0
Research Papers

Development of an Inertia-Driven Model of Sideways Fall for Detailed Study of Femur Fracture Mechanics

[+] Author and Article Information
Seth Gilchrist

Department of Mechanical Engineering,
University of British Columbia,
Vancouver, BC V6T-1Z4, Canada
e-mail: seth@mech.ubc.ca

Pierre Guy

Department of Orthopeadics,
University of British Columbia,
Vancouver, BC V5Z-1M9, Canada
e-mail: pierre.guy@ubc.ca

Peter A Cripton

Department of Mechanical Engineering,
University of British Columbia,
Vancouver, BC V6T-1Z4, Canada
e-mail: cripton@mech.ubc.ca

Contributed by the Bioengineering Division of ASME for publication in the JOURNAL OF BIOMECHANICAL ENGINEERING. Manuscript received April 10, 2013; final manuscript received August 9, 2013; accepted manuscript posted September 12, 2013; published online October 4, 2013. Assoc. Editor: Tammy Haut Donahue.

J Biomech Eng 135(12), 121001 (Oct 04, 2013) (8 pages) Paper No: BIO-13-1183; doi: 10.1115/1.4025390 History: Received April 10, 2013; Revised August 09, 2013; Accepted September 12, 2013

A new method for laboratory testing of human proximal femora in conditions simulating a sideways fall was developed. Additionally, in order to analyze the strain state in future cadaveric tests, digital image correlation (DIC) was validated as a tool for strain field measurement on the bone of the femoral neck. A fall simulator which included models for the body mass, combined lateral femur and pelvis mass, pelvis stiffness, and trochanteric soft tissue was designed. The characteristics of each element were derived and developed based on human data from the literature. The simulator was verified by loading a state-of-the-art surrogate femur and comparing the resulting force-time trace to published, human volunteer experiments. To validate the DIC, 20 human proximal femora were prepared with a strain rosette and speckle paint pattern, and loaded to 50% of their predicted failure load at a low compression rate. Strain rosettes were taken as the gold standard, and minimum principal strains from the DIC and the rosettes were compared using descriptive statistics. The initial slope of the force-time curve obtained in the fall simulator matched published human volunteer data, with local peaks superimposed in the model due to internal vibrations of the spring used to model the pelvis stiffness. Global force magnitude and temporal characteristics were within 2% of published volunteer experiments. The DIC minimum principal strains were found to be accurate to 127±239μɛ. These tools will allow more biofidelic laboratory simulation of falls to the side, and more detailed analysis of proximal femur failure mechanisms using human cadaver specimens.

FIGURES IN THIS ARTICLE
<>
Copyright © 2013 by ASME
Your Session has timed out. Please sign back in to continue.

