Saulo Martelli1, Peter Pivonka2, Peter R Ebeling2. 1. Medical Device Research Institute, School of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, SA, Australia; North West Academic Centre, The University of Melbourne, St Albans, Australia. Electronic address: saulo.martelli@flinders.edu.au. 2. North West Academic Centre, The University of Melbourne, St Albans, Australia; Australian Institute for Musculoskeletal Science, St Albans, Australia.
Abstract
BACKGROUND: Atypical femoral fractures are low-energy fractures initiating in the lateral femoral shaft. We hypothesized that atypical femoral fracture onset is associated with daily femoral strain patterns. We examined femoral shaft strains during daily activities. METHODS: We analyzed earlier calculations of femoral strain during walking, sitting and rising from a chair, stair ascent, stair descent, stepping up, and squatting based on anatomically consistent musculoskeletal and finite-element models from a single donor and motion recordings from a body-matched volunteer. Femoral strains in the femoral shaft were extracted for the different activities and compared. The dependency between femoral strains in the lateral shaft and kinetic parameters was studied using multi-parametric linear regression analysis. FINDINGS: Tensile strain in the lateral femoral shaft varied from 327 με (squatting) to 2004 με (walking). Walking and stair descent imposed tensile loading on the lateral shaft, whereas the other activities mainly imposed tensile loads on the anterior shaft. The multi-parametric linear regression showed a moderately strong correlation between tensile strains in the lateral shaft and the motion kinetic (joint moments and ground reaction force) in the proximal (R(2)=0.60) and the distal shaft (R(2)=0.46). INTERPRETATION: Bone regions subjected to tensile strains are associated with atypical femoral fractures. Walking is the daily activity that induces the highest tensile strain in the lateral femoral shaft. The kinetics of motion explains 46%-50% of the tensile strain variation in the lateral shaft, whereas the unexplained part is likely to be attributed to the way joint moments are decomposed into muscle forces.
BACKGROUND:Atypical femoral fractures are low-energy fractures initiating in the lateral femoral shaft. We hypothesized that atypical femoral fracture onset is associated with daily femoral strain patterns. We examined femoral shaft strains during daily activities. METHODS: We analyzed earlier calculations of femoral strain during walking, sitting and rising from a chair, stair ascent, stair descent, stepping up, and squatting based on anatomically consistent musculoskeletal and finite-element models from a single donor and motion recordings from a body-matched volunteer. Femoral strains in the femoral shaft were extracted for the different activities and compared. The dependency between femoral strains in the lateral shaft and kinetic parameters was studied using multi-parametric linear regression analysis. FINDINGS: Tensile strain in the lateral femoral shaft varied from 327 με (squatting) to 2004 με (walking). Walking and stair descent imposed tensile loading on the lateral shaft, whereas the other activities mainly imposed tensile loads on the anterior shaft. The multi-parametric linear regression showed a moderately strong correlation between tensile strains in the lateral shaft and the motion kinetic (joint moments and ground reaction force) in the proximal (R(2)=0.60) and the distal shaft (R(2)=0.46). INTERPRETATION: Bone regions subjected to tensile strains are associated with atypical femoral fractures. Walking is the daily activity that induces the highest tensile strain in the lateral femoral shaft. The kinetics of motion explains 46%-50% of the tensile strain variation in the lateral shaft, whereas the unexplained part is likely to be attributed to the way joint moments are decomposed into muscle forces.
Authors: Andrew Petraszko; Daniel Siegal; Michael Flynn; Sudhaker D Rao; Ed Peterson; Marnix van Holsbeeck Journal: Skeletal Radiol Date: 2016-02-10 Impact factor: 2.199
Authors: Joan C Lo; Rita L Hui; Christopher D Grimsrud; Malini Chandra; Romain S Neugebauer; Joel R Gonzalez; Amer Budayr; Gene Lau; Bruce Ettinger Journal: Bone Date: 2016-01-06 Impact factor: 4.398