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Huang Q, Zhou Z, Kleiven S. Effectiveness of energy absorbing floors in reducing hip fractures risk among elderly women during sideways falls. J Mech Behav Biomed Mater 2024; 157:106659. [PMID: 39029349 DOI: 10.1016/j.jmbbm.2024.106659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/27/2024] [Accepted: 07/10/2024] [Indexed: 07/21/2024]
Abstract
Falls among the elderly cause a huge number of hip fractures worldwide. Energy absorbing floors (EAFs) represent a promising strategy to decrease impact force and hip fracture risk during falls. Femoral neck force is an effective predictor of hip injury. However, the biomechanical effectiveness of EAFs in terms of mitigating femoral neck force remains largely unknown. To address this, a whole-body computational model representing a small-size elderly woman with a biofidelic representation of the soft tissue near the hip region was employed in this study, to measure the attenuation in femoral neck force provided by four commercially available EAFs (Igelkott, Kradal, SmartCells, and OmniSports). The body was positioned with the highest hip force with a -10∘ trunk angle and +10∘ anterior pelvis rotation. At a pelvis impact velocity of 3 m/s, the peak force attenuation provided by four EAFs ranged from 5% to 19%. The risk of hip fractures also demonstrates a similar attenuation range. The results also exhibited that floors had more energy transferred to their internal energy demonstrated greater force attenuation during sideways falls. By comparing the biomechanical effectiveness of existing EAFs, these results can improve the floor design that offers better protection performance in high-fall-risk environments for the elderly.
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Affiliation(s)
- Qi Huang
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden.
| | - Zhou Zhou
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Svein Kleiven
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
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Vlachos C, Ampadiotaki MM, Papagrigorakis E, Galanis A, Zachariou D, Vavourakis M, Rodis G, Vasiliadis E, Kontogeorgakos VA, Pneumaticos S, Vlamis J. Distinctive Geometrical Traits of Proximal Femur Fractures-Original Article and Review of Literature. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2131. [PMID: 38138234 PMCID: PMC10744519 DOI: 10.3390/medicina59122131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The incidence of proximal femoral fractures is escalating rapidly, generating a significant challenge for healthcare systems globally and, carrying serious social and economic implications. The primarily object of this study was to discover potential distinguishing factors between fractures occurring in the femoral neck and trochanteric region. Materials and Methods: We performed a prospective cohort study of the radiographic images of 70 people over 65 years of age who were admitted to the orthopedic department with hip fracture and who fulfilled our eligibility criteria. Neck Length (NL), Offset Lenth (OL), Hip Axis Length (HAL), Neck Shaft Angle (NSA), Wiberg Angle (WA), Acetabular Angle (AA), Femoral Neck Diameter (FND), Femoral Head Diameter (FHD), Femoral Shaft Diameter (FSD), Femoral Canal Diameter (FCD) and Tonnis classification were recorded. For the comparison of the categorical variables, Pearson's χ2 criterion was used, while Student's t-test was applied for the comparison of means of quantitative variables across fracture types. Results: There were no statistically significant variances observed while comparing the selected geometric parameters of the proximal femur with the type of fracture. This finding was reaffirmed in relation to age, gender, and Tonnis classification. However, a moderate correlation was noted, revealing comparatively reduced values of HAL, FHD, and FND in women as opposed to men. Conclusions: The inability of our research to establish the differentiative geometric factors between femoral neck and trochanteric fractures underscores the need for further investigations, which would take into consideration the intrinsic characteristics of the proximal femur.
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Affiliation(s)
- Christos Vlachos
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | | | - Eftychios Papagrigorakis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - Athanasios Galanis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - Dimitrios Zachariou
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - Michail Vavourakis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - George Rodis
- Department of Radiology, KAT General Hospital, 14561 Athens, Greece;
| | - Elias Vasiliadis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - Vasileios A. Kontogeorgakos
- 1st Orthopedic Department, National and Kapodistrian University of Athens, Attikon General University Hospital, 12462 Chaidari, Greece;
| | - Spiros Pneumaticos
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - John Vlamis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
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Fung A, Fleps I, Cripton PA, Guy P, Ferguson SJ, Helgason B. The efficacy of femoral augmentation for hip fracture prevention using ceramic-based cements: A preliminary experimentally-driven finite element investigation. Front Bioeng Biotechnol 2023; 11:1079644. [PMID: 36777252 PMCID: PMC9909544 DOI: 10.3389/fbioe.2023.1079644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
Femoral fractures due to sideways falls continue to be a major cause of concern for the elderly. Existing approaches for the prevention of these injuries have limited efficacy. Prophylactic femoral augmentation systems, particularly those involving the injection of ceramic-based bone cements, are gaining more attention as a potential alternative preventative approach. We evaluated the mechanical effectiveness of three variations of a bone cement injection pattern (basic ellipsoid, hollow ellipsoid, small ellipsoid) utilizing finite element simulations of sideways fall impacts. The basic augmentation pattern was tested with both high- and low-strength ceramic-based cements. The cement patterns were added to the finite element models (FEMs) of five cadaveric femurs, which were then subject to simulated sideways falls at seven impact velocities ranging from 1.0 m/s to 4.0 m/s. Peak impact forces and peak acetabular forces were examined, and failure was evaluated using a strain-based criterion. We found that the basic HA ellipsoid provided the highest increases in both the force at the acetabulum of the impacted femur ("acetabular force", 55.0% ± 22.0%) and at the force plate ("impact force", 37.4% ± 15.8%). Changing the cement to a weaker material, brushite, resulted in reduced strengthening of the femur (45.2% ± 19.4% acetabular and 30.4% ± 13.0% impact). Using a hollow version of the ellipsoid appeared to have no effect on the fracture outcome and only a minor effect on the other metrics (54.1% ± 22.3% acetabular force increase and 35.3% ± 16.0% impact force increase). However, when the outer two layers of the ellipsoid were removed (small ellipsoid), the force increases that were achieved were only 9.8% ± 5.5% acetabular force and 8.2% ± 4.1% impact force. These results demonstrate the importance of supporting the femoral neck cortex to prevent femoral fractures in a sideways fall, and provide plausible options for prophylactic femoral augmentation. As this is a preliminary study, the surgical technique, the possible effects of trabecular bone damage during the augmentation process, and the effect on the blood supply to the femoral head must be assessed further.
