The relationship between loading conditions and fracture patterns of the proximal femur

Yang, K. H.<sup>1</sup>; Shen, K.-L.<sup>1</sup>; Demetropoulos, C. K.<sup>1</sup>; King, A. I.<sup>1</sup>; Kolodziej, P.<sup>2</sup>; Levine, R. S.<sup>2</sup>; Fitzgerald, Jr, R. H.<sup>2</sup>

Affiliations

¹Bioengineering Center, Wayne State University, Detroit, MI 48201

²Department of Orthopaedic Surgery, Wayne State University, Detroit, MI 48201

Abstract

In an attempt to test the hypothesis of spontaneous hip fracture, seven pairs of femurs, with ages ranging from 59 to 90, were tested under two loading conditions designed to simulate muscular contraction. Simulated iliopsoas contraction produced femoral neck fractures at an average normalized ultimate load of 5.2 ± 0.8 times body weight. Simulated gluteus medius contraction produced sub-/inter-trochanteric fractures at an average normalized ultimate load of 4.1 ± 0.6 times body weight. The average ultimate load for all specimens was 3040 ± 720 N. Fracture patterns produced by both loading conditions were clinically relevant. The results from this study suggest that abnormal contraction produced by major rotator muscles could induce hip fracture.

Links

DOI: 10.1115/1.2796045

PubMed: 8950662

WoS: A1996VX04300018

History

Received: 1994-03-30

Revised: 1995-09-23

Cited Works (7)

Year	Entry
1974	Freeman MAR, Todd RC, Pirie CJ. The role of fatigue in the pathogenesis of senile femoral neck fractures. J Bone Joint Surg. November 1974;56B(4):698-702.
1990	Lotz JC, Hayes WC. The use of quantitative computed tomography to estimate risk of fracture of the hip from falls. J Bone Joint Surg. June 1990;72A(5):689-700.
1981	Patriarco AG, Mann RW, Simon SR, Mansour JM. An evaluation of the approaches of optimization models in the prediction of muscle forces during human gait. J Biomech. 1981;14(8):513-525.
1985	Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev. 1985;7:178-208.
1993	Hayes WC, Myers ER, Morris JN, Gerhart TN, Yett HS, Lipsitz LA. Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcif Tiss Int. March 1993;52(3):192-198.
1953	Smith LD. Hip fractures: the role of muscle contraction or intrinsic forces in the causation of fractures of the femoral neck. J Bone Joint Surg. April 1953;35A(2):367-383.
1964	Alffram P-A. An epidemiologic study of cervical and trochanteric fractures of the femur in an urban population analysis of 1,664 cases with special reference to etiologic factors. Acta Orthop Scand. 1964;35(suppl 65):1-109.

Cited By (14)

Year	Entry
2015	King AI. Introduction to and applications of injury biomechanics. In: Yoganandan N, Nahum AM, Melvin JW, eds. Accidental Injury: Biomechanics and Prevention. 3rd ed. New York: Springer; 2015:1-31.
2004	Doblaré M, García JM, Gomez MJ. Modelling bone tissue fracture and healing: a review. Eng Fract Mech. September 2004;71(13-14):1809-1840.
2009	Witkowski GP, Bilkhu SK, Siskosky MJ, Gates ME, Demetropoulos CK, Fortin PT. Effects of hindfoot constraint on syndesmotic displacement. Foot Ankle Int. April 2009;30(4):367-374.
2007	Cristofolini L, Juszczyk M, Martelli S, Taddei F, Viceconti M. In vitro replication of spontaneous fractures of the proximal human femur. J Biomech. 2007;40(13):2837-2845.
2008	Schileo E, Taddei F, Cristofolini L, Viceconti M. Subject-specific finite element models implementing a maximum principal strain criterion are able to estimate failure risk and fracture location on human femurs tested in vitro. J Biomech. 2008;41(2):356-367.
2009	de Bakker PM, Manske SL, Ebacher V, Oxland TR, Cripton PA, Guy P. During sideways falls proximal femur fractures initiate in the superolateral cortex: evidence from high-speed video of simulated fractures. J Biomech. August 25, 2009;42(12):1917-1925.
2010	Cristofolini L, Conti G, Juszczyk M, Cremonini S, Sint Jan SV, Viceconti M. Structural behaviour and strain distribution of the long bones of the human lower limbs. J Biomech. March 22, 2010;43(5):826-835.
2015	Zani L, Erani P, Grassi L, Taddei F, Cristofolini L. Strain distribution in the proximal human femur during in vitro simulated sideways fall. J Biomech. July 16, 2015;48(10):2130-2143.
2019	Lee Y, Ogihara N, Lee T. Assessment of finite element models for prediction of osteoporotic fracture. J Mech Behav Biomed Mater. September 2019;97:312-320.
2012	Hambli R, Bettamer A, Allaoui S. Finite element prediction of proximal femur fracture pattern based on orthotropic behaviour law coupled to quasi-brittle damage. Med Eng Phys. March 2012;34(2):202-210.
2010	Cristofolini L, Schileo E, Juszczyk M, Taddei F, Martelli S, Viceconti M. Mechanical testing of bones: the positive synergy of finite–element models and in vitro experiments. Philos Trans R Soc A-Math Phys Eng Sci. June 13, 2010;368(1920):2725-2763.
2009	Cristofolini L, Juszczyk M, Taddei F, Viceconti M. Strain distribution in the proximal human femoral metaphysis. Proc Inst Mech Eng Part H-J Eng Med. April 2009;2223(3):273-288.
2010	Anderson DE. An Examination of Age-Related Differences in Lower Extremity Joint Torques and Strains in the Proximal Femur During Gait [PhD thesis]. Virginia Polytechnic Institute and State University; March 26, 2010.
2005	Cao KD. Development of a 4-Vertebrae, Detailed Finite Element Model of Thoracolumbar Spine [PhD thesis]. Detroit, MI: Wayne State University; August 2005.