Effect of force direction on femoral fracture load for two types of loading conditions

wbldb

Keyak, Joyce H.^1,2,3; Skinner, Harry B.^1,2,3; Fleming, Judith A.³

Effect of force direction on femoral fracture load for two types of loading conditions

J Orthop Res. July 2001;19(4):539-544

©2001 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.

Affiliations

¹Department of Orthopaedic Surgery, University of California, Irvine Medical Center, 101 City Drive South, Orange, CA 92868‐5382, USA

²Department of Mechanical and Aerospace Engineering, University of California, Irvine, USA

³Center for Biomedical Engineering, University of California, Irvine, USA
Abstract

Identifying the loading conditions under which the femur is most likely to fracture may aid the prevention of hip fracture. This study quantified the effect of force direction on fracture load, a factor inherently associated with fracture risk. Finite element (FE) models of four femora were used to determine the force directions associated with the lowest fracture loads. Force directions were varied three‐dimensionally for two types of loading, one representing impact from a fall and one similar to joint loading during daily activities (atraumatic loading). For the fall configuration, the force direction with lowest fracture load corresponded to an impact onto the posterolateral aspect of the greater trochanter. For atraumatic loading, the lowest fracture loads for the force directions analyzed occurred when posterior force components were relatively large or when posterior and lateral components were both small, similar to conditions while standing on one leg or climbing stairs. When both fall and atraumatic configurations are considered, the type of loading associated with greatest fracture risk, i.e., with the greatest applied force and lowest fracture load, is impact from a fall onto the posterolateral aspect of the greater trochanter. Therefore, evaluation of hip fracture risk and development of fracture prevention technologies should focus on this high‐risk loading condition.
Links

DOI: 10.1016/S0736-0266(00)00046-2

PubMed: 11518258

WoS: 000170366100006
History

Received: 1999-08-08

Accepted: 2000-08-18

Cited Works (20)

Year	Entry
1994	Keyak JH, Lee IY, Skinner HB. Correlations between orthogonal mechanical properties and density of trabecular bone: use of different densitometric measures. J Biomed Mater Res. November 1994;A28(11):1329-1336.
1990	Keyak JH, Meagher JM, Skinner HB, Mote CD Jr. Automated three-dimensional finite element modelling of bone: a new method. J Biomed Eng. 1990;12(5):389-397.
1998	Keyak JH, Rossi SA, Jones KA, Skinner HB. Prediction of femoral fracture load using automated finite element modeling. J Biomech. February 1998;31(2):125-133.
2000	Keyak J, Rossi S. Prediction of femoral fracture load using finite element models: an examination of stress- and strain-based failure theories. J Biomech. 2000;33(2):209-214.
1999	Fenech CM, Keaveny TM. A cellular solid criterion for predicting the axial-shear failure properties of bovine trabecular bone. J Biomech Eng. August 1999;121(4):414-422.
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.
1994	Keller TS. Predicting the compressive mechanical behavior of bone. J Biomech. September 1994;27(9):1159-1168.
1994	Les CM, Keyak JH, Stover SM, Taylor KT, Kaneps AJ. Estimation of material properties in the equine metacarpus with use of quantitative computed tomography. J Orthop Res. November 1994;12(6):822-833.
1999	Oden ZM, Selvitelli DM, Bouxsein ML. Effect of local density changes on the failure load of the proximal femur. J Orthop Res. September 1999;17(5):661-667.
1975	Reilly DT, Burstein AH. The elastic and ultimate properties of compact bone tissue. J Biomech. 1975;8(6):393-405.
1981	Van Buskirk WC, Ashman RB. The elastic moduli of bone. In: Cowin SC, ed. Mechanical Properties of Bone. The Joint ASME-ASCE Applied Mechnics, Fluids Engineering and Bioengineering Conference; June 22-24, 1981; Boulder, CO. New York, NY: American Society of Mechical Engineers; 1981:131-143.
1995	Lotz JC, Cheal EJ, Hayes WC. Stress distributions within the proximal femur during gait and falls: implications for osteoporotic fracture. Osteoporos Int. July 1995;5(3):252-261.
1996	Ford CM, Keaveny TM, Hayes WC. The effect of impact direction on the structural capacity of the proximal femur during falls. J Bone Miner Res. March 1996;11(3):377-383.
1993	Bergmann G, Graichen F, Rohlmann A. Hip joint loading during walking and running, measured in two patients. J Biomech. August 1993;26(8):969-990.
1996	Pinilla TP, Boardman KC, Bouxsein ML, Myers ER, Hayes WC. Impact direction from a fall influences the failure load of the proximal femur as much as age-related bone loss. Calcif Tiss Int. April 1996;58(4):231-235.
1999	Cody DD, Gross GJ, Hou FJ, Spencer HJ, Goldstein SA, Fyhrie DP. Femoral strength is better predicted by finite element models than QCT and DXA. J Biomech. October 1999;32(10):1013-1020.
1995	Robinovitch SN, Hayes WC, McMahon TA. Energy-shunting hip padding system attenuates femoral impact force in a simulated fall. J Biomech Eng. November 1995;117(4):409-413.
1994	Courtney AC, Wachtel EF, Myers ER, Hayes WC. Effects of loading rate on strength of the proximal femur. Calcif Tiss Int. 1994;55(1):53-58.
1995	Courtney AC, Wachtel EF, Myers ER, Hayes WC. Age-related reductions in the strength of the femur tested in a fall-loading configuration. J Bone Joint Surg. March 1995;77A(3):387-395.
1991	Robinovitch SN, Hayes WC, McMahon TA. Prediction of femoral impact forces in falls on the hip. J Biomech Eng. November 1991;113(4):366-374.