References

Braithwaite, R. S., Col, N. F., and Wong, J. B., 2003, “Estimating Hip Fracture Morbidity, Mortality and Costs,” J. Am. Geriatrics Soc., 51(3), pp. 364–370. [CrossRef]
Forsn, L., Sgaard, A. J., Meyer, H. E., Edna, T.-H., and Kopjar, B., 1999. “Survival After Hip Fracture: Short- and Long-Term Excess Mortality According to Age and Gender,” Osteoporosis Int., 10(1), pp. 73–78. [CrossRef]
Wiktorowicz, M. E., Goeree, R., Papaioannou, A., Adachi, J. D., and Papadimitropoulos, E., 2001, “Economic Implications of Hip Fracture: Health Service Use, Institutional Care and Cost in Canada,” Osteoporosis Int., 12(4), pp. 271–278. [CrossRef]
Pinilla, T. P., Boardman, K. C., Bouxsein, M. L., Myers, E. R., and Hayes, W. C., 1996, “Impact Direction From a Fall Influences the Failure Load of the Proximal Femur as Much as Age-Related Bone Loss,” Calcified Tissue Int., 58(4), pp. 231–235. [CrossRef]
Ford, C. M., Keaveny, T. M., and Hayes, W. C., 1996. “The Effect of Impact Direction on the Structural Capacity of the Proximal Femur During Falls,” J. Bone Miner. Res., 11(3), pp. 377–383. [CrossRef] [PubMed]
Courtney, A. C., Wachtel, E. F., Myers, E. R., and Hayes, W. C., 1994. “Effects of Loading Rate on Strength of the Proximal Femur,” Calcified Tissue Int., 55(1), pp. 53–58. [CrossRef]
Weber, T., Yang, K., Woo, R., and Fitzgerald, R. J., 1992. “Proximal Femur Strength: Correlation of the Rate of Loading and Bone Mineral Density,” ASME Adv. Bioeng., 22, pp. 111–114. Available at: http://www.scopus.com/inward/record.url?eid=2-s2.0-0027004005&partnerID=40&md5=44ce10be01e7fdc0ca20d30f6b51f6b8
Lotz, J., and Hayes, W., 1990. “The Use of Quantitative Computed Tomography to Estimate Risk of Fracture of the Hip From Falls,” J. Bone Joint Surgery Am., 72(5), pp. 689–700. Available at: http://jbjs.org/article.aspx?articleid=21302
Lochmller, E. M., Groll, O., Kuhn, V., and Eckstein, F., 2002. “Mechanical Strength of the Proximal Femur as Predicted From Geometric and Densitometric Bone Properties at the Lower Limb Versus the Distal Radius,” Bone, 30(1), pp. 207–216. [CrossRef] [PubMed]
Manske, S. L., Liu-Ambrose, T., Cooper, D. M. L., Kontulainen, S., Guy, P., Forster, B. B., and McKay, H. A., 2008, “Cortical and Trabecular Bone in the Femoral Neck Both Contribute to Proximal Femur Failure Load Prediction,” Osteoporosis Int., 20(3), pp. 445–453. [CrossRef]
Boehm, H., Horng, A., Notohamiprodjo, M., Eckstein, F., Burklein, D., Panteleon, A., Lutz, J., and Reiser, M., 2008, “Prediction of the Fracture Load of Whole Proximal Femur Specimens by Topological Analysis of the Mineral Distribution in DXA-Scan Images,” Bone, 43(5), pp. 826–831. [CrossRef] [PubMed]
de Bakker, P. M., Manske, S. L., Ebacher, V., Oxland, T. R., Cripton, P. A., and Guy, P., 2009, “During Sideways Falls Proximal Femur Fractures Initiate in the Superolateral Cortex: Evidence From High-Speed Video of Simulated Fractures,” J. Biomech., 42(12), pp. 1917–1925. [CrossRef] [PubMed]
Roberts, B. J., Thrall, E., Muller, J. A., and Bouxsein, M. L., 2010, “Comparison of Hip Fracture Risk Prediction by Femoral aBMD to Experimentally Measured Factor of Risk,” Bone, 46(3), pp. 742–746. [CrossRef] [PubMed]
Keyak, J. H., 2000, “Relationships Between Femoral Fracture Loads for Two Load Configurations,” J. Biomech., 33(4), pp. 499–502. [CrossRef] [PubMed]
Backman, S., 1957, “The proximal End of the Femur: Investigations With Special Reference to the Etiology of Femoral Neck Fractures; Anatomical Studies; Roentgen Projections; Theoretical Stress Calculations; Experimental Production of Fractures,” Acta Radiol. Suppl.,146, pp. 1–166. [PubMed]
Feldman, F., and Robinovitch, S. N., 2007, “Reducing Hip Fracture Risk During Sideways Falls: Evidence In Young Adults Of The Protective Effects Of Impact To The Hands And Stepping,” J. Biomech., 40(12), pp. 2612–2618. [CrossRef] [PubMed]
