Comparing the fracture limits of the proximal femur under impact and quasi-static conditions in simulation of a sideways fall

wbldb

Jazinizadeh, Fatemeh¹; Mohammadi, Hojjat²; Quenneville, Cheryl E.^1,3

Comparing the fracture limits of the proximal femur under impact and quasi-static conditions in simulation of a sideways fall

J Mech Behav Biomed Mater. March 2020;103:103593

©2019 Elsevier Ltd. All rights reserved.

Affiliations

¹Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada

²Department of Civil Engineering, McMaster University, Hamilton, ON, Canada

³School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
Abstract and keywords

Sideways falls onto the hip are responsible for a great number of fractures in older adults. One of the possible ways to prevent these fractures is through early identification of people at greatest risk so that preventive measures can be properly implemented. Many numerical techniques that are designed to predict the femur fracture risk are validated through performing quasi-static (QS) mechanical tests on isolated cadaveric femurs, whereas the real hip fracture is a result of an impact (IM) incident. The goal of this study was to compare the fracture limits of the proximal femur under IM and QS conditions in the simulation of a sideways fall to identify any possible relationship between them.

Eight pairs of fresh frozen cadaveric femurs were divided into two groups of QS and IM (left and right randomized). All femurs were scanned with a Hologic DXA scanner and then cut and potted in a cylindrical tube. To measure the stiffness in two conditions of the single-leg stance (SLS) and sideways fall (SWF), non-destructive tests at a QS displacement rate were performed on the two groups. For the destructive tests, the QS group was tested in SWF configuration with the rate of 0.017 mm/s using a material testing machine, and the IM group was tested in the same configuration inside a pneumatic IM device with the projectile target displacement rate of 3 m/s.

One of the IM specimens was excluded due to multiple strikes. The result of this study showed that there were no significant differences in the SLS and SWF stiffnesses between the two groups (P = 0.15 and P = 0.64, respectively). The destructive test results indicated that there was a significant difference in the fracture loads of the two groups (P < 0.00001) with the impact ones being higher; however, they were moderately correlated (R² = 0.45). Also, the comparison of the fracture location showed a qualitatively good agreement between the two groups.

Using the relationship developed herein, results from another study were extrapolated with errors of less than 12%, showing that meaningful predictions for the impact scenario can be made based on the quasi-static tests. The result of this study suggests that there is a potential to replace IM tests with QS displacement rate tests, and this will provide important information that can be used for future studies evaluating clinical factors related to fracture risk.

Keywords: Proximal femur; Fracture risk; Sideways fall; Impact loading; Quasi-static loading; Rate; Hip
Links

DOI: 10.1016/j.jmbbm.2019.103593

PubMed: 32090922

WoS: 000517856400066
History

Received: 2019-08-2

Revised: 2019-12-10

Accepted: 2019-12-10

Online: 2019-12-13

Cited Works (22)

