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Cui Z, Fan J, Cao Y, Fu Y, Bai L, Lv Y. Biomechanical Study of Three Cannulated Screws Configurations for Femur Neck Fracture: A Finite Element Analysis. Geriatr Orthop Surg Rehabil 2024; 15:21514593241284481. [PMID: 39296708 PMCID: PMC11409286 DOI: 10.1177/21514593241284481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 08/10/2024] [Accepted: 09/01/2024] [Indexed: 09/21/2024] Open
Abstract
Background To improve the performance of cannulated screws (CSs) in the treatment of femoral neck fractures (FNF), a number of new screw configurations have been proposed. However, most of the studies have only analyzed the biomechanical performance of different screw configurations under static conditions. This study aimed to investigate the biomechanical performance of three cannulated screws configurations under different loadings through finite element analysis. Methods In this FEA study, nine numerical models of proximal femur were employed to analyze the mechanical response of various fracture types and different fixation strategies (three inverted triangular parallel cannulated screws (TCS), four non-parallel cannulated screws (FCS) and biplane double-supported screw fixation (BDSF) respectively). The maximum principal strain (MPS) on the proximal femur and the von Mises stress on the screws were compared for different models. Results In Pauwels I and II fractures, FCS had the lowest peak MPS on the proximal femur and the BDSF had highest peak MPS value. In Pauwels III fractures, BDSF performance in MPS is improved and better than FCS under partial loading conditions. FCS exhibits the lowest von Mises stress in all load conditions for all fracture types, demonstrating minimal risk of screws breakage. Conclusions FCS is an ideal screw configuration for the treatment of FNF. And BDSF has shown potential in the treatment of Pauwels type III FNF.
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Affiliation(s)
- Zengzhen Cui
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Jixing Fan
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Yuan Cao
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Yuliang Fu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Liangyu Bai
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Yang Lv
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
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DeClouette B, Resad Ferati S, Kingery MT, Egol KA. Screw Configuration Does Not Significantly Alter Neck Shortening After Valgus-Impacted Femoral Neck Fracture (OTA Type 31B1.1). J Orthop Trauma 2024; 38:484-490. [PMID: 39150299 DOI: 10.1097/bot.0000000000002850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVES To compare 3 different cancellous screw configurations used for Garden 1 femoral neck fractures (FNFs). METHODS DESIGN Retrospective review. SETTING A large urban academic medical center. PATIENT SELECTION CRITERIA All patients with Orthopaedic Trauma Association 31B1.1 FNF who underwent in situ fixation with cancellous screws between 2012 and 2021 were included. Patients were divided into 3 groups: 2 screws placed in a parallel fashion, 3 screws placed in an inverted triangle configuration, and 3-screw fixation with placement of 1 "out-of-plane" screw perpendicular to the long axis of the femur. OUTCOME MEASURES AND COMPARISONS Postoperative femoral neck shortening (mm) was the primary outcome, which was compared among the 3 groups of different screw configurations. RESULTS Sixty-one patients with a median follow-up of 1 year (interquartile range 0.6-1.8 years) and an average age of 72 years (interquartile range 65.0-83.0 years) were included. All fractures demonstrated bony healing. Overall, 68.9% of the cohort had ≤2 mm of femoral neck shortening. There was no difference between groups in the proportion of patients who experienced greater than 2 mm of shortening (P = 0.839) or in the amount (mm) of femoral neck shortening (Kruskal-Wallis χ2 = 0.517, P = 0.772). CONCLUSIONS Although most patients with valgus-impacted FNF treated with screw fixation do not experience further femoral neck shortening, some patients demonstrated continued radiographic shortening during the healing process. The development of further femoral neck shortening and the amount of shortening that occurs do not differ based on implant configuration. Multiple different screw configurations seem to be acceptable for achieving healing and minimizing further femoral neck impaction. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Jayant UK, Singh S, Chhuttani D. Comments on "Long-term differences in clinical prognosis between crossed- and parallel-cannulated screw fixation in vertical femoral neck fractures of non-geriatric patients". Injury 2024:111791. [PMID: 39153895 DOI: 10.1016/j.injury.2024.111791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 08/03/2024] [Indexed: 08/19/2024]
Affiliation(s)
- Udit Kumar Jayant
- Department of Orthopaedics, All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi, India.