Nachreiner, N. M., Findorff, M. J., Wyman, J. F., and McCarthy, T. C., 2007, “Circumstances and Consequences Of Falls In Community-Dwelling Older Women,” J. Women's Health, 16(10), pp. 1437–1446. [CrossRef]
McElhaney, J. H., 1966. “Dynamic Response of Bone and Muscle Tissue,” J. Appl. Physiol., 21(4), p. 1231–1236. Available at: http://jap.physiology.org/content/21/4/1231.short [PubMed]
Crowninshield, R. D., and Pope, M. H., 1974, “The Response of Compact Bone In Tension At Various Strain Rates,” Ann. Biomed. Eng., 2(2), p. 217–225. [CrossRef]
Saha, S., and Hayes, W. C., 1974, “Instrumented Tensile-Impact Tests Of Bone,” Exp. Mech., 14(12), p. 473–478. [CrossRef]
Currey, J., 1975, “The Effects Of Strain Rate, Reconstruction And Mineral Content On Some Mechanical Properties Of Bovine Bone,” J. Biomech., 8(1), pp. 81–86. [CrossRef] [PubMed]
Carter, D. R., and Hayes, W. C., 1976, “Bone Compressive Strength: The Influence Of Density And Strain Rate,” Science, 194(4270), pp. 1174–1176. [CrossRef] [PubMed]
Robertson, D. M., and Smith, D. C., 1978, “Compressive Strength Of Mandibular Bone As A Function Of Microstructure And Strain Rate,” J. Biomech., 11(1012), pp. 455–471. [CrossRef] [PubMed]
Linde, F., Nrgaard, P., Hvid, I., Odgaard, A., and Sballe, K., 1991, “Mechanical Properties of Trabecular Bone. Dependency On Strain Rate,” J. Biomech., 24(9), pp. 803–809. [CrossRef] [PubMed]
Pithioux, M., Subit, D., and Chabrand, P., 2004, “Comparison of Compact Bone Failure Under Two Different Loading Rates: Experimental And Modelling Approaches,” Med. Eng. Phys., 26(8), pp. 647–653. [CrossRef] [PubMed]
Hansen, U., Zioupos, P., Simpson, R., Currey, J. D., and Hynd, D., 2008, “The Effect of Strain Rate On The Mechanical Properties Of Human Cortical Bone,” ASME J. Biomech. Eng., 130(1), p. 011011. [CrossRef]
Zioupos, P., Hansen, U., and Currey, J. D., 2008, “Microcracking Damage And The Fracture Process In Relation To Strain Rate In Human Cortical Bone Tensile Failure,” J. Biomech., 41(14), pp. 2932–2939. [CrossRef] [PubMed]
Borissova, A.-M., Rashkov, R., Boyanov, M., Shinkov, A., Popivanov, P., Temelkova, N., Vlahov, J., and Gavrailova, M., 2011, “Femoral Neck Bone Mineral Density And 10-Year Absolute Fracture Risk In A National Representative Sample of Bulgarian Women Aged 50 Years and Older,” Archives of Osteoporosis, 6(1–2), pp. 189–195. [CrossRef] [PubMed]
Cauley, J. A., Lui, L.-Y., Genant, H. K., Salamone, L., Browner, W., Fink, H. A., Cohen, P., Hillier, T., Bauer, D. C., and Cummings, S. R., 2009, “Risk Factors For Severity And Type Of The Hip Fracture,” J. Bone Miner. Res., 24(5), pp. 943–955. [CrossRef] [PubMed]
Stone, K. L., Seeley, D. G., Lui, L.-Y., Cauley, J. A., Ensrud, K., Browner, W. S., Nevitt, M. C., and Cummings, S. R., 2003, “BMD at Multiple Sites And Risk Of Fracture Of Multiple Types: Long-Term Results From The Study Of Osteoporotic Fractures,” J. Bone Miner. Res., 18(11), pp. 1947–1954. [CrossRef] [PubMed]
Siris, E. S., Chen, Y.-T., Abbott, T. A., Barrett-Connor, E., Miller, P. D., Wehren, L. E., and Berger, M. L., 2004, “Bone Mineral Density Thresholds For Pharmacological Intervention To Prevent Fractures,” Arch. Int. Med., 164(10), pp. 1108–1112. [CrossRef]
Greenspan, S. L., Myers, E. R., Maitland, L. A., Resnick, N. M., and Hayes, W. C., 1994, “Fall Severity And Bone Mineral Density As Risk Factors For Hip Fracture In Ambulatory Elderly,” JAMA, 271(2), pp. 128–133. [CrossRef] [PubMed]
Singh, M., Nagrath, A. R., and Maini, P. S., 1970, “Changes in Trabecular Pattern Of The Upper End Of The Femur As An Index Of Osteoporosis,” J. Bone and Joint Surg. Am., 52(3), pp. 457–467. Available at: http://jbjs.org/article.aspx?articleid=15347
