The effect of body configuration on the strain magnitude and distribution within the acetabulum during sideways falls: A finite element approach.
While the incidence of hip fractures has declined during the last decades, the incidence of acetabular fractures resulting from low-energy sideways falls has increased, and the mechanisms responsible for this trend remain unknown. Previous studies have suggested that body configuration during the impact plays an important role in a hip fracture. Thus, the aim of this study was to investigate the effect of body configuration angles (trunk tilt angle, trunk flexion angle, femur horizontal rotation angle, and femur diaphysis angle) on low-energy acetabular fractures via a parametric analysis. A computed tomography-based (CT) finite element model of the ground-proximal femur-pelvis complex was created, and strain magnitude, time-history response, and distribution within the acetabulum were evaluated. Results showed that while the trunk tilt angle and femur diaphysis angle have the greatest effect on strain magnitude, the direction of the fall (lateral vs. posterolateral) contributes to strain distribution within the acetabulum. The results also suggest that strain level and distribution within the proximal femur and acetabulum resulting from a sideways fall are not similar and, in some cases, even opposite. Taken together, our simulations suggest that a more horizontal trunk and femoral shaft at the impact phase can increase the risk of low-energy acetabular fractures.