Location of atypical femoral fracture can be determined by tensile stress distribution influenced by femoral bowing and neck-shaft angle: a CT-based nonlinear finite element analysis model for the assessment of femoral shaft loading stress |
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| Institution: | 1. Department of Orthopaedic and Trauma Research, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan;2. Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan;3. Department of Orthopaedic Surgery, Yokohama City Minato Red Cross Hospital, Kanagawa, Japan;4. Department of Orthopaedic Surgery, Saku Central Hospital, Nagano, Japan;1. Department of Oral and Maxillofacial Surgery/Pathology & 3D Innovation Lab, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands;2. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hasanuddin, Makassar, Indonesia;3. Department of Oral and Maxillofacial Surgery, University of Oulu, Oulu University Hospital, Oulu, Finland;1. Academic Department of Trauma and Orthopaedics, Floor D, Clarendon Wing, LGI, University of Leeds, Leeds, UK;2. NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK;1. Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, Denmark;2. Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA;3. Institute for Inflammation Research, Copenhagen University Hospital, Rigshospitalet, Denmark;4. Department of Anaesthesia, Center of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Denmark;1. University hospital of Erlangen, Department of Orthopedic and Trauma Surgery, Krankenhausstr. 12, 91054 Erlangen, Germany;2. University hospital of Erlangen, Department of Pediatric Surgery, Krankenhausstr. 12, 91054 Erlangen, Germany;3. University of Erlangen, Institute of Anatomy I, Krankenhausstr. 12, 91054 Erlangen, Germany |
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| Abstract: | IntroductionLoading stress due to individual variations in femoral morphology is thought to be strongly associated with the pathogenesis of atypical femoral fracture (AFF). In Japan, studies on AFF regarding pathogenesis in the mid-shaft are well-documented and a key factor in the injury is thought to be femoral shaft bowing deformity. Thus, we developed a CT-based finite element analysis (CT/FEA) model to assess distribution of loading stress in the femoral shaft.Patients and MethodsA multicenter prospective study was performed at 12 hospitals in Japan from August 2015 to February 2017. We assembled three study groups—the mid-shaft AFF group (n = 12), the subtrochanteric AFF group (n = 10), and the control group (n = 11)—and analyzed femoral morphology and loading stress in the femoral shaft by nonlinear CT/FEA.ResultsFemoral bowing in the mid-shaft AFF group was significantly greater (lateral bowing, p < 0.0001; anterior bowing, p < 0.01). Femoral neck-shaft angle in the subtrochanteric AFF group was significantly smaller (p < 0.001). On CT/FEA, both the mid-shaft and subtrochanteric AFF group showed maximum tensile stress located adjacent to the fracture site. Quantitatively, there was a correlation between femoral bowing and the ratio of tensile stress, which was calculated between the mid-shaft and subtrochanteric region (lateral bowing, r = 0.6373, p < 0.0001; anterior bowing, r = ?0.5825, p < 0.001).ConclusionsCT/FEA demonstrated that tensile stress by loading stress can cause AFF. The location of AFF injury could be determined by individual stress distribution influenced by femoral bowing and neck-shaft angle. |
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| Keywords: | Atypical femoral fracture stress fracture femoral shaft biomechanics finite element method CT-based finite element analysis |
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