Finite Element Prediction of Hip Fracture during a Sideways Fall

Authors: M. Ikhwan Z. Ridzwan, Bidyut Pal, Ulrich N. Hansen

Abstract:

Finite element method was applied to model damage development in the femoral neck during a sideways fall. The femoral failure was simulated using the maximum principal strain criterion. The evolution of damage was consistent with previous studies. It was initiated by compressive failure at the junction of the superior aspect of the femoral neck and the greater trochanter. It was followed by tensile failure that occurred at the inferior aspect of the femoral neck before a complete transcervical fracture was observed. The estimated failure line was less than 50° from the horizontal plane (Pauwels type II).

Keywords: Femoral Strength, Finite Element Models, Hip Fracture, Progressive Failure, Sideways Fall.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1057735

References:

[1] T. P. Van Staa, E. M. Dennison, H. G. Leufkens and C. Cooper, "Epidemiology of fractures in England and Wales," Bone, 29, pp. 517- 522, 2001.
[2] S. A. Wainwright, L. M. Marshall, K. E. Ensrud, J. A. Cauley, D. M. Black, T. A. Hillier, M. C. Hochberg, M. T. Vogt, and E. S. Orwoll, "Hip fracture in women without osteoporosis," J Clin Endocrinol Metab., vol. 90, pp.2787-2793, 2005.
[3] S.C.E. Schuit, M. van der Klift, A.E.A.M. Weel, C.E.D.H. de Laet, H. Burger, E. Seeman, A. Hofman, A.G. Uitterlinden, J.P.T.M. van Leeuwen, and H.A.P. Pols, "Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study," Bone, vol. 34, pp. 195-202, 2004.
[4] E. S. Orwoll, L. M. Marshall, C. M. Nielson, S. R. Cummings, J. Lapidus, J. A. Cauley, K. Ensrud, N. Lane, P. R. Hoffmann, D. L. Kopperdahl, and T. M. Keaveny, "Finite element analysis of the proximal femur and hip fracture risk in older men," J Bone Miner Res., vol.24(3), pp. 475-483, 2009.
[5] W. C. Hayes, E. R. Myers, J. N. Morris, T. N. Gerhart, H. S. Yett, and L. A. Lipsitz, "Impact near the hip dominates fracture risk in elderly nursing home residents who fall," Calcif Tissue Int., vol.52, pp. 192-198, 1993.
[6] D. D. Cody, G. J. Gross, F. J. Hou, H. J. Spencer, S. A. Goldstein, and D. P. Fyhrie, Femoral strength is better predicted by finite element models than QCT and DXA, Journal of Biomechanics, vol.32, pp. 1013- 1020, 1999.
[7] J. C. Lotz, E. J. Cheal and W. C. Hayes, "Stress distributions within the proximal femur during gait and falls: Implications for osteoporotic fracture," Osteoporosis Int., vol.5, pp. 252-261, 1995.
[8] C. M. Ford, T. M. Keaveny, and W. C. Hayes, "The effect of impact direction on the structural capacity of the proximal femur during falls," Journal of Bone and Mineral Research, vol.11(3), pp. 377-383, 1996.
[9] J.H. Keyak, S.A. Rossi, K.A. Jones, C.M. Les, and H.B. Skinner, "Prediction of fracture location in the proximal femur using finite element models," Medical Engineering & Physics, vol. 23, pp. 657-664, 2001.
[10] N. Wakao, A. Harada, Y. Matsui, M. Takemura, H. Shimokata, M. Mizuno, M. Ito, Y. Matsuyama, and N. Ishiguro, "The effect of impact direction on the fracture load of osteoporotic proximal femurs," Medical Engineering & Physics, vol. 31, pp. 1134-1139, 2009.
[11] J. H. Keyak, S. A. Rossi, K. A. Jones, and H. B. Skinner, 1998, Prediction of femoral fracture load using automated finite element modelling, Journal of Biomechanics, vol.31, pp. 125-133.
[12] M. Bessho, I. Ohnishi, T. Matsumoto, S. Ohashi, J. Matsuyama, K. Tobita, M. Kaneko, and K. Nakamura, "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, vol.45, pp. 226-231, 2009.
[13] D. Dragomir-Daescu, Op Den Buijs J., McEeligot S., Dai Y., Entwistle RC., Salas C., Melton III, J. , Bennet E., Khosla S., and Amin S., "Robust QCT/FEA models of proximal femur stiffness and fracture load during a sideways fall on the hip," Annals of Biomedical Engineering, vol.39(2), pp. 742-755, 2011.
[14] R. Hambli, A. Bettamer, and S. Allaoui, "Finite element prediction of proximal femur fracture pattern based on orthotropic behaviour law coupled to quasi-brittle damage," Medical Engineering & Physics, vol.34, pp. 202- 210, 2012.
[15] E. F. Morgan, and Tony M. Keaveny, "Dependence of yield strain of human trabecular bone on anatomic site," Journal of Biomechanics, vol.34, pp. 569-577, 2001.
[16] P. M. deBakker, S. L. Manske, V. Ebacher, T. R. Oxland, P. A. Cripton, and P. Guy, "During sideways falls proximal femur fractures initiate in the superolateral cortex: Evidence from high-speed video of simulated fractures," Journal of Biomechanics, vol. 42, pp.1917-1925, 2009.
[17] R. Bryan, P. B. Nair, and M. Taylor, "Use of a statistical model of the whole femur in a large scale, multi-model study of femoral neck fracture risk," Journal of Biomechanics, vol. 42, pp. 2171-2176, 2009.
[18] C. Zannoni, R. Mantovani, and M. Viceconti, "Material properties assignment to finite element models of bone structures: a new method," Medical Engineering & Physics, vol.20, pp. 735-740, 1998.
[19] E. F. Morgan, Harun H. Bayraktar, and Tony M. Keaveny, "Trabecular bone modulus-density relationships depend on anatomic site," Journal of Biomechanics, vol.36, pp. 897-904, 2003.
[20] E. Verhulp, B. van Rietbergen, and R. Huiskes, "Load distribution in the healthy and osteoporotic human proximal femur during a fall to the side," Bone, vol.42, pp. 30-35, 2008.
[21] A. C. Courtney, E. F. Wachtel, E. R. Myers, and W. C. Hayes, "Effects of loading rate on strength of the proximal femur," Calcif Tissue Int, vol.55, pp. 53-58, 1994.
[22] A. C. Courtney, E. F. Wachtel, E. R. Myers and W. C. Hayes, "Agerelated reductions in the strength of the femur tested in a fall-loading configuration," J Bone Joint Surg Am., vol.77, pp.387-395, 1995.
[23] T. P. Pinilla, K. C. Boardman, M. L. Bouxsein, E. R. Myers, W. C. Hayes, "Impact direction from a fall influences the failure load of the proximal femur as much as age-related bone loss," Calcif Tissue Int., vol.58, pp.231-235, 1996.
[24] J. C. Lotz and W. C. Hayes, "The use of quantitative computed tomography to estimate risk of fracture of the hip from falls," J Bone Joint Surg Am., vol.72, pp. 689-700, 1990.