The influence of osteoporotic bone structures of the pelvic-hip complex on stress distribution under impact load

Purpose: The aim of this study was to determine the effect of bone mineral density (BMD) on the stress distribution in pelvic-hip complex (PHC) model which included bone structures and soft tissues. Bone mass changes in osteoporosis and osteopenia were considered in this analysis. In addition, the relations between force direction and stress distribution causing PHC fractures were determined. Methods: This paper presents the development and validation of a detailed 3D finite element model with high anatomical fidelity of the PHC and BMD changes in trabecular and cortical bones, modelled based on CT scans. 10 kN loading was induced on a model consisting of 8 ligaments, the pelvis, sacrum, femur in front and side directions. Results: For validation, the results of this model were compared to physiological stress in standing position and previous results with high-energy crashes under side impact load. Analysis of side-impact indicated the influence of BMD on femoral neck fractures, acetabular cartilage and sacroiliac joint delaminations. Front-impact analysis revealed the inferior pubic ramus, femoral neck fractures and soft tissue injuries, i.e., acetabular cartilage and symphysis pubis in osteoporosis and osteopenia. Conclusions: The elaborated PHC model enables effective prediction of pelvis injuries in high-energy trauma, according to Young-Burgess classification, and the determination of the influence of BMD reduction on pelvis trauma depending on force direction. The correlation between BMD and stress distribution causing varying injuries was determined.