Naylor, K. E., McCloskey, E. V., Eastell, R., and Yang, L., 2012, “The Use of DXA Based Finite Element Analysis of the Proximal Femur in a Longitudinal Study of Hip Fracture,” J. Bone Miner. Res., 28(5), pp. 1014–1021. [CrossRef]
Bouxsein, M. L., 2003, “Bone Quality: Where Do We Go From Here?” Osteoporosis Int., 14(5S), pp. 118–127. [CrossRef]
Robinovitch, S. N., Evans, S. L., Minns, J., Laing, A. C., Kannus, P., Cripton, P. A., Derler, S., Birge, S. J., Plant, D., Cameron, I. D., Kiel, D. P., Howland, J., Khan, K., and Lauritzen, J. B., 2009, “Hip Protectors: Recommendations For Biomechanical Testingan International Consensus Statement (Part I),” Osteoporosis Int., 20(12), pp. 1977–1988. [CrossRef]
Laing, A. C., and Robinovitch, S. N., 2008, “The Force Attenuation Provided By Hip Protectors Depends On Impact Velocity, Pelvic Size, And Soft Tissue Stiffness,” ASME J. Biomech. Eng., 130(6), pp. 061005–9. [CrossRef]
Laing, A. C., Tootoonchi, I., Hulme, P. A., and Robinovitch, S. N., 2006, “Effect of Compliant Flooring On Impact Force During Falls on the Hip,” J. Orthop. Res., 24(7), pp. 1405–1411. [CrossRef] [PubMed]
Cristofolini, L., Juszczyk, M., Martelli, S., Taddei, F., and Viceconti, M., 2007, “in vitro Replication of Spontaneous Fractures Of The Proximal Human Femur,” J. Biomech., 40(13), pp. 2837–2845. [CrossRef] [PubMed]
Verhulp, E., van Rietbergen, B., and Huiskes, R., 2006, “Comparison of Micro-Level and Continuum-Level Voxel Models of the Proximal Femur,” J. Biomech., 39(16), pp. 2951–2957. [CrossRef] [PubMed]
Cristofolini, L., McNamara, B. P., Freddi, A., and Viceconti, M., 1997, “in vitro Measured Strains In The Loaded Femur: Quantification Of Experimental Error,” J. Strain Anal. Eng. Design, 32(3), pp. 193–200. [CrossRef]
Orwoll, E. S., Marshall, L. M., Nielson, C. M., Cummings, S. R., Lapidus, J., Cauley, J. A., Ensrud, K., Lane, N., Hoffmann, P. R., Kopperdahl, D. L., and Keaveny, T. M., 2009, “Finite Element Analysis Of The Proximal Femur And Hip Fracture Risk In Older Men,” J. Bone Miner. Res., 24(3), pp. 475–483. [CrossRef] [PubMed]
Parker, E. D., Pereira, M. A., Virnig, B., and Folsom, A. R., 2008, “The Association of Hip Circumference With Incident Hip Fracture In A Cohort Of Postmenopausal Women: The Iowa Women's Health Study,” Ann. Epidemiology, 18(11), pp. 836–841. [CrossRef]
Nguyen, N. D., Pongchaiyakul, C., Center, J. R., Eisman, J. A., and Nguyen, T. V., 2005, “Abdominal Fat And Hip Fracture Risk In The Elderly: The Dubbo Osteoporosis Epidemiology Study,” BMC Musculoskeletal Disorders, 6(1), p. 11. [CrossRef] [PubMed]
Nguyen, N. D., Pongchaiyakul, C., Center, J. R., Eisman, J. A., and Nguyen, T. V., 2005, “Identification of High-Risk Individuals For Hip Fracture: A 14 Year Prospective Study,” J. Bone Miner. Res., 20(11), pp. 1921–1928. [CrossRef] [PubMed]
Minns, R. J., Marsh, A.-M., Chuck, A., and Todd, J., 2007, “Are Hip Protectors Correctly Positioned In Use?” Age and Aging, 36(2), pp. 140–144. [CrossRef]
Nielson, C. M., Marshall, L. M., Adams, A. L., LeBlanc, E. S., Cawthon, P. M., Ensrud, K., Stefanick, M. L., Barrett-Connor, E., and Orwoll, E. S., 2011, “BMI and Fracture Risk In Older Men: The Osteoporotic Fractures In Men Study (MrOS),” J. Bone and Mineral Res., 26(3), pp. 496–502. [CrossRef]
van den Kroonenberg, A. J., Hayes, W. C., and McMahon, T. A., 1995, “Dynamic Models for Sideways Falls From Standing Height,” ASME J. Biomech. Eng., 117(3), pp. 309–318. [CrossRef]
Robinovitch, S. N., Hayes, W. C., and McMahon, T. A., 1991, “Prediction of Femoral Impact Forces In Falls On The Hip,” ASME J. Biomech. Eng., 113(4), pp. 366–374. [CrossRef]
Laing, A. C., and Robinovitch, S. N., 2010, “Characterizing the Effective Stiffness Of The Pelvis During Sideways Falls On The Hip,” J. Biomech.43(10), pp. 1898–1904. [CrossRef] [PubMed]
Robinovitch, S. N., Hayes, W. C., and McMahon, T. A., 1997, “Distribution of Contact Force During Impact To The Hip,” Ann. Biomed. Eng., 25(3), pp. 499–508. [CrossRef] [PubMed]