| | - Sanjay Singh
- Department of Orthopaedics, All India Institute of Medical Sciences (A.I.I.M.S.), Raebareli, India
| | - Devashish Chhuttani
- Department of Orthopaedics, All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi, India
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Chen Z, Chen F, Xu X, Li X, Cui H, Zhang W, Jiang D, Zhang F, Chen Y, Zhou S, Lyu S. Biomechanical analysis of a new cannulated screw for unstable femoral neck fractures. Front Bioeng Biotechnol 2024; 12:1382845. [PMID: 38803846 PMCID: PMC11128572 DOI: 10.3389/fbioe.2024.1382845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
Background The treatment of unstable femoral neck fractures (FNFs) remains a challenge. In this study, a new cannulated screw for unstable FNFs was designed to provide a new approach for the clinical treatment of these injuries, and its biomechanical stability was analyzed using finite element analysis and mechanical tests. Methods An unstable FNF model was established. An internal fixation model with parallel inverted triangular cannulated screws (CSs) and a configuration with two superior cannulated screws and one inferior new cannulated screw (NCS) were used. The biomechanical properties of the two fixation methods were compared and analyzed by using finite element analysis and mechanical tests. Results The NCS model outperformed the CSs model in terms of strain and stress distribution in computer-simulated reconstruction of the inverted triangular cannulated screw fixation model for unstable FNFs. In the biomechanical test, the NCS group showed significantly smaller average femoral deformation (1.08 ± 0.15 mm vs. 1.50 ± 0.37 mm) and fracture line displacement (1.43 ± 0.30 mm vs. 2.01 ± 0.47 mm). In the NCS group, the mean stiffness was significantly higher than that in the CSs group (729.37 ± 82.20 N/mm vs. 544.83 ± 116.07 N/mm), and the mean compression distance was significantly lower than that in the CSs group (2.87 ± 0.30 mm vs. 4.04 ± 1.09 mm). Conclusion The NCS combined with two ordinary cannulated screws in an inverted triangle structure to fix unstable FNFs can provide better biomechanical stability than CSs and exhibit a length- and angle-stable construct to prevent significant femoral neck shortening.
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Affiliation(s)
- Zhigang Chen
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
- Department of Orthopaedics, Affiliated Hai’an Hospital of Nantong University, Hai’an, Jiangsu, China
| | - Feiyang Chen
- Medical School, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xinbao Xu
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
| | - Xin Li
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
| | - Haidong Cui
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
| | - Wen Zhang
- Institute of Orthopaedics, Soochow University, Suzhou, Jiangsu, China
| | - Dong Jiang
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
| | - Feixiang Zhang
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
| | - Yinbing Chen
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
| | - Shiran Zhou
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
| | - Shujun Lyu
- Department of Orthopaedics, Hai’an People’s Hospital, Hai’an, Jiangsu, China
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Zhan S, Jiang D, Hu Q, Wang M, Feng C, Jia W, Hu H, Niu W. Single-plane osteotomy model is inaccurate for evaluating the optimal strategy in treating vertical femoral neck fractures: A finite element analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 245:108036. [PMID: 38244341 DOI: 10.1016/j.cmpb.2024.108036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND AND OBJECTIVES The conventional method for simulating vertical femoral neck fractures (vFNFs) is via a vertical single-plane osteotomy (SPO) across the entire femur. However, the accuracy of SPO for evaluating the optimal internal fixation strategy (IFS) and the appropriate assessment parameters is not clear. This study thus aimed to examine the accuracy of SPO in evaluating IFSs and to identify appropriate evaluation parameters using finite element analysis. METHODS Eighty patient-specific finite element models were developed based on CT images from eight vFNF patients. The natural fracture model was built using structural features of the affected side, while the SPO was simulated on the healthy side. Five different IFSs were applied to both the natural fracture and SPO groups. Thirteen parameters, including stress, displacement, and stiffness, were subjected to a two-way repeated measures ANOVA to determine the effect of IFSs and fracture morphology on stability. A Pearson correlation analysis was performed on varied parameters with various IFSs to identify independent parameters. Based on these independent parameters, the entropy evaluation method (EEM) score was used to rank the performance of IFSs for each patient. RESULTS Eight of the thirteen parameters were significantly influenced by IFSs (p < 0.05), two by fracture morphology (p < 0.01), and none by the interaction between IFS and fracture morphology. In the natural fracture group, parameters including screw stress and displacement, bone cut rate (BCR), and compression effects varied independently with distinct IFSs. In the SPO group, trunk displacement, BCR, cut-out risk, and compression effects parameters changed independently. The BCR of the Alpha strategy was significantly higher than that of the Inverted strategy in the natural fracture group (p = 0.002), whereas the opposite was observed in the SPO group (p = 0.016). Regarding compression effects, two IFS pairings in the natural fracture group and seven IFS pairings in the SPO group exhibited significant differences. None of the five IFSs achieved the optimal EEM score for each patient. CONCLUSIONS The single-plane osteotomy model may have limitations in assessing IFSs, particularly when the bone cut rate and compression effects are the main influencing factors. Parameters of the screw stress and displacement, BCR, and compression effects appear to be relevant in evaluating IFSs for natural fracture models. It indicates that individualized natural fracture models could provide more comprehensive insights for determining the optimal IFS in treating vFNFs.
