Kinematics and kinetics of unanticipated misstep conditions: Femoral fracture implications in the elderly

Most hip fractures are thought to occur after falling during everyday activities. We speculated that hip fractures might also occur because of excessive loading of the hip joint during an unexpected misstep consequently leading to a fall. The aims of this study were to explore the kinematics and kinetics of the lower extremity joints during missteps as compared with regular stepping, as well as to compare the magnitude of forces acting upon the hip joint with the threshold forces expected to fracture the hip. Fourteen healthy adults performed two forward steps on a 17.8 cm high platform under the following four conditions: forward with and without vision, as well as a misstep (the box for the final step unexpectedly removed without participant awareness), and regular stepping down with eyes open. The results revealed no differences between stepping forward with and without vision. When compared with both stepping forward and regular stepping down, the misstep revealed altered joint positions accompanied by increased forces and moments acting upon the hip joint. For example, the peak vertical proximal thigh segment force was 3.05±0.55 BW vs. 1.23±0.14 BW and 0.91±0.09 BW (p<.001; misstep vs. regular stepping down and stepping forward, respectively), while the proximal thigh segment moment in frontal plane was 1.39±0.70 Nm/kg vs. 0.18±0.32 Nm/kg of adduction and 0.16±0.19 Nm/kg of abduction (p<.001). When compared with the literature data, the forces during misstep were within the range of those forces that could result in hip fractures in the elderly. Therefore, it may be possible for the elderly to experience hip/proximal femur fractures during missteps prior to falling.