Journal
ANNALS OF BIOMEDICAL ENGINEERING
Volume 49, Issue 5, Pages 1380-1390Publisher
SPRINGER
DOI: 10.1007/s10439-020-02682-y
Keywords
Femur; Sideways fall; Fracture mechanics; Strain analysis; High-speed testing
Categories
Funding
- University of Bologna
- Flinders University
- Australian Research Council [DP180103146, FT180100338]
- Australian Research Council [FT180100338] Funding Source: Australian Research Council
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This study found that the risk of osteoporotic hip fractures in a sideways fall depends on both variations of body anthropometry and bone strength. The overlapping ranges of hip impact energy and fracture energy showed relatively small differences. Evaluating factors such as fracture patterns, force, and energy can help in correctly classifying fracture cases.
We hypothesize that variations of body anthropometry, conjointly with the bone strength, determine the risk of hip fracture. To test the hypothesis, we compared, in a simulated sideways fall, the hip impact energy to the energy needed to fracture the femur. Ten femurs from elderly donors were tested using a novel drop-tower protocol for replicating the hip fracture dynamics during a fall on the side. The impact energy was varied for each femur according to the donor's body weight, height and soft-tissue thickness, by adjusting the drop height and mass. The fracture pattern, force, energy, strain in the superior femoral neck, bone morphology and microarchitecture were evaluated. Fracture patterns were consistent with clinically relevant hip fractures, and the superior neck strains and timings were comparable with the literature. The hip impact energy (11 - 95 J) and the fracture energy (11 - 39 J) ranges overlapped and showed comparable variance (CV = 69 and 61%, respectively). The aBMD-based definition of osteoporosis correctly classified 7 (70%) fracture/non-fracture cases. The incorrectly classified cases presented large impact energy variations, morphology variations and large subcortical voids as seen in microcomputed tomography. In conclusion, the risk of osteoporotic hip fracture in a sideways fall depends on both body anthropometry and bone strength.
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