Influence of femoral external shape on internal architecture and fracture risk

The internal architecture of the femur and its fracture behaviour vary greatly between subjects. Femoral architecture and subsequent fracture risk are strongly influenced by load distribution during physical activities of daily living. The objective of this work is to evaluate the impact of outer cortical surface shape as a key affector of load distribution driving femoral structure and fracture behaviour. Different femur cortical shapes are generated using a statistical shape model. Their mesoscale internal architecture is predicted for the same activity regime using a structural optimisation approach previously reported by the authors and fracture under longitudinal compression is simulated. The resulting total volume of bone is similar in all geometries although substantial differences are observed in distribution between trabecular and cortical tissue. Greater neck-shaft and anteversion angles show a protective effect in longitudinal compression while a thinner shaft increases fracture risk.