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Proximal Cadaveric Femur Preparation for Fracture Strength Testing and Quantitative CT-based Finite Element Analysis
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Femur Fracture Risk Assessment in Patients with Lytic Metastases Using CT-Based Finite Element Models and Bone Crack

Davide Bentivoglio1, Cristina Curreli2, Barbara Dozza3

  • 1Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

Annals of Biomedical Engineering
|May 4, 2026
PubMed
Summary

This study introduces a new finite element (FE) model to predict fracture risk in femurs with lytic metastases. The FE model accurately identifies high-risk patients, improving upon the Mirels score for better clinical management.

Keywords:
Crack propagationElements deactivationFemoral bone metastasesPatient-specific finite element models

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Area of Science:

  • Biomechanical engineering
  • Computational modeling
  • Oncology

Background:

  • Femoral bone metastases are a severe complication in advanced cancers.
  • Current fracture risk assessment (Mirels' score) has limited specificity, leading to overtreatment.
  • Patient-specific finite element (FE) models show promise but lack standardized methodology and fracture process simulation.

Purpose of the Study:

  • To investigate a linear FE approach with incremental element deletion for simulating fracture initiation and propagation in femurs with lytic metastases.
  • To evaluate the FE model's accuracy in stratifying patients by pathological fracture risk compared to existing methods.
  • To assess a novel failure threshold parameter derived from fracture work.

Main Methods:

  • Retrospective analysis of 24 patients with femoral lytic lesions.
  • Development and application of a linear FE model using incremental element deletion.
  • Comparison of model outcomes with clinical results, conventional FE methods, and the Mirels score.

Main Results:

  • Simulations successfully replicated clinical fracture paths.
  • The FE model demonstrated strong capability in differentiating high- and low-risk patients.
  • A failure criterion based on the last applied load during crack propagation achieved excellent sensitivity and specificity.

Conclusions:

  • The proposed FE modeling framework accurately predicts fracture paths in femurs with lytic metastases.
  • This approach offers valuable clinical insight for improved patient stratification.
  • It represents a significant advancement in managing femoral metastases and preventing pathological fractures.