Cited By (38)

Year	Entry
2009	Keyak JH, Koyama AK, LeBlanc A, Lu Y, Lang TF. Reduction in proximal femoral strength due to long-duration spaceflight. Bone. March 2009;44(3):449-453.
2009	Bessho M, Ohnishi I, Matsumoto T, Ohashi S, Matsuyama J, Tobita K, Kaneko M, Nakamura K. Prediction of proximal femur strength using a CT-based nonlinear finite element method: differences in predicted fracture load and site with changing load and boundary conditions. Bone. August 2009;45(2):226-231.
2013	Dall'Ara E, Luisier B, Schmidt R, Kainberger F, Zysset P, Pahr D. A nonlinear QCT-based finite element model validation study for the human femur tested in two configurations in vitro. Bone. January 2013;52(1):27-38.
2013	Keyak JH, Sigurdsson S, Karlsdottir GS, Oskarsdottir D, Sigmarsdottir A, Kornak J, Harris TB, Sigurdsson G, Jonsson BY, Siggeirsdottir K, Eiriksdottir G, Gudnason V, Lang TF. Effect of finite element model loading condition on fracture risk assessment in men and women: the AGES-Reykjavik study. Bone. November 2013;57(1):18-29.
2020	Iori G, Schneider J, Reisinger A, Heyer F, Peralta L, Wyers C, Glüer CC, van den Bergh JP, Pahr D, Raum K. Cortical thinning and accumulation of large cortical pores in the tibia reflect local structural deterioration of the femoral neck. Bone. August 2020;137:115446.
2022	Abe S, Kouhia R, Nikander R, Narra N, Hyttinen J, Sievänen H. Effect of fall direction on the lower hip fracture risk in athletes with different loading histories: a finite element modeling study in multiple sideways fall configurations. Bone. May 2022;158:116351.
2005	Keyak JH, Kaneko TS, Tehranzadeh J, Skinner HB. Predicting proximal femoral strength using structural engineering models. Clin Orthop Relat Res. August 2005;437:219-228.
2017	Fuchs RK, Kersh ME, Carballido-Gamio J, Thompson WR, Keyak JH, Warden SJ. Physical activity for strengthening fracture prone regions of the proximal femur. Curr Osteoporos Rep. February 2017;15(1):43-52.
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.
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.
2011	Juszczyk MM, Cristofolini L, Viceconti M. The human proximal femur behaves linearly elastic up to failure under physiological loading conditions. J Biomech. August 11, 2011;44(12):2259-2266.
2012	Grassi L, Schileo E, Taddei F, Zani L, Juszczyk M, Cristofolini L, Viceconti M. Accuracy of finite element predictions in sideways load configurations for the proximal human femur. J Biomech. January 10, 2012;45(2):394-399.
2013	Nishiyama KK, Gilchrist S, Guy P, Cripton P, Boyd SK. Proximal femur bone strength estimated by a computationally fast finite element analysis in a sideways fall configuration. J Biomech. April 26, 2013;46(7):1231-1236.
2015	Nawathe S, Yang H, Fields AJ, Bouxsein ML, Keaveny TM. Theoretical effects of fully ductile versus fully brittle behaviors of bone tissue on the strength of the human proximal femur and vertebral body. J Biomech. May 1, 2015;48(7):1264-1269.
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.
2021	Khakpour S, Tanska P, Saarakkala S, Korhonen RK, Jämsä T. The effect of body configuration on the strain magnitude and distribution within the acetabulum during sideways falls: a finite element approach. J Biomech. January 4, 2021;114:110156.
2024	Choi JW, Park JW, Choi WJ. Effects of hip joint kinematics on the effective pelvis stiffness and hip impact force during simulated sideways falls. J Biomech. January 2024;162:111885.
2020	Gastaldi D, Baleani M, Fognani R, Airaghi F, Bonanni L, Vena P. An experimental procedure to perform mechanical characterization of small-sized bone specimens from thin femoral cortical wall. J Mech Behav Biomed Mater. December 2020;112:104046.