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Affiliation(s)
- Shi Zhan
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, PR China; Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, PR China
| | - Dajun Jiang
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, PR China
| | - Qingxiang Hu
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, PR China
| | - Miao Wang
- College of Communication and Information Technology, Shanghai Technical Institute of Electronics Information, Shanghai, PR China
| | - Chenglong Feng
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, PR China
| | - Weitao Jia
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, PR China
| | - Hai Hu
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, PR China.
| | - Wenxin Niu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, PR China.
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Yin BH, Liu CJ, Sherrier MC, Sun H, Zhang W. Compressive buttress compared with off-axial screw fixation for vertical femoral neck fractures in young adults: a prospective, randomized controlled trial. J Orthop Surg Res 2024; 19:42. [PMID: 38184587 PMCID: PMC10771671 DOI: 10.1186/s13018-023-04493-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND To compare the clinical outcomes of compressive buttress screw (CBS) fixation, a novel screw fixation strategy, to off-axial screw fixation (off-axial partial threaded cannulated screw, OPTCS) for vertical femoral neck fractures (FNFs) in young adults. METHODS A total of 146 adults younger than 55 years old with high-energy Pauwels type III FNFs were randomized to receive CBS fixation or OPTCS fixation. Primary outcomes were complication rates, including fixation failure, fracture nonunion, and avascular necrosis of the femoral head (ANFH) at 24 months after treatment. Fixation loosening, femoral neck shortening and varus collapse, patient function and quality of life using the Harris hip score (HHS), and EuroQol-5 dimensional-5 levels (EQ-5D-5L) questionnaire (including EQ-5D-5L and EQ-VAS) were assessed as secondary outcomes at 24 months. RESULTS CBS and OPTCS fixation groups were similar with regard to demographics at baseline. At 24 months, patients in the CBS fixation cohort had a significantly lower rate of fixation failure (10.5% vs. 25.0%, p = 0.041) and fracture nonunion (1.8% vs. 18.3%, p = 0.003) compared with patients who received OPTCS fixation. There was no difference in rate of ANFH (7.0% vs. 11.7%, p = 0.389) between groups. Additionally, patients managed with CBS fixation showed significantly less fixation loosening (19.3% vs. 58.3%, p < 0.001), less severe femoral neck shortening and varus collapse (10.5% vs. 25.0%, p = 0.007), higher HHS (93 vs. 83, p = 0.001) and more excellent grade (68.4% vs. 36.7%, p = 0.008), higher EQ-5D-5L (0.814 vs, 0.581, p < 0.001) and EQ-VAS (85 vs. 80, p = 0.002). CONCLUSION CBS screw fixation confers significantly lower complication rate in addition to higher functional and quality of life outcomes for young adults with high-energy FNF compared with OPTCS fixation. TRIAL REGISTRATION This prospective, randomized controlled trial was approved by the institutional review board of our center, Ethics Committee of Shanghai sixth people's Hospital, and registered at www.chictr.org.cn (Approval Number: ChiCTR1900026283; Registered 29 September 2019-Retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=43164 ).
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Affiliation(s)
- Bo-Hao Yin
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Sixth People's Hospital, National Center for Orthopaedics, Shanghai, 200233, China
| | - Chen-Jun Liu
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Sixth People's Hospital, National Center for Orthopaedics, Shanghai, 200233, China
| | - Matthew C Sherrier
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Hui Sun
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
- Shanghai Sixth People's Hospital, National Center for Orthopaedics, Shanghai, 200233, China.
| | - Wei Zhang
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
- Shanghai Sixth People's Hospital, National Center for Orthopaedics, Shanghai, 200233, China.