Armstrong, M., Spencer, E. A., Cairns, B. J., Banks, E., Pirie, K., Green, J., Wright, F. L., Reeves, G. K., Beral, V., 2011, “Body Mass Index And Physical Activity In Relation To The Incidence Of Hip Fracture In Postmenopausal Women,” J. Bone Miner. Res., 26(6), pp. 1330–1338. [CrossRef] [PubMed]
Bouxsein, M. L., Szulc, P., Munoz, F., Thrall, E., Sornay-Rendu, E., and Delmas, P. D., 2007, “Contribution of Trochanteric Soft Tissues To Fall Force Estimates, The Factor Of Risk, And Prediction Of Hip Fracture Risk,” J. Bone Miner. Res., 22(6), pp. 825–831. [CrossRef] [PubMed]
Nielson, C. M., Bouxsein, M. L., Freitas, S. S., Ensrud, K. E., Orwoll, E. S., and for the Osteoporotic Fractures in Men (MrOS) Research Group, 2009, “Trochanteric Soft Tissue Thickness And Hip Fracture In Older Men,” J. Clin. Endocrin. Metabol., 94(2), pp. 491–496. [CrossRef]
Beason, D. P., Dakin, G. J., Lopez, R. R., Alonso, J. E., Bandak, F. A., and Eberhardt, A. W., 2003, “Bone Mineral Density Correlates With Fracture Load In Experimental Side Impacts Of The Pelvis,” J. Biomech., 36(2), pp. 219–27. [CrossRef] [PubMed]
Nightingale, R. W., McElhaney, J. H., Camacho, D. L., Kleinberger, M., Winkelstein, B. A., and Myers, B. S., 1997, “The Dynamic Responses Of The Cervical Spine: Buckling, End Conditions, And Tolerance In Compressive Impacts,” SAE Conference Proceedings P, Stapp Car Crash Conference, pp. 451–472.
Saari, A., Itshayek, E., and Cripton, P. A., 2011, “Cervical Spinal Cord Deformation During Simulated Head-First Impact Injuries,” J. Biomech., 44(14), pp. 2565–2571. [CrossRef] [PubMed]
van den Kroonenberg, A. J., Hayes, W. C., and McMahon, T. A., 1996, “Hip Impact Velocities And Body Configurations For Voluntary Falls From Standing Height,” J. Biomech., 29(6), pp. 807–811. [CrossRef] [PubMed]
Majumder, S., Roychowdhury, A., and Pal, S., 2008, “Effects of Trochanteric Soft Tissue Thickness And Hip Impact Velocity On Hip Fracture In Sideways Fall Through 3D Finite Element Simulations,” J. Biomech., 41(13), pp. 2834–2842. [CrossRef] [PubMed]
Robinovitch, S. N., McMahon, T. A., and Hayes, W. C., 1995, “Force Attenuation in Trochanteric Soft Tissues During Impact From A Fall,” J. Orthop. Res., 13(6), pp. 956–962. [CrossRef] [PubMed]
Viceconti, M., Toni, A., and A., G., 1992, Experimental Mechanics: Technology Transfer Between High Tech Engineering and Biomechanics (Clinical Aspects of Biomedicine), F. G. Little, ed., Elsevier Science, Amsterdam.
Bayraktar, H. H., Morgan, E. F., Niebur, G. L., Morris, G. E., Wong, E. K., and Keaveny, T. M., 2004, “Comparison of the Elastic And Yield Properties Of Human Femoral Trabecular And Cortical Bone Tissue,” J. Biomech., 37(1), pp. 27–35. [CrossRef] [PubMed]
Toogood, P. A., Skalak, A., and Cooperman, D. R., 2009, “Proximal Femoral Anatomy In The Normal Human Population,” Clin. Orthop. Relat. Res., 467(4), pp. 876–885. [CrossRef] [PubMed]
Yasuyuki, M., Masakazu, U., Mitsugu, T., Yasuyuki, M., Kazuo, A., and Kiyoshi, K., 2009, “Relationship Between The Load-Displacement Curve And Deformation Distribution In Porcine Mandibular Periodontium,” J. Biomech. Sci. Eng., 4(3), pp. 336–344. [CrossRef]
Sztefek, P., Vanleene, M., Olsson, R., Collinson, R., Pitsillides, A. A., and Shefelbine, S., 2010, “Using Digital Image Correlation To Determine Bone Surface Strains During Loading And After Adaptation Of The Mouse Tibia,” J. Biomech., 43(4), pp. 599–605. [CrossRef] [PubMed]
Dickinson, A. S., Taylor, A. C., Ozturk, H., and Browne, M., 2011, “Experimental Validation Of A Finite Element Model Of The Proximal Femur Using Digital Image Correlation And A Composite Bone Model,” ASME J. Biomech. Eng., 133(1), p. 014504. [CrossRef]
Gray, H., and Harmon Lewis, W., 1918, Anatomy of the Human Body, 20th ed., Lea & Febiger, Philadelphia.

