their trays and had no such damage. The failures in Substrates2 occurred in the central regions where ink would not penetrate. Brown areas appeared, clearly identifying regions of failure which were further investigated using SEM imaging (Discussion 12), thus negating the need for ink tests. 12) SEM Images of Damage to Substrates2 SEM imaging was used to gain insight into the failures on Substrates2 (Figure 17), which could be compared to the normal appearance of the gaps (Figure 10). Images were taken of the substrate encapsulated in MED-6015 with primer and dye, after it was tested and had had the encapsulant removed. Brown patches were visible extending into the rectangles and the strain gauge appeared darker on its far left (Figure 17a). The SEM images showed an apparent increase in gap-width where damage had occurred (Figure 17(b-d)). This may have been caused during dendrite formation, when metal was removed from one side, before being deposited on the other (Results: Primary Investigation Results, 5). Shixin Bickerton SN: 707229 42 Figure 17 – a) Photograph of a damaged substrate with brown marks visible. SEM Images of b) damage of 10µm gap, b) damage of 20µm gap, and b) damage of strain gauge. a) b) c) d) 13) Effect of Noise on Statistical Analysis The level of noise varied slightly between channels. Although not apparent on the graphs, this would have caused errors in the statistical analyses, where the noise could significantly increase the range of data for particular channels, affecting their rank. This would have caused substantial bias when testing for the difference caused by gap width, because the channels with higher noise levels were always wired to the same width gap. 14) Discussion of Results, with respect to Hypotheses and Relevance to Clinical Use Although many of the results were not significant (p>0.05), they appeared to be supported by the appearance of the substrates and graphs. The lack of statistical significance is probably due to the limited number of samples available and not a true lack of effect. a) The Effect of Gap Width (Introduction: Hypothesis for Primary Investigation 1) Most of the graphs showed the 10µm gap to have less instability than wider gaps. Where primer had decreased the effectiveness of the encapsulation, the larger widths of the gaps exhibited lower levels of leakage. Although the results were not statistically significant, gap Shixin Bickerton SN: 707229 43 width is likely to affect current leakage. I would recommend a gap >10µm to be used on the instrumented nail, due to its likely benefits and no suggestion of detrimental effects. b) The Effect of Primer (Introduction: Hypothesis for Primary Investigation 2) In contrary to the hypothesis, the results have shown the primer MED6-161 to be detrimental to MED-6015 silicone encapsulations. However, it did not significantly affect the MED44220 encapsulation. On an electrical basis, I would not recommend the use of a primer for the instrumented nail, but if one was to be used (possibly for mechanical advantages), investigations should be carried out first to ensure that it would not be detrimental to the encapsulant. c) The Effect of Dye (Introduction: Hypothesis for Primary Investigation 3) Where the results suggested the dye may be detrimental, it should be noted that the mixing process was ineffective, which may have led to high concentrations in certain areas affecting the adhesion. A darker, homogenous mixture may be attainable if the dye is first mixed alone (to negate any settling of the bottles contents), then mixed with part A of the MED-6015 and left to cool, before the 2 parts of the rubber are combined. This method of mixing may prove to be more effective and it should be investigated in the future. d) The Effect of Rubber Type (Introduction: Hypothesis for Primary Investigation 4) Despite finding some very different properties (different viscosities, miscibility with the black dye and reaction