Dynamic models for sideways falls from standing height.

Abstract

Despite our growing understanding of the importance of fall mechanics in the etiology of hip fracture, previous studies have largely ignored the kinematics and dynamics of falls from standing height. Beginning from basic principles, we estimated peak impact force on the greater trochanter in a sideways fall from standing height. Using a one degree-of-freedom impact model, this force is determined by the impact velocity of the hip, the effective mass of that part of the body that is moving prior to impact, and the overall stiffness of the soft tissue overlying the hip. To determine impact velocity and effective mass, three different paradigms of increasing complexity were used: 1) a falling point mass or a rigid bar pivoting at its base; 2) two-link models consisting of a leg segment and a torso; and 3) three-link models including a knee. The total mechanical energy of each model before falling was equated to the total mechanical energy just prior to impact in order to estimate the hip impact velocity. In addition, the configuration of the model just before impact was used to estimate the effective mass. Our model predictions were compared with the results of an earlier experimental study with young subjects falling on a 10-inch thick mattress. Values from literature were used to estimate the soft tissue stiffness. For the models, predicted values for hip impact velocity and effective mass ranged from 2.47 to 4.34 m/s and from 15.9 to 70.0 kg, respectively. Predicted values for the peak force applied to the greater trochanter ranged from 2.90k to 9.99k N. Based on comparisons to the experimental falls, impact velocity and impact force were best predicted by a simple two-link model with the trunk at 45 degrees to the vertical at impact. A three-link model with a quadratic spring incorporated in the knee of the model was the best predictor of effective mass. Using our most accurate model, the peak impact force was 2.90k N for a 5th percentile female and 4.26k N for a 95th percentile female, thereby confirming the widely held perception that "the bigger they are, the harder they fall".