Aim of the present study was to evaluate the influence on the global model's accuracy of the strategy adopted to define the average element Young's modulus in subject-specific finite element models of bones from computed tomography data. The classic strategy of calculating the Young's modulus from an average element density and the one that averages the Young's moduli directly derived from each voxel Hounsfield Unit were considered. These strategies were applied to the finite element model of a real human femur. The accuracy of the superficial stress and strain predictions was evaluated against experimentally measured values in 13 strain-gauge locations for five different loading conditions. The results obtained for the two material distributions were statistically different. Both models predicted very accurately the superficial stresses, with regression coefficients higher than 0.9 and slopes not significantly different from unity. The second strategy definitely improved the strains prediction accuracy: the regression coefficient raised from 0.69 to 0.79; the average and peak errors decreased from 45.1% to 31.3% and from 228% to 134% of the maximum measured strain, respectively. The stress fields predicted inside the bone were also significantly different. A new software implementing the second strategy was made available in the public domain.

This paper offers an overview of the potentialities and limitations of digital image correlation (DIC) as a technique for measuring displacements and strain in biomechanical applications. This review is mainly intended for biomechanists who are not yet familiar with DIC. This review includes over 150 papers and covers different dimensional scales, from the microscopic level (tissue level) up to macroscopic one (organ level). As DIC involves a high degree of computation, and of operator-dependent decisions, reliability of displacement and strain measurements by means of DIC cannot be taken for granted. Methodological problems and existing solutions are summarized and compared, whilst open issues are addressed. Topics addressed include: preparation methods for the speckle pattern on different tissues; software settings; systematic and random error associated with DIC measurement. Applications to hard and soft tissues at different dimensional scales are described and analyzed in terms of strengths and limitations. The potentialities and limitations of DIC are highlighted, also in comparison with other experimental techniques (strain gauges, other optical techniques, digital volume correlation) and numerical methods (finite element analysis), where synergies and complementarities are discussed. In order to provide an overview accessible to different scientists working in the field of biomechanics, this paper intentionally does not report details of the algorithms and codes used in the different studies.