to primer) the effects of the different rubbers on current leakage was not statistically significant. It was suggested that MED-6015 may not be as effective as MED44220. However, significant bias may have been introduced by the difference between the cleaning methods used for those two encapsulants (Discussion 4). The increased ionic contamination of the deionised water used to clean MED-6015 encapsulated substrates, may have been responsible for difference in performance. With few complete failures and graphs Shixin Bickerton SN: 707229 44 that showed promise for all the rubber types tested, further future investigations into different rubber types is recommended. 15) In the Context of Existing Literature Without primer, almost all of the thin film structures were successfully protected against leakage currents, using the 4 types of silicone. The results of this investigation have added more evidence to the existing literature, in favour of using silicone rubbers as an effectively encapsulant under water. More specifically, it has added additional data with the specific consideration of requiring very low leakage currents; a condition on which far fewer studies have been conducted. Although the lack of statistical significance limits these results, much has been learnt from the methodology, forming a good basis for further research. Shixin Bickerton SN: 707229 45 CONCLUSION The most striking conclusion drawn from this investigation, was the detrimental effect of MED6-161 primer on the ability of MED-6015 silicone to protect the thin film structures against leakage currents. The analyses of the effect of the black dye was inconclusive. No statistically significant results were found for the effect of the width of gap or rubber type. However, the graphs and results do suggest that small gaps (10 and 20µm) may be subject to more fluctuations and leakage currents, than larger ones. Again from observation of the graphs, all the silicones investigated have shown promising results, but further research to better differentiate between the choices of silicone and refinement of techniques (such as the use of MED-4900-2 Pigment) could prove highly beneficial. Despite numerous minor adjustments to the methodology, the main point for improvement of this investigation, would be to use a larger number of samples, allowing more statistically significant results to be gained, in order to better answer the hypotheses initially proposed. Shixin Bickerton SN: 707229 46 APPENDIX 1) Relationship between Counts and Microstrain (Method 1.9, Discussion 2) Initial readings were taken to establish the relationship between “counts” in LabVIEW and Microstrain, in order to determine how many counts constituted an acceptable level of noise (equivalent to 2 microstrain). A much larger (33MΩ) fixed precision resistor was used to simulate a known change in strain. This resistor was joined in parallel to one of the 20kΩ fixed precision resistor on the circuit board, which produced an increase of 5000 counts. Both Resistors in Parallel =33000 x 20 = 19.9878861296… 33000 + 20 Change in Resistance = Resistance in parallel - Original Resistance = 19.98… 20kΩ = 0.01211387037… kΩ Change in resistance Original Resistance = 0.012… 20 = 0.000605693519… Divide by Gauge Factor (2) = 0.00030284675… strain = 302.846759 microstrain (known change in strain simulated). Counts per microstrain = 5000 302.8… = 16.51 (to 4s.f.) A noise level of about 33 counts equates to a change in 2 microstrain, which shows that all the channels after shielding (with a standard deviation <20 counts) are acceptable. 