Can neck fractures in proximal humeri be predicted by CT-based FEA?

Background: Proximal humeri fractures at anatomical and surgical neck (∼5% and ∼50% incidence respectively) are frequent in elderly population. Yet, neither in-vitro experiments nor CT-based finite element analyses (CTFEA) have investigated these in depth. Herein we enhance (Dahan et al., 2019) (addressing anatomical neck fractures) by more experiments and specimens, accounting for surgical neck fractures and explore CTFEA's prediction of humeri mechanical response and yield force. Methods: Four fresh frozen human humeri were tested in a new experimental configuration inducing surgical neck fractures. Digital image correlation (DIC) provided strains and displacements on humeri surfaces and used to validate CTFEA predictions. CTFEA were enhanced herein to improve the accuracy at the proximal neck: A cortical bone mapping (CBM) algorithm was implemented to overcome insufficient scanning resolution, and a new trabecular material mapping was investigated. Results: The new experimental setting induced impacted surgical neck fractures in all humeri. Excellent DIC to CTFEA correlation in strains was obtained at the shaft (slope 0.984, R²=0.99) and a fair agreement (slope 0.807, R²=0.73) at the neck. CBM algorithm had worsened the correlation, whereas the new material mapping had a negligible influence. Yield loads predictions improved considerably when trabecular yielding (maximum principal strain criterion) was considered instead of surface cortical yielding. Discussion: CTFEA well predicts strains on the shaft and reasonably well on the neck. This enhances former conclusions by past studies conducted using SGs, now also evident by DIC. Yield load prediction for surgical neck fractures (involving crushing of trabecular bone) is predicted better by trabecular failure laws rather than cortex ones. Further FEA studies using trabecular orthotropic constitutive models and failure laws are warrant.