Prediction and determinants of forearm forces during a fall on the outstretched hand: a pilot study

Introduction. Wrist (Colles') and forearm fractures commonly occur when a person falls on the outstretched forearm and the force exceeds bone strength. There is lack of experimental evidence testing the available force prediction models and assessing factors that determine forearm forces during a fall. Objective. The primary objective was to compare experimentally measured force peaks (F1max-E and F2max-E) to the force peaks that were predicted by an engineering based force prediction model (F1max-M and F2max-M), at heights greater than 5cm. The second objective was to describe the relationships between the experimentally measured peak forces and forearm bone and muscle strength properties, body mass, and stature as a function of fall height. Methods. Using 3D motion tracking, we assessed the first (F1max) and second (F2max) peak forces from 10 young adults (5 male; 5 female) who volunteered to fall from heights up to 25cm onto a foam covered force plate. Peripheral QCT was used to determine the bone strength index (BSIc), strength-strain index (SSIp), and muscle cross sectional area (MCSA) of each participant. Two 2x8 between-within factorial ANOVAs determined the difference between the experimental and model force peaks, with post hoc analyses at all fall heights. Pearson's correlation was used to determine the relationship between the pQCT-derived bone and muscle strength indices and the force peaks. Results. There was no significant differences between F1max-E and F1max-M across all fall heights, but the model significantly over-predicted the F2max-E across all fall heights. After controlling F1max-E and F2max-E for body mass, the force peaks appeared to be weakly related to the anthropometric as well as bone and muscle strength outcomes (r=0.2-0.7, p>0.05). The relationship between bone and muscle strength outcomes appeared to have a tendency to get stronger at higher fall heights. Conclusion. The model predicted experimental F1max, but not experimental F2max. This study presents preliminary pilot results. Larger sample size is needed to confirm whether incorporating bone and muscle strength estimates into fall force prediction models could enhance forearm fracture risk assessments