A micro-architectural evaluation of osteoporotic human femoral heads to guide implant placement in proximal femoral fractures

Paul J Jenkins, Rishikesan Ramaesh, Pankaj Pankaj, James T Patton, Colin R Howie, Jérôme M Goffin, Andrew van der Merwe, Robert J Wallace, Daniel E Porter, A Hamish Simpson

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Abstract

BACKGROUND AND PURPOSE: The micro-architecture of bone has been increasingly recognized as an important determinant of bone strength. Successful operative stabilization of fractures depends on bone strength. We evaluated the osseous micro-architecture and strength of the osteoporotic human femoral head.

MATERIAL AND METHODS: 6 femoral heads, obtained during arthroplasty surgery for femoral neck fracture, underwent micro-computed tomography (microCT) scanning at 30 μm, and bone volume ratio (BV/TV), trabecular thickness, structural model index, connection density, and degree of anisotropy for volumes of interest throughout the head were derived. A further 15 femoral heads underwent mechanical testing of compressive failure stress of cubes of trabecular bone from different regions of the head.

RESULTS: The greatest density and trabecular thickness was found in the central core that extended from the medial calcar to the physeal scar. This region also correlated with the greatest degree of anisotropy and proportion of plate-like trabeculae. In the epiphyseal region, the trabeculae were organized radially from the physeal scar. The weakest area was found at the apex and peripheral areas of the head. The strongest region was at the center of the head.

INTERPRETATION: The center of the femoral head contained the strongest trabecular bone, with the thickest, most dense trabeculae. The apical region was weaker. From an anatomical and mechanical point of view, implants that achieve fixation in or below this central core may achieve the most stable fixation during fracture healing.

Original languageEnglish
Pages (from-to)453-459
Number of pages7
JournalActa Orthopaedica
Volume84
Issue number5
DOIs
Publication statusPublished - Oct 2013

Fingerprint

Femoral Fractures
Thigh
Head
Bone and Bones
Anisotropy
Cicatrix
Femoral Neck Fractures
Fracture Healing
Structural Models
Arthroplasty
Tomography
Cancellous Bone

Keywords

  • aged
  • aged, 80 and over
  • arthroplasty, replacement, hip
  • bone density
  • bone nails
  • bone screws
  • female
  • femoral neck fractures
  • femur head
  • humans
  • male
  • middle aged
  • osteoporotic fractures
  • tomography, X-ray computed

Cite this

Jenkins, P. J., Ramaesh, R., Pankaj, P., Patton, J. T., Howie, C. R., Goffin, J. M., ... Simpson, A. H. (2013). A micro-architectural evaluation of osteoporotic human femoral heads to guide implant placement in proximal femoral fractures. Acta Orthopaedica, 84(5), 453-459. https://doi.org/10.3109/17453674.2013.842432

A micro-architectural evaluation of osteoporotic human femoral heads to guide implant placement in proximal femoral fractures. / Jenkins, Paul J; Ramaesh, Rishikesan; Pankaj, Pankaj; Patton, James T; Howie, Colin R; Goffin, Jérôme M; Merwe, Andrew van der; Wallace, Robert J; Porter, Daniel E; Simpson, A Hamish.

In: Acta Orthopaedica, Vol. 84, No. 5, 10.2013, p. 453-459.

Research output: Contribution to journalArticle

Jenkins, PJ, Ramaesh, R, Pankaj, P, Patton, JT, Howie, CR, Goffin, JM, Merwe, AVD, Wallace, RJ, Porter, DE & Simpson, AH 2013, 'A micro-architectural evaluation of osteoporotic human femoral heads to guide implant placement in proximal femoral fractures', Acta Orthopaedica, vol. 84, no. 5, pp. 453-459. https://doi.org/10.3109/17453674.2013.842432
Jenkins, Paul J ; Ramaesh, Rishikesan ; Pankaj, Pankaj ; Patton, James T ; Howie, Colin R ; Goffin, Jérôme M ; Merwe, Andrew van der ; Wallace, Robert J ; Porter, Daniel E ; Simpson, A Hamish. / A micro-architectural evaluation of osteoporotic human femoral heads to guide implant placement in proximal femoral fractures. In: Acta Orthopaedica. 2013 ; Vol. 84, No. 5. pp. 453-459.
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AU - Jenkins, Paul J

AU - Ramaesh, Rishikesan

AU - Pankaj, Pankaj

AU - Patton, James T

AU - Howie, Colin R

AU - Goffin, Jérôme M

AU - Merwe, Andrew van der

AU - Wallace, Robert J

AU - Porter, Daniel E

AU - Simpson, A Hamish

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N2 - BACKGROUND AND PURPOSE: The micro-architecture of bone has been increasingly recognized as an important determinant of bone strength. Successful operative stabilization of fractures depends on bone strength. We evaluated the osseous micro-architecture and strength of the osteoporotic human femoral head.MATERIAL AND METHODS: 6 femoral heads, obtained during arthroplasty surgery for femoral neck fracture, underwent micro-computed tomography (microCT) scanning at 30 μm, and bone volume ratio (BV/TV), trabecular thickness, structural model index, connection density, and degree of anisotropy for volumes of interest throughout the head were derived. A further 15 femoral heads underwent mechanical testing of compressive failure stress of cubes of trabecular bone from different regions of the head.RESULTS: The greatest density and trabecular thickness was found in the central core that extended from the medial calcar to the physeal scar. This region also correlated with the greatest degree of anisotropy and proportion of plate-like trabeculae. In the epiphyseal region, the trabeculae were organized radially from the physeal scar. The weakest area was found at the apex and peripheral areas of the head. The strongest region was at the center of the head.INTERPRETATION: The center of the femoral head contained the strongest trabecular bone, with the thickest, most dense trabeculae. The apical region was weaker. From an anatomical and mechanical point of view, implants that achieve fixation in or below this central core may achieve the most stable fixation during fracture healing.

AB - BACKGROUND AND PURPOSE: The micro-architecture of bone has been increasingly recognized as an important determinant of bone strength. Successful operative stabilization of fractures depends on bone strength. We evaluated the osseous micro-architecture and strength of the osteoporotic human femoral head.MATERIAL AND METHODS: 6 femoral heads, obtained during arthroplasty surgery for femoral neck fracture, underwent micro-computed tomography (microCT) scanning at 30 μm, and bone volume ratio (BV/TV), trabecular thickness, structural model index, connection density, and degree of anisotropy for volumes of interest throughout the head were derived. A further 15 femoral heads underwent mechanical testing of compressive failure stress of cubes of trabecular bone from different regions of the head.RESULTS: The greatest density and trabecular thickness was found in the central core that extended from the medial calcar to the physeal scar. This region also correlated with the greatest degree of anisotropy and proportion of plate-like trabeculae. In the epiphyseal region, the trabeculae were organized radially from the physeal scar. The weakest area was found at the apex and peripheral areas of the head. The strongest region was at the center of the head.INTERPRETATION: The center of the femoral head contained the strongest trabecular bone, with the thickest, most dense trabeculae. The apical region was weaker. From an anatomical and mechanical point of view, implants that achieve fixation in or below this central core may achieve the most stable fixation during fracture healing.

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KW - bone density

KW - bone nails

KW - bone screws

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KW - humans

KW - male

KW - middle aged

KW - osteoporotic fractures

KW - tomography, X-ray computed

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JO - Acta Orthopaedica

JF - Acta Orthopaedica

SN - 1745-3674

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