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Affiliation(s)
- Anita Fung
- Laboratory for Orthopaedic Technology, Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland,*Correspondence: Anita Fung,
| | - Ingmar Fleps
- Orthopaedic and Developmental Biomechanics Laboratory, Department of Mechanical Engineering, Boston University, Boston, MA, United States
| | - Peter A. Cripton
- Orthopaedic and Injury Biomechanics Group, School of Biomedical Engineering and Departments of Mechanical Engineering and Orthopaedics, University of British Columbia, Vancouver, BC, Canada,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Pierre Guy
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada,Division of Orthopaedic Trauma, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Stephen J. Ferguson
- Laboratory for Orthopaedic Technology, Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Benedikt Helgason
- Laboratory for Orthopaedic Technology, Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
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Fleps I, Morgan EF. A Review of CT-Based Fracture Risk Assessment with Finite Element Modeling and Machine Learning. Curr Osteoporos Rep 2022; 20:309-319. [PMID: 36048316 PMCID: PMC10941185 DOI: 10.1007/s11914-022-00743-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW We reviewed advances over the past 3 years in assessment of fracture risk based on CT scans, considering methods that use finite element models, machine learning, or a combination of both. RECENT FINDINGS Several studies have demonstrated that CT-based assessment of fracture risk, using finite element modeling or biomarkers derived from machine learning, is equivalent to currently used clinical tools. Phantomless calibration of CT scans for bone mineral density enables accurate measurements from routinely taken scans. This opportunistic use of CT scans for fracture risk assessment is facilitated by high-quality automated segmentation with deep learning, enabling workflows that do not require user intervention. Modeling of more realistic and diverse loading conditions, as well as improved modeling of fracture mechanisms, has shown promise to enhance our understanding of fracture processes and improve the assessment of fracture risk beyond the performance of current clinical tools. CT-based screening for fracture risk is effective and, by analyzing scans that were taken for other indications, could be used to expand the pool of people screened, therefore improving fracture prevention. Finite element modeling and machine learning both provide valuable tools for fracture risk assessment. Future approaches should focus on including more loading-related aspects of fracture risk.
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Affiliation(s)
- Ingmar Fleps
- College of Mechanical Engineering, Boston University, Boston, USA.
| | - Elise F Morgan
- College of Mechanical Engineering, Boston University, Boston, USA
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
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Galliker ES, Laing AC, Ferguson SJ, Helgason B, Fleps I. The Influence of Fall Direction and Hip Protector on Fracture Risk: FE Model Predictions Driven by Experimental Data. Ann Biomed Eng 2022; 50:278-290. [PMID: 35129719 PMCID: PMC8847295 DOI: 10.1007/s10439-022-02917-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/02/2022] [Indexed: 11/25/2022]
Abstract
Hip fractures in older adults, which often lead to lasting impairments and an increased risk of mortality, are a major public health concern. Hip fracture risk is multi-factorial, affected by the risk of falling, the load acting on the femur, and the load the femur can withstand. This study investigates the influence of impact direction on hip fracture risk and hip protector efficacy. We simulated falls for 4 subjects, in 7 different impact directions (15° and 30° anterior, lateral, and 15°, 30°, 60°, and 90° posterior) at two different impact velocities (2.1 and 3.1 m/s), all with and without hip protector, using previously validated biofidelic finite element models. We found the highest number of fractures and highest fragility ratios in lateral and 15° posterior impacts. The hip protector attenuated femur forces by 23–49 % for slim subjects under impact directions that resulted in fractures (30° anterior to 30° posterior). The hip protector prevented all fractures (6/6) for 2.1 m/s impacts, but only 10% of fractures for 3.1 m/s impacts. Our results provide evidence that, regarding hip fracture risk, posterior-lateral impacts are as dangerous as lateral impacts, and they support the efficacy of soft-shell hip protectors for anterior- and posterior-lateral impacts.
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Affiliation(s)
| | - Andrew C Laing
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
| | | | | | - Ingmar Fleps
- Institute for Biomechanics, ETH-Zurich, Zurich, Switzerland.
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