How accurately can we predict the fracture load of the proximal femur using finite element models?

Munckhof, Sven van den; Zadpoor, Amir A.

doi:10.1016/j.clinbiomech.2013.12.018

Cited by 39 publications

(24 citation statements)

References 107 publications

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“…114 That is partly due to the fact that the methodologies used for FE modeling of bones are not standardized and partly because there has not been enough corroboration of FE models used in femoral fracture prediction. With the advent of optical full-field strain measurement techniques such as digital image correlation (DIC), [115][116][117] the strain pattern could potentially be measured with very high temporal and spatial resolutions.…”

Section: Corroboration Of Finite Element Modelsmentioning

confidence: 99%

Assessment of Osteoporotic Femoral Fracture Risk: Finite Element Method as a Potential Replacement for Current Clinical Techniques

Munckhof

Nikooyan

Zadpoor

2015

J. Mech. Med. Biol.

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Femoral fracture risk prediction is a necessary step preceding effective pharmacological intervention or pre-operative planning. Current clinical methods for fracture risk prediction rely on 2D imaging methods and have limited predictive value. Researchers are therefore trying to find improved methods for fracture prediction. During last few decades, many studies have focused on integration of 3D imaging techniques and the finite element (FE) method to improve the accuracy of fracture assessment techniques. In this paper, we review the recent advances in FE and other techniques for predicting the risk of femoral fractures. Based on a number of selected studies, the different steps that are involved in generation of patient-specific FE models are reviewed with particular emphasis on the fracture criteria. The inaccuracies that might arise due to the imperfections of the involved steps are also discussed. It is concluded that compared to image-and geometry-based techniques, FE is a more promising approach for prediction of fracture loads. However, certain technological advancements in FE modeling protocols are required before FE modeling can be recruited in clinical settings.

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Section: Corroboration Of Finite Element Modelsmentioning

confidence: 99%

Assessment of Osteoporotic Femoral Fracture Risk: Finite Element Method as a Potential Replacement for Current Clinical Techniques

Munckhof

Nikooyan

Zadpoor

2015

J. Mech. Med. Biol.

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“…The complete CT-based FEA methodology from image acquisition through model generation to the final computing of strength has been validated extensively using in vitro biomechanical tests by numerous investigators [3,4]. Some, but not all studies demonstrated the superior value of FEA over DXA-based areal bone mineral density (aBMD) or quantitative computed tomography (QCT)-based volumetric bone mineral density (vBMD) in predicting in vitro proximal femur and vertebral body strength [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Comparison of proximal femur and vertebral body strength improvements in the FREEDOM trial using an alternative finite element methodology

Zysset

Pahr

Engelke³

et al. 2015

Bone

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“…Average angles approximating the neutral position, measured from nine patients, are reported in Table 1 [22]. Using geometry of the proximal femur alone, these angles may be measured and reproduced in order to ensure that the load direction applied during future in vitro studies closely match the load directions measured in vivo by Bergman et al [16].…”

Section: Figurementioning

confidence: 99%

“…Coordinate system of the left femur as defined by Bergmann et al [16].The x-axis is the line joining the dorsal contour of the femoral condyles and the z-axis is the line joining the center of the condyles to the mid-point of the implant shaft. Image adopted from [50]…”

Section: Figurementioning

confidence: 99%

“…However, FE modelling for the prediction of bone fracture load remains an area of current research. Linear elastic models are often used because they can be simulated quickly, but can result in large errors between measured and predicted fracture load (up to 45%) [15], [16]. Nonlinear models perform better, but there is no apparent consensus in the literature regarding the best material/failure model to use [17]- [19].…”

Section: Chapter 1: Introductionmentioning

confidence: 99%

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An Investigation on the Influence of Stumbling Loads on Femoral Fracture Risk, Using a Novel Gradient Enhanced Quasi-Brittle Finite Element Model

Haider¹

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Stumbling is associated with large hip contact forces, but it remains unclear whether these events contribute to osteoporotic hip fracture risk. We hypothesized that stumbling may increase risk, either causing fracture directly, or damaging the femur leaving it susceptible to future loading. This hypothesis can be tested in-silico, but previously published finite element (FE) models are susceptible to large errors in predicted fracture load and pattern. We developed and validated a novel gradient enhanced quasi-brittle damage model, for improved fracture prediction, and used the model to assess the influence of stumbling on fracture risk. Preliminary FE models were used to explore relevant physics and boundary conditions (BC's) needed to accurately model the femur in fall and stumbling configurations. The study investigated the influence of different BCs, viscoelasticity, inertial dynamics, and biphasic (pore fluid) effects; the potential importance of these phenomenon had been discussed, but not well-explored, in literature. After implementation, the gradient enhanced quasi-brittle damage model was validated through experimental testing. Average fracture load prediction error was 9.6%, compared to 10%-20% errors reported in previous models and fracture pattern was correctly predicted for all cases, compared to the 60-80% accuracy of previous models. This validated model predicted that four of six specimens had a moderate risk of fracture due to stumbling alone, and risk increased significantly with simulated advanced osteoporosis. The model also predicted compaction of the subcapital region, a pattern consistent with impacted fractures observed in clinical settings.Finally, we investigated if progressive damage accumulation from combinations of stumble and fall could increase fracture risk. Most specimens were resilient to accumulated damage and only one experienced reductions in strength (5-15%) from repeat loading. However, two specimens II experienced moderate (20-30%) increase in fracture load, for some load cases; this was a novel finding. In these cases, initial damage accumulation caused the load to be more evenly distributed upon subsequent loading events. These results suggest that stumbling alone can result in hip fracture and therefore future preventative intervention strategies may be more effective if they target both fall and stumbling induced fractures. III

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How accurately can we predict the fracture load of the proximal femur using finite element models?

Cited by 39 publications

References 107 publications

Assessment of Osteoporotic Femoral Fracture Risk: Finite Element Method as a Potential Replacement for Current Clinical Techniques

Assessment of Osteoporotic Femoral Fracture Risk: Finite Element Method as a Potential Replacement for Current Clinical Techniques

Comparison of proximal femur and vertebral body strength improvements in the FREEDOM trial using an alternative finite element methodology

An Investigation on the Influence of Stumbling Loads on Femoral Fracture Risk, Using a Novel Gradient Enhanced Quasi-Brittle Finite Element Model

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