Geometry reconstruction method for patient-specific finite element models for the assessment of tibia fracture risk in osteogenesis imperfecta

Objectives In this prospective cohort study, we investigated whether patient-specific finite element (FE) models can identify patients at risk of a pathological femoral fracture resulting from metastatic bone disease, and compared these FE predictions with clinical assessments by experienced clinicians. Methods A total of 39 patients with non-fractured femoral metastatic lesions who were irradiated for pain were included from three radiotherapy institutes. During follow-up, nine pathological fractures occurred in seven patients. Quantitative CT-based FE models were generated for all patients. Femoral failure load was calculated and compared between the fractured and non-fractured femurs. Due to inter-scanner differences, patients were analyzed separately for the three institutes. In addition, the FE-based predictions were compared with fracture risk assessments by experienced clinicians. Results In institute 1, median failure load was significantly lower for patients who sustained a fracture than for patients with no fractures. In institutes 2 and 3, the number of patients with a fracture was too low to make a clear distinction. Fracture locations were well predicted by the FE model when compared with post-fracture radiographs. The FE model was more accurate in identifying patients with a high fracture risk compared with experienced clinicians, with a sensitivity of 89% versus 0% to 33% for clinical assessments. Specificity was 79% for the FE models versus 84% to 95% for clinical assessments. Conclusion FE models can be a valuable tool to improve clinical fracture risk predictions in metastatic bone disease. Future work in a larger patient population should confirm the higher predictive power of FE models compared with current clinical guidelines. Cite this article: F. Eggermont, L. C. Derikx, N. Verdonschot, I. C. M. van der Geest, M. A. A. de Jong, A. Snyers, Y. M. van der Linden, E. Tanck. Can patient-specific finite element models better predict fractures in metastatic bone disease than experienced clinicians? Towards computational modelling in daily clinical practice. Bone Joint Res 2018;7:430–439. DOI: 10.1302/2046-3758.76.BJR-2017-0325.R2.

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Prediction on fracture risk of femur with Osteogenesis Imperfecta using finite element models: Preliminary study

Journal of Physics Conference Series ◽

10.1088/1742-6596/908/1/012022 ◽

2017 ◽

Vol 908 ◽

pp. 012022 ◽

Cited By ~ 2

Author(s):

S B C Wanna ◽

K S Basaruddin ◽

M H Mat Som ◽

M S Mohamad Hashim ◽

R Daud ◽

...

Keyword(s):

Finite Element ◽

Osteogenesis Imperfecta ◽

Fracture Risk ◽

Finite Element Models ◽

Preliminary Study

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Primary stability of a cementless acetabular cup in a cohort of patient-specific finite element models

Journal of Orthopaedic Research® ◽

10.1002/jor.23709 ◽

2017 ◽

Cited By ~ 3

Author(s):

Dermot O'Rourke ◽

Rami MA Al-Dirini ◽

Mark Taylor

Keyword(s):

Finite Element ◽

Primary Stability ◽

Patient Specific ◽

Finite Element Models ◽

Acetabular Cup

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Fracture risk assessment in metastatic femurs: a patient-specific CT-based finite-element approach

Meccanica ◽

10.1007/s11012-019-01097-x ◽

2019 ◽

Vol 55 (4) ◽

pp. 861-881 ◽

Cited By ~ 2

Author(s):

Cristina Falcinelli ◽

Alberto Di Martino ◽

Alessio Gizzi ◽

Giuseppe Vairo ◽

Vincenzo Denaro

Keyword(s):

Risk Assessment ◽

Finite Element ◽

Fracture Risk ◽

Fracture Risk Assessment ◽

Patient Specific ◽

Finite Element Approach ◽

Element Approach

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Generic finite element models of human ribs, developed and validated for stiffness and strain prediction – To be used in rib fracture risk evaluation for the human population in vehicle crashes

Journal of the Mechanical Behavior of Biomedical Materials ◽

10.1016/j.jmbbm.2020.103742 ◽

2020 ◽

Vol 106 ◽

pp. 103742

Author(s):

Johan Iraeus ◽

Karin Brolin ◽

Bengt Pipkorn

Keyword(s):

Finite Element ◽

Fracture Risk ◽

Risk Evaluation ◽

Human Population ◽

Rib Fracture ◽

Finite Element Models ◽

Vehicle Crashes

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Fracture Prediction for the Proximal Femur Using Finite Element Models: Part I—Linear Analysis

Journal of Biomechanical Engineering ◽

10.1115/1.2895412 ◽

1991 ◽

Vol 113 (4) ◽

pp. 353-360 ◽

Cited By ~ 198

Author(s):

J. C. Lotz ◽

E. J. Cheal ◽

W. C. Hayes

Keyword(s):

Finite Element ◽

Fracture Risk ◽

Strain Gage ◽

Proximal Femur ◽

Material Properties ◽

The United States ◽

Nonlinear Material ◽

Finite Element Models ◽

Model Predictions

Over 90 percent of the more than 250,000 hip fractures that occur annually in the United States are the result of falls from standing height. Despite this, the stresses associated with femoral fracture from a fall have not been investigated previously. Our objectives were to use three-dimensional finite element models of the proximal femur (with geometries and material properties based directly on quantitative computed tomography) to compare predicted stress distributions for one-legged stance and for a fall to the lateral greater trochanter. We also wished to test the correspondence between model predictions and in vitro strain gage data and failure loads for cadaveric femora subjected to these loading conditions. An additional goal was to use the model predictions to compare the sensitivity of several imaging sites in the proximal femur which are used for the in vivo prediction of hip fracture risk. In this first of two parts, linear finite element models of two unpaired human cadaveric femora were generated. In Part II, the models were extended to include nonlinear material properties for the cortical and trabecular bone. While there was poor correspondence between strain gage data and model predictions, there was excellent agreement between the in vitro failure data and the linear model, especially using a von Mises effective strain failure criterion. Both the onset of structural yielding (within 22 and 4 percent) and the load at fracture (within 8 and 5 percent) were predicted accurately for the two femora tested. For the simulation of one-legged stance, the peak stresses occurred in the primary compressive trabeculae of the subcapital region. However, for a simulated fall, the peak stresses were in the intertrochanteric region. The Ward’s triangle (basicervical) site commonly used for the clinical assessment of osteoporosis was not heavily loaded in either situation. These findings suggest that the intertrochanteric region may be the most sensitive site for the assessment of fracture risk due to a fall and the subcapital region for fracture risk due to repetitive activities such as walking.

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