Off‐axis loads cause failure of the distal radius at lower magnitudes than axial loads: A side‐to‐side experimental study

Off‐axis loading associated with a fall onto the outstretched hand has been hypothesized to induce distal radius failure at lower magnitudes than axially directed loading commonly used in biomechanical models for estimating fracture risk. However, this hypothesis has not been tested with side‐to‐side experimental testing. The objective of this study was to compare distal radius failure loads between forearm pairs experimentally tested in an axial or off‐axis loading configuration. We acquired 18 pairs of cadaveric forearms from 18 female donors (mean age (standard deviation): 84.4 (7.9) years). Each forearm pair was tested to failure using either an axial compression test (vertical orientation with 0° dorsal inclination, 3°‐6° radial inclination) or an off‐axis test corresponding to the hand position during a fall (15° dorsal inclination, 3°‐6° radial inclination). Failure testing was performed at 3 mm/s onto the palm of the hand until fracture occurred. Of the 18 pairs, 11 sustained a distal radius fracture. We compared failure loads between the two groups using a paired t test. Results indicated that failure load under off‐axis loading was 29% lower than failure load under axial compressive loading (mean difference: −0.31 kN; 95% confidence interval: −0.47 to −0.16 kN, P = .001). In conclusion, off‐axis loading associated with a fall onto the outstretched hand resulted in a 29% lower failure load. Integrating an off‐axis loading configuration into current biomechanical models of distal radius bone strength may prevent overestimating of failure load and may offer a clinically relevant option to estimate distal radius fracture risk and monitor therapy efficacy.