Year	Entry
2014	Gilchrist S, Nishiyama KK, de Bakker P, Guy P, Boyd SK, Oxland T, Cripton PA. Proximal femur elastic behaviour is the same in impact and constant displacement rate fall simulation. J Biomech. November 28, 2014;47(15):3744-3749.
2001	Keyak JH. Improved prediction of proximal femoral fracture load using nonlinear finite element models. Med Eng Phys. April 2001;23(3):165-173.
1996	van den Kroonenberg AJ, Hayes WC, McMahon TA. Hip impact velocities and body configurations for voluntary falls from standing height. J Biomech. June 1996;29(6):807-811.
2010	Nikander R, Sievänen H, Heinonen A, Daly RM, Uusi-Rasi K, Kannus P. Targeted exercise against osteoporosis: a systematic review and meta-analysis for optimising bone strength throughout life. BMC Med. 2010;8:47.
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.
2012	Koivumäki JEM, Thevenot J, Pulkkinen P, Kuhn V, Link TM, Eckstein F, Jämsä T. CT-based finite element models can be used to estimate experimentally measured failure loads in the proximal femur. Bone. April 2012;50(4):824-829.
2000	Keyak JH. Relationships between femoral fracture loads for two load configurations. J Biomech. April 2000;33(4):499-502.
2011	Dragomir-Daescu D, Op Den Buijs J, McEligot S, Dai Y, Entwistle RC, Salas C, Melton LJ III, Bennet KE, Khosla S, Amin S. Robust QCT/FEA models of proximal femur stiffness and fracture load during a sideways fall on the hip. Ann Biomed Eng. February 2011;39(2):742-755.
1977	Carter DR, Hayes WC. The compressive behavior of bone as a two-phase porous structure. J Bone Joint Surg. 1977;59A(7):954-962.
2018	Enns-Bray WS, Ferguson SJ, Helgason B. Strain rate dependency of bovine trabecular bone under impact loading at sideways fall velocity. J Biomech. June 2018;75:46-52.
2016	Prot M, Cloete TJ, Saletti D, Laporte S. The behavior of cancellous bone from quasi-static to dynamic strain rates with emphasis on the intermediate regime. J Biomech. May 3, 2016;49(7):1050-1057.
2018	Martinez AA, Chakravarty AB, Quenneville CE. The effect of impact duration on the axial fracture tolerance of the isolated tibia during automotive and military impacts. J Mech Behav Biomed Mater. February 2018;78:315.
2017	Chakravarty AB, Martinez AA, Quenneville CE. The injury tolerance of the tibia under off-axis impact loading. Ann Biomed Eng. June 2017;45(6):1534-1542.
1999	Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Järvinen M. Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tiss Int. July 1999;65(3):183-187.
2005	Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ III, O'Neill T, Pols H, Reeve J, Silman A, Tenenhouse A. Predictive value of BMD for hip and other fractures. J Bone Miner Res. July 2005;20(7):1185-1194.
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.
2007	Feldman F, Robinovitch SN. Reducing hip fracture risk during sideways falls: evidence in young adults of the protective effects of impact to the hands and stepping. J Biomech. 2007;40(12):2612-2618.
2013	Gilchrist S, Guy P, Cripton PA. Development of an inertia-driven model of sideways fall for detailed study of femur fracture mechanics. J Biomech Eng. December 2013;135(12):121001.
2007	Bessho M, Ohnishi I, Matsuyama J, Matsumoto T, Imai K, Nakamura K. Prediction of strength and strain of the proximal femur by a CT-based finite element method. J Biomech. 2007;40(8):1745-1753.
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.
1991	Linde F, Nørgaard P, Hvid I, Odgaard A, Søballe K. Mechanical properties of trabecular bone: dependency on strain rate. J Biomech. 1991;24(9):803-809.
2008	Laing AC, Robinovitch SN. The force attenuation provided by hip protectors depends on impact velocity, pelvic size, and soft tissue stiffness. J Biomech Eng. December 2008;130(6):061005.

Cited By (8)

Year	Entry
2021	Schubert A, Erlinger N, Leo C, Iraeus J, John J, Klug C. Development of a 50th percentile female femur model. In: Proceedings of the 2021 International IRCOBI Conference on the Biomechanics of Injury. September 8-10, 2021; Online.308-332.
2022	Yano S, Matsuura Y, Hagiwara S, Nakamura J, Kawarai Y, Suzuki T, Kanno K, Shoda J, Tsurumi Y, Ohtori S. Determinants of fracture type in the proximal femur: biomechanical study of fresh frozen cadavers and finite element models. Bone. May 2022;158:116352.
2021	Mohammadi H, Pietruszczak S, Quenneville CE. Numerical analysis of hip fracture due to a sideways fall. J Mech Behav Biomed Mater. March 2021;115:104283.
2020	Jazinizadeh F, Quenneville CE. Enhancing hip fracture risk prediction by statistical modeling and texture analysis on DXA images. Med Eng Phys. April 2020;78:14-20.
2021	Nyberg N. Dynamic Finite Element Modelling of a Fall on the Hip [Master's thesis]. Lund, Sweden: Lund University; 2021.
2020	Jazinizadeh F. Assessment of Hip Fracture Risk in Older Adults by Considering the Effect of Geometry and Bone Mineral Density Distribution in the Femur Using Single Dual-Energy X-Ray Absorptiometry Scans [PhD thesis]. Hamilton, ON: McMaster University; August 2020.
2020	Steinmann N. Development of a Modified Anthropomorphic Test Device for the Quantification of Behind Shield Blunt Impacts [Master's thesis]. Hamilton, ON: McMaster University; August 2020.
2022	Martel DR. Contributors to Proximal Femur Fracture Force: Multiscale Considerations of Rate, Toughness, and Bone Composition [PhD thesis]. University of Waterloo; 2022.