title: A micro-architectural evaluation of osteoporotic human femoral heads to guide implant placement in proximal femoral fractures.
abstract: OBJECTIVE
  The micro-architecture of bone has been increasingly recognized as an important determinant of bone strength. Successful operative stabilization of fractures depends on bone strength. We evaluated the osseous micro-architecture and strength of the osteoporotic human femoral head.
  
  
  METHODS
  6 femoral heads, obtained during arthroplasty surgery for femoral neck fracture, underwent micro-computed tomography (microCT) scanning at 30 μm, and bone volume ratio (BV/TV), trabecular thickness, structural model index, connection density, and degree of anisotropy for volumes of interest throughout the head were derived. A further 15 femoral heads underwent mechanical testing of compressive failure stress of cubes of trabecular bone from different regions of the head.
  
  
  RESULTS
  The greatest density and trabecular thickness was found in the central core that extended from the medial calcar to the physeal scar. This region also correlated with the greatest degree of anisotropy and proportion of plate-like trabeculae. In the epiphyseal region, the trabeculae were organized radially from the physeal scar. The weakest area was found at the apex and peripheral areas of the head. The strongest region was at the center of the head.
  
  
  CONCLUSIONS
  The center of the femoral head contained the strongest trabecular bone, with the thickest, most dense trabeculae. The apical region was weaker. From an anatomical and mechanical point of view, implants that achieve fixation in or below this central core may achieve the most stable fixation during fracture healing.
authors.affiliation: Department of Orthopaedics , University of Edinburgh.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Jenkins
authors.forename: Rishikesan
authors.initials: R
authors.lastname: Ramaesh
authors.forename: Pankaj
authors.initials: P
authors.lastname: Pankaj
authors.forename: James T
authors.initials: JT
authors.lastname: Patton
authors.forename: Colin R
authors.initials: CR
authors.lastname: Howie
authors.forename: Jérôme M
authors.initials: JM
authors.lastname: Goffin
authors.forename: Andrew van der
authors.initials: Av
authors.lastname: Merwe
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wallace
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Porter
authors.forename: A Hamish
authors.initials: AH
authors.lastname: Simpson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D015519:Bone Density / Q000502:physiology; D001858:Bone Nails; D001863:Bone Screws; D005260:Female; D005265:Femoral Neck Fractures / Q000473:pathology* / Q000503:physiopathology; D005270:Femur Head / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000473:pathology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods
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