Prediction Accuracy of Femoral and Tibial Stress and Strain Using Statistical Shape and Density Model-Based Finite Element Models in Paediatrics

Computed tomography (CT)-based finite element (FE) models cannon-invasively assess bone mechanical properties, but their clinical application in paediatrics is limited due to fewer datasets and models. Predicted FE models using statistically inferred shape and density have application to predict bone fracture, strength, and strains, however, their accuracy in children remains unexplored. This study assessed the accuracy of stress-strain distributions estimated from predicted FE models of paediatric femora and tibiae. CT-based FE models used geometry and densities derived from 330 CT scans from children aged 4 to 18 years. Paediatric statistical shape-density models of the femur and tibia were used to predict bone geometries and densities from participants’ demographics and linear bone measurements. Forces during single leg standing were estimated and applied to each bone. Stress and strain distribution were compared between the predicted FE models and CT-based FE models, which served as the gold standard. The average normalized root-mean-square error (NRMSE) for Von Mises stress was 6% for the femur and 8% for the tibia. Principal strains NRMSE ranged from 1.2% to 5.5%. High correlations between the predicted modelsand CT-based models were observed, with determination coefficients ranging from 0.80 to 0.96. These results illustrate the potential of predictedFE models for paediatric application, such as personalized implant design and surgical planning.