Body Anthropometry and Bone Strength Conjointly Determine the Risk of Hip Fracture in a Sideways Fall
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Annals of Biomedical Engineering (Ó 2020) https://doi.org/10.1007/s10439-020-02682-y
Original Article
Body Anthropometry and Bone Strength Conjointly Determine the Risk of Hip Fracture in a Sideways Fall MARCO PALANCA ,1,2 EGON PERILLI,3 and SAULO MARTELLI3,4 1
Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum – Universita` di Bologna, Bologna, Italy; 2Department of Oncology and Metabolism, and INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, UK; 3Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, Australia; and 4School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia (Received 13 June 2020; accepted 26 October 2020) Associate Editor Sean S. Kohles oversaw the review of this article.
Abstract—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. Keywords—Femur, Sideways fall, Fracture mechanics, Strain analysis, High-speed testing.
Address correspondence to Marco Palanca, Department of Oncology and Metabolism, and INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, UK. Electronic mail: m.palanca@sheffield.ac.uk
INTRODUCTION Osteoporotic fractures are a burden for the public health costing 37 billion Euros in EU and 16 billion Dollars in USA every year.6,24 Hip fractures occur when the hip load generated at the hip while falling exceeds its load bearing capacity, or strength.5 Hip strength is a function of femur morphology, bone mineral density (BMD) and bone architecture43,45,47 whereas the hip load experienced during a fall relates to the dynamics of the fall, the body size and shape, the stiffness of the h
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