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Assi C, Boulos K, Yammine K. Outcomes of three cannulated screws in a modified triangular transverse configuration for fixation of intra-capsular femoral neck fractures. Musculoskelet Surg 2023; 107:423-430. [PMID: 37221315 DOI: 10.1007/s12306-023-00788-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Intra-capsular femoral neck fractures (FNF) are commonly encountered in trauma settings and are associated with high rates of morbidity and mortality. One of the most used methods of FNF treatment is the use of multiple cannulated screws. Many different screw constructs are reported in the literature, with no evidence of superiority of one construct over others. We present a series of patients treated by one senior surgeon with three cannulated screws positioned in a specific configuration. MATERIALS AND METHODS We conducted a retrospective monocentric analysis. All charts of patients hospitalized between January 2004 and June 2022 for an intra-capsular femoral neck fracture treated by three cannulated screws by the same senior surgeon were retrieved and analyzed. The clinical and radiological evaluations were performed by two independent researchers. Functional status of patients was assessed using the modified Harris Hip score (mHHS). Complications such as secondary displacement, non-union, avascular necrosis (AVN) and femoral neck shortening were all recorded. RESULTS A total of 38 patients met the inclusion criteria. There were 17 males and 21 females with an average age of 66.3 ± 13.6 years and a follow-up period of 16 ± 20 months. Bone union was observed in 34 (89.5%) patients. Mild shortening was observed in two patients (5.2%) with no functional limitation. Four patients (10.5%) underwent reoperations, three due to another fall and one due to AVN four years post-fracture fixation. CONCLUSION In our series, we demonstrate that the use of three cannulated screws in a triangular transverse configuration for fixation of intra-capsular femoral neck fractures provides excellent results with low rates of femoral neck shortening, AVN or non-union.
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Affiliation(s)
- C Assi
- Department of Orthopedic Surgery, School of Medicine, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, Beirut, Lebanon
| | - K Boulos
- Department of Orthopedic Surgery, School of Medicine, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, Beirut, Lebanon
| | - K Yammine
- Department of Orthopedic Surgery, School of Medicine, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, Beirut, Lebanon.
- Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Jdeideh, Lebanon.
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Jiang D, Zhan S, Hai H, Wang L, Zhao J, Zhu Z, Wang T, Jia W. What makes vertical femoral neck fracture with posterior inferior comminution different? An analysis of biomechanical features and optimal internal fixation strategy. Injury 2023:110842. [PMID: 37296009 DOI: 10.1016/j.injury.2023.110842] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND PURPOSE Fracture comminution occurs in 83.9%-94% of vertical femoral neck fractures (VFNFs), the majority of which were located in posterior-inferior region, and poses a clinical challenge in fixation stability. We conducted a subject-specific finite element analysis to determine the biomechanical features and optimal fixation selection for treating VFNF with posterior-inferior comminution. PATIENTS AND METHODS Eighteen models with three fracture types (VFNF without comminution [NCOM], with comminution [COM], with comminution + osteoporosis [COMOP]) and six internal fixation types (alpha [G-ALP], buttress [G-BUT], rhomboid [G-RHO], dynamic hip screw [G-DHS], invert triangle [G-ITR], femoral neck system (G-FNS)) were created based on the computed tomography data. By using the subject-specific finite element analysis method, stiffness, implant stress, yielding rate (YR) were compared. Additionally, in order to elucidate distinct biomechanical characters of different fracture types and fixation strategies, we calculated interfragmentary movement (IFM), detached interfragmentary movement (DIM), shear interfragmentary movement (SIM) of all fracture surface nodes. RESULTS Generally, in comparison with NCOM, COM showed a 30.6% reduction of stiffness and 1.46-times higher mean interfragmentary movement. Besides, COM had a 4.66-times (p = 0.002) higher DIM at the superior-middle position, but similar SIM across fracture line, which presented as varus deformation. In COM and COMOP, among all six fixation strategies, G-ALP had significantly the lowest IFM (p<0.001) and SIM (p<0.001). Although G-FNS had significantly highest IFM and SIM (p<0.001), it had the highest stiffness and lowest DIM (p<0.001). In COMOP, YR was the lowest in G-FNS (2.67%). CONCLUSIONS Posterior-inferior comminution primarily increases superior-middle detached interfragmentary movement in VFNF, which results in varus deformation. For comminuted VFNF with or without osteoporosis, alpha fixation has the best interfragmentary stability and anti-shear property among six current mainstream fixation strategies, but a relatively weaker stiffness and anti-varus property compared to fixed-angle devices. FNS is advantageous owing to stiffness, anti-varus property and bone yielding rate in osteoporosis cases, but is insufficient in anti-shear property.
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Affiliation(s)
- Dajun Jiang
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Shi Zhan
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Hu Hai
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Lingtian Wang
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Jinhui Zhao
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Ziyang Zhu
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Tao Wang
- Department of emergency trauma center, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Weitao Jia
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China.