Figures

Grahic Jump Location
Fig. 2

In previous tests on osteoligamentous pelvises an instrumented impactor was dropped on the greater trochanter at 4.5 m/s. When the impactor came into contact with the trochanter a force spike was seen before deformation of the pelvis had begun, as indicated by highlighted peak in the inset graph (adapted from Beason et. al [55] with permission). This spike was created by the acceleration of the mass of the lateral pelvis and femur. Illustrations adapted from Gray et al. [67], copyright expired.

Grahic Jump Location
Fig. 3

A photo of the fall simulator showing each element of the model

Grahic Jump Location
Fig. 1

Schematic of the fall simulator showing the mass and spring structures that influence loading a fall to the side. meff_p+f is the effective mass of the lateral pelvis and femur.

Grahic Jump Location
Fig. 6

Example data from the DIC analysis. Time versus strain plot (a) for specimen 16 shows the character and magnitude of the random noise, and an example DIC strain contour map (b) shows how the strain varied over the surface of the bone at the maximum applied load. The bone is oriented such that superior is to the left and lateral to the top. The head of the femur is in the lower left and the trochanter occupies the upper portion of the image, with the strain gauge wires visible on the right.

Grahic Jump Location
Fig. 5

The averages and standard deviations of the strain errors measured for each specimen. Three specimens, 5, 8, and 10, were subjected to camera vibration, leading to incorrect DIC strain readings.

Grahic Jump Location
Fig. 4

An example response of the fall simulator plotted with human pelvis drop data [50]. The dashed line indicates the initial loading slope of the scaled volunteer data and the circle indicates the location of the peak forces. The human data was scaled by the ratio of the impact velocities.

Tables

Errata

Discussions

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging and repositioning the boxes below.

Related Journal Articles
Related eBook Content
Topic Collections

Sorry! You do not have access to this content. For assistance or to subscribe, please contact us:

  • TELEPHONE: 1-800-843-2763 (Toll-free in the USA)
  • EMAIL: asmedigitalcollection@asme.org
Sign In