2023	Mirzaei M, Jafari R, Allaveisi F, Jafari H, Alavi F. Fracture analysis of healthy and osteoporotic femora using clinical CT images, phantomless densitometry, and linear FE method. J Orthop Res. March 2023;41(3):629-640.
2001	Keyak JH, Rossi SA, Jones K, Les CM, Skinner HB. Prediction of fracture location in the proximal femur using finite element models. Med Eng Phys. November 2001;23(9):657-664.
2003	Keyak JH, Falkinstein Y. Comparison of in situ and in vitro CT scan-based finite element model predictions of proximal femoral fracture load. Med Eng Phys. November 2003;25(9):781-787.
2020	Iori G, Peralta L, Reisinger A, Heyer F, Wyers C, van den Bergh J, Pahr D, Raum K. Femur strength predictions by nonlinear homogenized voxel finite element models reflect the microarchitecture of the femoral neck. Med Eng Phys. May 2020;79:60-66.
2020	Lim K-t, Choi WJ. Effect of fall characteristics on the severity of hip impact during a fall on the ground from standing height. Osteoporos Int. September 2020;31(9):1713-1719.
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.
2011	Genc KO. The Effects of Altered Gravity Environments on the Mechanobiology of Bone: From Bedrest to Spaceflight [PhD thesis]. Cleveland, OH: Case Western Reserve University; August 2011.
2018	Deng C. Femur/femoral Neck Load Estimation During Stair Navigation [PhD thesis]. Iowa State University; 2018.
2016	Grassi L. Femoral Strength Prediction Using Finite Element Models: Validation of Models Based on CT and Reconstructed DXA Images Against Full-Field Strain Measurements [PhD thesis]. Lund, Sweden: Lund University; 2016.
2022	Khakpour S. Multi-Component Finite Element Analysis of Low- Energy Acetabular Fracture: Computational Study of Pelvic Girdle Fracture Mechanism [PhD thesis]. University of Oulu; 2022.
2023	Branni MG. Constitutive Models of Bone: The Human Femur [PhD thesis]. Queensland University of Technology; 2023.
2008	Choi WJ. Factors Affecting the Efficacy of Hip Protectors During Falls [Master's thesis]. Simon Fraser University; 2008.
2013	Choi WJ. Biomechanics of Falls and Hip Fractures in Older Adults [PhD thesis]. Simon Fraser University; F 2013.
2012	Dall'Ara E. QCT Based Finite Element Models of the Human Vertebra and Femur: Validation With Experiments and Comparison With Bone Densitometry [PhD thesis]. Vienna University of Technology; October 2012.
2014	Gilchrist SM. Comparison of Proximal Femur Deformations, Failures and Fractures in Quasi-Static and Inertially-Driven Simulations of a Sideways Fall from Standing: An Experimental Study Utilizing Novel Fall Simulation, Digital Image Correlation, and Development of Digital Volume Correlation Techniques [PhD thesis]. Vancouver, BC: University of British Columbia; January 2014.
2012	Nishiyama KKS. In Vivo Assessment of Bone Microarchitecture and Estimated Bone Strength [PhD thesis]. Calgary, AB: University of Calgary; October 2012.
2020	Michalski AS. A Quantitative Computed Tomography Approach Towards Opportunistic Osteoporosis Screening [PhD thesis]. Calgary, AB: University of Calgary; March 2020.
2003	Bayraktar HH. Multiaxial Strength and Micromechanics of Human Bone [PhD thesis]. Berkeley, CA: Berkeley, University of California; 2003.
2003	Fox JC. Biomechanics of the Proximal Femur: Role of Bone Distribution and Architecture [PhD thesis]. Berkeley, CA: Berkeley, University of California; 2003.
2017	Levine IC. The Effects of Body Composition and Body Configuration on Impact Dynamics During Lateral Falls: Insights from in-Vivo, in-Vitro, and in-Silico Approaches [PhD thesis]. University of Waterloo; 2017.