2) The Purity of Store-bought Deionised water (Discussion 4) With the store-bought deionised water, the lyometer showed a current >10mA and probably closer to 20mA. With 5MΩ.cm equating to 500µA, the water was <250kΩ.cm and probably <18kΩ.cm, which meant it was probably <1% of the ultimate purity of water (18MΩ.cm). The standard water deioniser produced water at 15MΩ.cm (83.3% of ultimate purity). Shixin Bickerton SN: 707229 47 References Allen W C, Piotrowski G, Burstein A H, & Frankel V H 1968, "Biomechanical Principles of Intramedullary Fixation", Clinical Orthopaedics and Related Research, vol. 60, pp. 12-20. Barlow J W, Goldie I F, Horwood J M K, Lee A J C, & Ramson R P 1984, "In vivo records of strain in total hip joint", Journal of Mechanical Engineering, vol. C216, no. 84, pp. 55-61. Bergmann G, Graichen F, Siraky J, Jendrzynski J, & Rohlmann A 1988, "Multichannel strain gauge telemetry for orthopaedic implants", Journal of Biomechanics, vol. 21, no. 2, pp. 169-176. Bhandari M, Guyatt G H, Swiontkowski M F, & Schemitsch E H 2001, "Treatment of open fractures of the shaft of the tibia: a systematic overview and meta-analysis", Journal of Bone and Joint Surgery (Br), vol. 83, pp. 62-68. Bhandari M, Guyatt G H, Tong D, Adili A, & Shaughnessy S G 2000, "Reamed Versus Nonreamed Intramedullary Nailing of Lower Extremity Long Bone Fractures: A Systematic Overview and Metaanalysis.", Journal of Orthopaedic Trauma, vol. 14, no. 1, pp. 2-9. Blachut P A, O'Brien P J, Meek R N, & Broekhuys H M 1997, "Interlocking Intramedullary Nailing with and without Reaming for the Treatment of Closed Fractures of the Tibial Shaft. A Prospective, Randomized Study", Journal of Bone and Joint Surgery, vol. 79, pp. 640-646. Brand R, Pedersen D R, Davy D T, Kotzar G M, Heiple K G, & Goldberg V 1994, "Comparison of hip force calculations and measurements in the same patient", Journal of Arthroplasty, vol. 9, no. 1, pp. 45-51. Brown R H, Burstein A H, & Frankel V H 1982, "Telemetering in vivo loads from nail plate implants", Journal of Biomechanics, vol. 15, no. 11, pp. 815-823. den Outer A J, Meeuwis J D, Hermans J, & Zwaveling A 1990, "Conservative versus operative treatment of displaced noncomminuted tibial shaft fractures: A retrospective comparative study.", Clin.Orthop., vol. 252, pp. 231-237. Donaldson P E K 1973, "Experimental Visual Prosthesis", IEEE Proc, vol. 120, pp. 281-298. Donaldson P E K 1976, "The Encapsulation of Microelectronic Devices for Long-Term Surgical Implantation", IEEE Transactions on Biomedical Engineering, vol. BME-23, no. 4, pp. 281-285. Donaldson P E K 1989, "Encapsulating microelectronic implants in one-part silicone rubbers", Journal of Medical and Biological Engineering and Computing, vol. 27, no. 1, pp. 93-94. Donaldson P E K 1991, "Aspects of silicone rubber as an encapsulants for neurological prostheses, part1 osmosis", Journal of Medical and Biological Engineering and Computing, vol. 29, pp. 34-39. English T A & Kilvington M 1979, "In vivo records of hip loads using a femoral implant with telemetric output", Journal of Biomedical Engineering, vol. 1, pp. 111-115. Shixin Bickerton SN: 707229 48 Ferguson M, Brand C, Lowe A, Gabbe B, Dowrick A, Hart M, Richardson M, & VOTOR research group 2008, "Outcomes of isolated tibial shaft fractures treated at level 1 trauma centres", Injury, vol. 39, no. 2, pp. 187-195. Gregory P & Sanders R 1995, "The management of severe fractures of the lower extremities", Clinical Orthopaedics, vol. 318, pp. 95-105. GülerN F & Übeyl E D 2002, "Theory and Applications of Biotelemetry", Journal of Medical Systems, vol. 26, no. 2, pp. 164-165. Howard M & Court Brown C M 1997, "Epidemiology and management of open fractures of the lower limb", Br.J.Hosp.Med., vol. 57, pp. 582-587. Jackson N, Anand S, Okandan M, & Muthuswamy J 2009, "Nonhermetic Encapsulation Materials for MEMS-Based Movable Microelectrodes for Long-Term Implantation in the Brain", Journal of Microelectromechanical Systems, vol. 18, no. 6, pp. 1234-1245. Joint Assessment of Commodity Chemicals 1994, Linear Polydimethylsiloxanes 26. Ko W H & Spear T M 1983, "Packaging Materials and Techniques for Implantable Instruments", Engineering in Medicine and Biology Magazine, vol. 2, no. 1, pp. 24-38. Küntscher G 1940, "Die marknagelung von knochen-bruchen", Klin