Fracture strength of the proximal femur injected with a calcium sulfate/hydroxyapatite bone substitute.
Accidental Falls
Aged
Aged, 80 and over
Biocompatible Materials
Bone Substitutes
/ chemistry
Calcium Sulfate
/ chemistry
Calibration
Durapatite
/ chemistry
Female
Femur
/ drug effects
Femur Neck
Finite Element Analysis
Flexural Strength
Hip Fractures
/ physiopathology
Humans
Male
Middle Aged
Stress, Mechanical
Tomography, X-Ray Computed
Bone strength
Ceramics
Finite element analysis
Hip fracture
Osteoporosis
Prophylactic injection
Journal
Clinical biomechanics (Bristol, Avon)
ISSN: 1879-1271
Titre abrégé: Clin Biomech (Bristol, Avon)
Pays: England
ID NLM: 8611877
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
10
01
2019
revised:
05
03
2019
accepted:
11
03
2019
pubmed:
25
3
2019
medline:
24
3
2020
entrez:
24
3
2019
Statut:
ppublish
Résumé
Available interventions for preventing fragility hip fractures show limited efficacy. Injection of a biomaterial as bone substitute could increase the fracture strength of the hip. This study aimed to show the feasibility of injecting a calcium sulfate/hydroxyapatite based biomaterial in the femoral neck and to calculate the consequent change in strength using the finite element method. Five patients were injected with 10 ml calcium sulfate/hydroxyapatite in their femoral neck. Quantitative CT scans were taken before and after injection. Five additional patients with fragility hip fractures were also scanned and the images from the non-fractured contralateral sides were used. Finite element models were created for all proximal femora with and without injection and the models were tested under stance and sideways fall loading until fracture. The change in fracture strength caused by the injection was calculated. Additionally, perturbations in volume, location, and stiffness of the injected material were created to investigate their contribution to the fracture strength increase. The 10 ml injection succeeded in all patients. Baseline simulations showed theoretical fracture strength increases of 0-9%. Volume increase, change in location and increase in stiffness of the material led to increases in fracture strength of 1-27%, -8-26% and 0-17%, respectively. Altering the location of the injection to a more lateral position and increasing the stiffness of the material led to increases in fracture strength of up to 42%. This study shows that an injection of calcium sulfate/hydroxyapatite is feasible and can theoretically increase the hip's fracture strength.
Sections du résumé
BACKGROUND
Available interventions for preventing fragility hip fractures show limited efficacy. Injection of a biomaterial as bone substitute could increase the fracture strength of the hip. This study aimed to show the feasibility of injecting a calcium sulfate/hydroxyapatite based biomaterial in the femoral neck and to calculate the consequent change in strength using the finite element method.
METHODS
Five patients were injected with 10 ml calcium sulfate/hydroxyapatite in their femoral neck. Quantitative CT scans were taken before and after injection. Five additional patients with fragility hip fractures were also scanned and the images from the non-fractured contralateral sides were used. Finite element models were created for all proximal femora with and without injection and the models were tested under stance and sideways fall loading until fracture. The change in fracture strength caused by the injection was calculated. Additionally, perturbations in volume, location, and stiffness of the injected material were created to investigate their contribution to the fracture strength increase.
FINDINGS
The 10 ml injection succeeded in all patients. Baseline simulations showed theoretical fracture strength increases of 0-9%. Volume increase, change in location and increase in stiffness of the material led to increases in fracture strength of 1-27%, -8-26% and 0-17%, respectively. Altering the location of the injection to a more lateral position and increasing the stiffness of the material led to increases in fracture strength of up to 42%.
INTERPRETATION
This study shows that an injection of calcium sulfate/hydroxyapatite is feasible and can theoretically increase the hip's fracture strength.
Identifiants
pubmed: 30903873
pii: S0268-0033(19)30023-3
doi: 10.1016/j.clinbiomech.2019.03.008
pii:
doi:
Substances chimiques
Biocompatible Materials
0
Bone Substitutes
0
Durapatite
91D9GV0Z28
Calcium Sulfate
WAT0DDB505
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
172-178Informations de copyright
Copyright © 2019 Elsevier Ltd. All rights reserved.