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Jiang D, Zhan S, Hu H, Zhu H, Zhang C, Jia W. The Effect of Vertical and Oblique Inclinations on Fracture Stability and Reoperation Risks in Femoral-Neck Fractures of Nongeriatric Patient. Front Bioeng Biotechnol 2021; 9:782001. [PMID: 34805128 PMCID: PMC8595327 DOI: 10.3389/fbioe.2021.782001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/19/2021] [Indexed: 01/16/2023] Open
Abstract
Background: For nongeriatric patients with femoral neck fractures (FNFs), preoperative evaluation of fracture three-dimensional inclination is essential to identify fracture stability, select appropriate fixation strategies, and improved clinical prognoses. However, there is lack of evaluation system which takes into account both vertical and oblique inclinations. The purpose of this study was to comprehensively investigate the effect of vertical and oblique inclinations on fracture stability and reoperation risks. Methods: We retrospectively reviewed the medical records of 755 FNFs patients with over 2 years follow-up. The 3-D inclination angle in vertical (α) and oblique plane (β) were measured based on CT images. The optimal threshold for unstable 3-D inclination were identified by seeking the highest Youden Index in predicting reoperation and validated in the biomechanical test. According to the cut-off value proposed in the diagnostic analysis, forty-two bone models were divided into seven groups, and were all fixed with traditional three parallel screws. Interfragmentary motion (IFM) was used for comparison among seven groups. The association between reoperation outcome and 3-D inclination was analysed with a multivariate model. Results and Conclusion: The overall reoperation rate was 13.2%. Unstable 3-D inclination angles with an optimally determined Youden index (0.39) included vertical (α > 70°) and oblique (50°<α < 70° and β > 20°/β < −20°) types. Biomechanical validation showed these fractures had significantly greater (p < 0.05) interfragmentary motion (1.374–2.387 mm vs. 0.330–0.681 mm). The reoperation rate in 3-D unstable group (32.7%) is significantly (p < 0.001) higher than that in 3-D stable group (7.9%). Multivariate analysis demonstrated that 3-D inclination angle was significantly (OR = 4.699, p < 0.001) associated with reoperation. FNFs with α > 70°; 50°<α < 70° and β > 20°/β < −20° are real unstable types with significantly worse interfragmentary stability and higher reoperation risks. Fracture inclination in vertical and oblique planes is closely related to reoperation outcomes and may be a useful complement to the way FNFs are currently evaluated.
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Affiliation(s)
- Dajun Jiang
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shi Zhan
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hai Hu
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hongyi Zhu
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Changqing Zhang
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weitao Jia
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Zhan S, Jiang D, Ling M, Ding J, Yang K, Duan L, Tsai TY, Feng Y, van Trigt B, Jia W, Zhang C, Hu H. Fixation effects of different types of cannulated screws on vertical femoral neck fracture: A finite element analysis and experimental study. Med Eng Phys 2021; 97:32-39. [PMID: 34756336 DOI: 10.1016/j.medengphy.2021.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/21/2022]
Abstract
Femoral neck fractures (FNFs) in young patients usually result from high-energy violence, and the vertical transcervical type is typically challenging for its instability. FNFs are commonly treated with three cannulated screws (CS), but the role of screws type on fixation effects (FE) is unclear. The purpose of this study was to evaluate the FE of ten types of CS with different diameters, lengths, depths, and pitches of thread via finite element analysis which was validated by a biomechanical test. Ten vertical FNF models were grouped, fixed by ten types of CS, respectively, all in a parallel, inverted triangular configuration. Their FE were scored comprehensively from six aspects via an entropy evaluation method, as higher scores showed better results. For partial-thread screws, thread length and thread shape factor (TSF) are determinative factors on stability of FNF only if thread depth is not too thick, and they have less cut-out risk, better compression effects and better detached resistance of fracture than full-thread screws, whereas full-thread screws appear to have better shear and shortening resistance. A combination of two superior partial-thread screws and one inferior full-thread screw for vertical FNF may get optimal biomechanical outcomes. The type of cannulated screw is important to consider when treating vertical FNF.
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Affiliation(s)
- Shi Zhan
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Dajun Jiang
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Ming Ling
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Jian Ding
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Kai Yang
- Radiology Department, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Lei Duan
- State Key Laboratory of Ocean Engineering, School of Naval Architecture, Ocean & Civil Engineering, Shanghai Jiao Tong University, Shanghai, 200240, PR China
| | - Tsung-Yuan Tsai
- Engineering Research Center of Clinical Translational Digital Medicine, Ministry of Education of P.R. China, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, PR China
| | - Yong Feng
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Bart van Trigt
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 4, 2628 CD Delft, the Netherlands
| | - Weitao Jia
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China.
| | - Changqing Zhang
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China.
| | - Hai Hu
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China.
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