Wochenschr, vol. 19, pp. 6-10. Küntscher G & Maatz R 1945, "Technik der Marknagelung. Leipzig,", Georg Thieme. Lin A W & Wong C P 1992, "Encapsulant for nonhermetic multichip packaging applications", IEEE Trans.Comp., Hybrids, Manufact., Technol, vol. 15, pp. 510-518. Lowet G, Auderkercke R V, Van der Perre G, Guesens P, Dequeker J, & Lammens J 1993, "The relation between resonant frequencies and torsional stiffness of long bones in vitro. Validation of a simple beam model", Journal of Biomechanics, vol. 26, no. 6, pp. 689-696. Mollie J P 1999, "Silicone MAterials for Electronic Components and Circuit Protection," in Plastics for Electronics, 2 edn, Goosey M T, ed., Kliuwer Acedemic Publishers, Netherlands, pp. 33-34. Nishimura N 1984, "Serial strain gauge measurement of bone healing in Hoffmann external fixation", Nippon Seikeigeka Gakkai Zasshi (Journal of the Japanese Orthopaedic Association (Tokyo)), vol. 58, no. 1, pp. 23-40. Nork S E, Schwartz A K, Agel J, Holt S K, Schrick J L, & Winquis R A 2005, "Intramedullary Nailing of Distal Metaphyseal Tibial Fractures", Journal of Bone and Joint Surgery (Am), vol. 87, pp. 1213-1221. Robb W L 1968, "Thin silicone membranes – their permeation properties and some applications", Ann N Y Acad Sci, vol. 146, pp. 119-137. Rydell N W 1966, "Forces acting in the femoral head prosthesis. A study on strain gauge supplied prostheses in living persons.", Acta.Orthop.Scand., vol. 37, no. 88, pp. 1-132. Schneider E, Michel M C, Genge M, Zubera K, Ganz R, & Perren S M 2001, "Loads acting in an intramedullary nail during fracture healing in the human femur.", Journal of Biomechanics, vol. 34, pp. 849-857. Shixin Bickerton SN: 707229 49 Smith A L 1974, The Analytical Chemistry of Silicones New York: Wiley Interscience. Stieglitz T, Schuettler M, & Koch K P 2005, "Implantable Biomedical Microsystems for Neural Prostheses: Flexible, Polyimide-Based, and Modular", IEEE Engineering in Medicine and Biology Magazine, vol. 24, no. 5, pp. 58-65. Taylor S J G, Perry J S, Meswania J M, Donaldson N, Walker P S, & Cannon S R 1997, "Telemetry of forces from proximal femoral replacements and relevance to fixation.", Journal of Biomechanics, vol. 30, no. 3, pp. 225-234. Taylor S J G & Walker P S 2001, "Forces and moments telemetered from two distal femoral replacements during various activities", Journal of Biomechanics, vol. 34, no. 7, pp. 839-848. Vanlathem E & Oellers E 2001, "Silicone Materials for IC Packaging and Opto-electronics. Polymers and Adhesives in Microelectronics and Photonics", First International IEEE Conference pp. 324-328. Wilson D J, Morgan R L, Hesselden K L, Dodd J R, Janna S W, & Fagan M J 2009, "A Single-Channel Telemetric Intramedullary Nail for In Vivo Measurement of Fracture Healing", Journal of Orthopaedic Trauma, vol. 23, pp. 702-709. Wong C P 1988, "Application of Polymer in Encapsulation of Electronic Parts. Advances in Polymer Science," Springer Berlin/Heidelberg, pp. 63-68. Wong C P 1989, "Electrical Performance and Reaction Kinetics of Silicone Gels", J.Mat.Res., vol. 5, no. 4, pp. 795-800. Wong C P & Looby-Calvert M M 1993, "Analyses of Contaminant Mobile Ions in Silicone Encapsulant for Hermetically Equivalent (Nonhermetic) IC Packaging", IEEE Trans.Comp., Hybrids, Manufact., Technol, vol. 16, no. 7, pp. 731-734. Wong C P, Segelken J M, & Balde J W 1989, "Understanding the Use of Silicone Gels for Nonhermetic Plastic Packaging", IEEE Trans.Comp., Hybrids, Manufact., Technol, vol. 12, no. 4, pp. 421-425. Wu J, Pike R T, Wong C P, Kim N P, & Tanielian M H 2000, "Evaluation and Characterization of Reliable Non-Hermetic Conformal Coatings for Microelectromechanical System (MEMS) Device Encapsulation", IEE Transactions on Advanced Packaging, vol. 23, no. 4, pp. 712-728. Zenios H, Malik M H A, & Al-Mesri A R 2004, "Current Intramedullary Nail Insertion and Removal Practice in the UK", Eur J Orthop Surg Trauma, vol. 14, pp. 19-22. Shixin Bickerton SN: 707229