Biomechanical evaluation of dual-energy x-ray absorptiometry for predicting fracture loads of the infant femur for injury investigation: An in vitro porcine model

Mary Clyde Pierce*, Antonio Valdevit, Lisa Anderson, Nozomu Inoue, Diana L. Hauser

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Objective: The purpose of this study was to determine the ability of bone mineral density (BMD) measured by dual-energy x-ray absorptiometry (DXA) and geometry measured by biplanar x-ray to predict fracture mechanics in vitro in an immature femur model. Design: Prospective analysis of radiographic and biomechanical data was performed. Setting: In vitro experimentation. Interventions: Bone geometry and DXA data were obtained before mechanical testing. Twenty-two porcine femora from males and females (age 3 to 12 months; body weight 3.6 to 7.0 kilograms) were fractured. Mechanical tests were performed on the diaphysis of the femora in two loading configurations: (a) three-point bending to simulate loads that result in transverse fractures; and (b) torsion to simulate twisting injuries that result in spiral fractures. Main Outcome Measures: Correlation of radiographic data with the experimentally determined bone strength. Results: Three-point bending consistently resulted in transverse fractures. Femoral diaphysis BMD (mean, 0.304 grams per square centimeter; SD, 0.028 grams per square centimeter) strongly correlated (r2 = 0.938) to fracture load in bending. Load at failure ranged from 530 to 1,024 N (mean, 726 N; SD, 138 N), consistent with the findings of Miltner. Empirically derived strength parameters coupling BMD with geometry accurately predicted bending loads (r2 = 0.84, p < 0.001) and energy to failure (r2 = 0.88, p < 0.05). Torsional loading failed to generate spiral fractures consistently, resulting in either end plate or diaphyseal fractures. Load at failure for torsion ranged from 1,383 to 3,559 Newton-millimeters (mean, 2,703 Newton-millimeters; SD, 826 Newton-millimeters). Because of these inconsistent fracture results, empirical strength parameters for torsion could not be derived. Conclusion: BMD coupled with geometry is a strong predictor of bending fracture loads in the immature femoral diaphysis. A similar relationship could not be shown for torsion because of inconsistent failure results. This study represents an initial attempt at developing a methodology for predicting the strength of young bones from radiographic measures. Further research is required to establish this methodology and to show the necessary correlation with immature human bone.

Original languageEnglish (US)
Pages (from-to)571-576
Number of pages6
JournalJournal of orthopaedic trauma
Issue number8
StatePublished - Nov 2000


  • Child abuse
  • Etiology
  • Femoral shaft fractures
  • Infant femur
  • Non-accidental trauma

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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