In-vivo fall simulations generally evaluate hip fracture risk through differences in impact force magnitude; however, the distribution of force over the hip likely modulates loading and subsequent injury risk of the underlying femur. The current study characterized impact force distribution over the hip during falls, and the influence of biological sex and trochanteric soft tissue thickness (TSTT). Forty young adults completed fall simulation protocols (FSP) including highly controlled vertical pelvis and more dynamic kneeling and squat releases. At the instant of peak force, percentage of impact force applied in a circular region (r = 5 cm) centered over the greater trochanter (F) was determined to characterize force localization. To assess the need for anatomically aligned pressure analysis, this process was repeated utilizing peak pressure location as a surrogate for the greater trochanter (F). F was 10.8 and 21.9% greater in pelvis release than kneeling and squat releases respectively. F was 19.1 and 30.4% greater in males and low-TSTT individuals compared to females and high-TSTT individuals. TSTT explained the most variance (43.7-55.3%) in F across all protocols, while sex explained additional variance (5.3-19.0%) during dynamic releases. In all FSP, TSTT-groups and sexes, average peak pressure location was posterior and distal to the GT. F overestimated F by an average of 15.7%, highlighting the need for anatomically aligned pressure analysis. This overestimation was FSP and sex dependent, minimized during pelvis release and in males. The data have important implications from clinical and methodological perspectives, and for implementation in tissue-level computational models.
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