Cortical and trabecular load sharing in the human femoral neck

Nawathe, Shashank; Nguyen, Bich Phuong; Barzanian, Nasim; Akhlaghpour, Hosna; Bouxsein, Mary L.; Keaveny, Tony M.

doi:10.1016/j.jbiomech.2014.12.022

Cited by 66 publications

(59 citation statements)

References 34 publications

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“…Although cortical bone in the proximal femur is mainly responsible for the whole bone strength, cancellous bone still contributes to about 10% to the total strength in stance [14,15] and 35% during a sideways fall [15]. Trauma mechanisms of femoral neck fractures may either be direct, e.g., fall onto the greater trochanter or a forced external rotation of the leg, or indirect, if muscle forces overwhelm the internal strength of the femur.…”

Section: Hip Fracturesmentioning

confidence: 99%

Biomechanics of Osteoporotic Fracture Fixation

Hollensteiner

Sandriesser

Bliven

et al. 2019

Curr Osteoporos Rep

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Purpose of Review Fractures of osteoporotic bone in elderly individuals need special attention. This manuscript reviews the current strategies to provide sufficient fracture fixation stability with a particular focus on fractures that frequently occur in elderly individuals with osteoporosis and require full load-bearing capacity, i.e., pelvis, hip, ankle, and peri-implant fractures. Recent Findings Elderly individuals benefit immensely from immediate mobilization after fracture and thus require stable fracture fixation that allows immediate post-operative weight-bearing. However, osteoporotic bone has decreased holding capacity for metallic implants and is thus associated with a considerable fracture fixation failure rate both short term and long term. Modern implant technologies with dedicated modifications provide sufficient mechanical stability to allow immediate weight-bearing for elderly individuals. Depending on fracture location and fracture severity, various options are available to reinforce or augment standard fracture fixation systems. Summary Correct application of the basic principles of fracture fixation and the use of modern implant technologies enables mechanically stable fracture fixation that allows early weight-bearing and results in timely fracture healing even in patients with osteoporosis.

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Section: Hip Fracturesmentioning

confidence: 99%

Biomechanics of Osteoporotic Fracture Fixation

Hollensteiner

Sandriesser

Bliven

et al. 2019

Curr Osteoporos Rep

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“…For example, a 50% loss of horizontal trabecular bone cross-sectional area results in a 75% loss of load-bearing capacity (18)(19)(20)(21). Three-dimensional analysis of CT and MR imaging data has shown striking changes in the shape and connectivity of the trabeculae that make up cancellous bone (22). (distal femur and proximal tibia), distal tibia, proximal humerus, distal radius and ulna, and the anterior rib ends of the middle ribs.…”

Section: Rickets and Osteomalaciamentioning

confidence: 99%

Imaging Findings of Metabolic Bone Disease

Chang¹,

Rosenthal

Mitchell³

et al. 2016

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Metabolic bone diseases are a diverse group of diseases that result in abnormalities of (a) bone mass, (b) structure mineral homeostasis, (c) bone turnover, or (d) growth. Osteoporosis, the most common metabolic bone disease, results in generalized loss of bone mass and deterioration in the bone microarchitecture. Impaired chondrocyte development and failure to mineralize growth plate cartilage in rickets lead to widened growth plates and frayed metaphyses at sites of greatest growth. Osteomalacia is the result of impaired mineralization of newly formed osteoid, which leads to characteristic Looser zones. Hypophosphatasia is a congenital condition of impaired bone mineralization with wide phenotypic variability. Findings of hyperparathyroidism are the result of bone resorption, most often manifesting as subperiosteal resorption in the hand. Renal osteodystrophy is the collection of skeletal findings observed in patients with chronic renal failure and associated secondary hyperparathyroidism and can include osteopenia, osteosclerosis, and "rugger jersey spine." Hypoparathyroidism is most commonly due to iatrogenic injury, and radiographic findings of hypoparathyroidism reflect an overall increase in bone mass. Thyroid hormone regulates endochondral bone formation; and congenital hypothyroidism, when untreated, leads to delayed bone age and absent, irregular, or fragmented distal femoral and proximal tibial epiphyses. Soft-tissue proliferation of thyroid acropachy is most often observed in the hands and feet. The findings of acromegaly are due to excess growth hormone secretion and therefore proliferation of the bones and soft tissues. Vitamin C deficiency, or scurvy, impairs posttranslational collagen modification, leading to subperiosteal hemorrhage and fractures. RSNA, 2016.

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“…Greatest compressive stresses and strains now occur in or about the region of the thin superolateral femoral neck while the thick inferomedial femoral neck is exposed to lower tensile stresses and strains (Fig. 1B) [20, 21, 23, 24, 41]. The net result is the exposure of the superolateral cortex and bone nearby to potentially injurious stress and strain, with high-speed video recordings revealing that fracture initiation during an in vitro simulated side-ways fall occurs within the superolateral cortex [42, 43].…”

Section: Fracture Prone Regions Within the Proximal Femurmentioning

confidence: 99%

Physical Activity for Strengthening Fracture Prone Regions of the Proximal Femur

Fuchs

Kersh

Carballido‐Gamio

et al. 2017

Curr Osteoporos Rep

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Purpose of review Physical activity improves proximal femoral bone health; however, it remains unclear whether changes translate into a reduction in fracture risk. To enhance any fracture-protective effects of physical activity, fracture prone regions within the proximal femur need to be targeted. Recent findings The proximal femur is designed to withstand forces in the weight bearing direction, but less so forces associated with falls in a sideways direction. Sideways falls heighten femoral neck fracture risk by loading the relatively weak superolateral region of femoral neck. Recent studies exploring regional adaptation of the femoral neck to physical activity have identified heterogeneous adaptation, with adaptation principally occurring within inferomedial weight bearing regions and little to no adaptation occurring in the superolateral femoral neck. Summary There is a need to develop novel physical activities that better target and strengthen the superolateral femoral neck within the proximal femur. Design of these activities may be guided by subject-specific musculoskeletal modeling and finite element modeling approaches.

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Cortical and trabecular load sharing in the human femoral neck

Cited by 66 publications

References 34 publications

Biomechanics of Osteoporotic Fracture Fixation

Biomechanics of Osteoporotic Fracture Fixation

Imaging Findings of Metabolic Bone Disease

Physical Activity for Strengthening Fracture Prone Regions of the Proximal Femur

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