A robust 3D finite element simulation of human proximal femur progressive fracture under stance load with experimental validation.

Clinical implementation of quantitative computed tomography-based finite element analysis (QCT/FEA) of proximal femur (hip) fractures requires (i) to develop a bone material behavior able to describe the progressive fracturing process until complete failure of the hip. And (ii) to validate the model with realistic test data that represent typical hip fractures. The objective of the current study was to develop and experimentally validate an accurate 3D finite element (FE) model coupled to a quasi-brittle damage law to simulate human proximal femur fracture considering the initiation and progressive propagation of multiple cracks phases under quasi-static load. The model is based on continuum damage mechanics that can predict hip fracture in more adequate physical terms than criteria-based fracture models. In order to validate the model, ten human proximal femurs were tested until complete fracture under one-legged stance quasi-static load. QCT/FE models were generated and FE simulations were performed on these femurs with the same applied loads and boundary conditions than in the stance experiments. The proposed FE model leads to excellent agreement (R(2) = 0.9432) between predicted and measured results concerning the shape of the force-displacement curve (yielding and fracturing) and the profile of the fractured edge. The motivation of this work was to propose a FE model for possible clinical use with a good compromise between complexity and capability of the simulation.