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Sun X, Han Z, Cao D, Han C, Xie M, Zeng X, Dong Q. Finite Element Analysis of Six Internal Fixations in the Treatment of Pauwels Type III Femoral Neck Fracture. Orthop Surg 2024; 16:1695-1709. [PMID: 38747083 PMCID: PMC11216836 DOI: 10.1111/os.14069] [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: 11/30/2023] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVE The current investigation sought to utilize finite element analysis to replicate the biomechanical effects of different fixation methods, with the objective of establishing a theoretical framework for the optimal choice of modalities in managing Pauwels type III femoral neck fractures. METHODS The Pauwels type III fracture configuration, characterized by angles of 70°, was simulated in conjunction with six distinct internal fixation methods, including cannulated compression screw (CCS), dynamic hip screw (DHS), DHS with de-rotational screw (DS), CCS with medial buttress plate (MBP), proximal femoral nail anti-rotation (PFNA), and femoral neck system (FNS). These models were developed and refined using Geomagic and SolidWorks software. Subsequently, finite element analysis was conducted utilizing Ansys software, incorporating axial loading, torsional loading, yield loading and cyclic loading. RESULTS Under axial loading conditions, the peak stress values for internal fixation and the femur were found to be highest for CCS (454.4; 215.4 MPa) and CCS + MBP (797.2; 284.2 MPa), respectively. The corresponding maximum and minimum displacements for internal fixation were recorded as 6.65 mm for CCS and 6.44 mm for CCS + MBP. When subjected to torsional loading, the peak stress values for internal fixation were highest for CCS + MBP (153.6 MPa) and DHS + DS (72.8 MPa), while for the femur, the maximum and minimum peak stress values were observed for CCS + MBP (119.3 MPa) and FNS (17.6 MPa), respectively. Furthermore, the maximum and minimum displacements for internal fixation were measured as 0.249 mm for CCS + MBP and 0.205 mm for PFNA. Additionally, all six internal fixation models showed excellent performance in terms of yield load and fatigue life. CONCLUSION CCS + MBP had the best initial mechanical stability in treatment for Pauwels type III fracture. However, the MBP was found to be more susceptible to shear stress, potentially increasing the risk of plate breakage. Furthermore, the DHS + DS exhibited superior biomechanical stability compared to CCS, DHS, and PFNA, thereby offering a more conducive environment for fracture healing. Additionally, it appeared that FNS represented a promising treatment strategy, warranting further validation in future studies.
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Affiliation(s)
- Xiang Sun
- Department of Hip TraumaTianjin HospitalTianjinChina
| | - Zhe Han
- Department of Hip TraumaTianjin HospitalTianjinChina
| | - Dongdong Cao
- Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Chao Han
- Department of Hip TraumaTianjin HospitalTianjinChina
| | - Mengqi Xie
- Department of Hip TraumaTianjin HospitalTianjinChina
| | - Xiantie Zeng
- Department of Foot and Ankle SurgeryTianjin HospitalTianjinChina
| | - Qiang Dong
- Department of Hip TraumaTianjin HospitalTianjinChina
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Yang Y, Tong Y, Cheng X, Zhu Y, Chen W, Cui Y, Zhang Q, Zhang Y. Comparative study of a novel proximal femoral bionic nail and three conventional cephalomedullary nails for reverse obliquity intertrochanteric fractures: a finite element analysis. Front Bioeng Biotechnol 2024; 12:1393154. [PMID: 38938983 PMCID: PMC11208680 DOI: 10.3389/fbioe.2024.1393154] [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: 02/28/2024] [Accepted: 05/27/2024] [Indexed: 06/29/2024] Open
Abstract
Purpose Conventional cephalomedullary nails (CMNs) are commonly employed for internal fixation in the treatment of reverse obliquity intertrochanteric (ROI) fractures. However, the limited effectiveness of conventional CMNs in addressing ROI fractures results in significant implant-related complications. To address challenges associated with internal fixation, a novel Proximal Femoral Bionic Nail (PFBN) has been developed. Methods In this study, a finite element model was constructed using a normal femoral specimen, and biomechanical verification was conducted using the GOM non-contact optical strain measurement system. Four intramedullary fixation approaches-PFBN, Proximal Femoral Nail Antirotation InterTan nail (ITN), and Gamma nail (Gamma nail)-were employed to address three variations of ROI fractures (AO/OTA 31-A3). The biomechanical stability of the implant models was evaluated through the calculation of the von Mises stress contact pressure and displacement. Results Compared to conventional CMNs, the PFBN group demonstrated a 9.36%-59.32% reduction in the maximum VMS at the implant. The A3.3 ROI fracture (75% bone density) was the most unstable type of fracture. In comparison to conventional CMNs, PFBN demonstrated more stable data, including VMS values (implant: 506.33 MPa, proximal fracture fragment: 34.41 MPa), contact pressure (13.28 MPa), and displacement (17.59 mm). Conclusion Compared to the PFNA, ITN, and GN, the PFBN exhibits improvements in stress concentration, stress conduction, and overall model stability in ROI fractures. The double triangle structure aligns better with the tissue structure and biomechanical properties of the proximal femur. Consequently, the PFBN has significant potential as a new fixation strategy for the clinical treatment of ROI fractures.
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Affiliation(s)
- Yanjiang Yang
- Trauma Emergency Center, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Yu Tong
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Xiaodong Cheng
- Trauma Emergency Center, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Yanbin Zhu
- Trauma Emergency Center, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Wei Chen
- Trauma Emergency Center, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Yunwei Cui
- Trauma Emergency Center, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Qi Zhang
- Trauma Emergency Center, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Yingze Zhang
- Trauma Emergency Center, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, China
- Hebei Orthopaedic Clinical Research Center, Shijiazhuang, China
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Xian H, Cheng W, Xie W, Wang L, Luo D, Liu H, Lian K, Lin D. Does the angle between dynamic hip screw and anti-rotation screw affect the outcome of vertically oriented femoral neck fractures? A biomechanical analysis and clinical results. Injury 2024; 55:111317. [PMID: 38215569 DOI: 10.1016/j.injury.2024.111317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/24/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVE To analyze the effects of the angle between dynamic hip screw (DHS) and anti-rotation screw (AS) on vertically oriented femoral neck fractures (VOFNFs) and investigate the clinical results of them. METHODS Eighteen synthetic femurs were simulated and divided into 3 groups. The angle between DHS and AS in anteroposterior-view was marked as α, and in lateral-view was marked as β, thus the total angle (TA) was defined as the summation of α and β. The groups were categorized as group A (TA ≤ 5°), B (5° < TA ≤ 10°), and C (TA > 10°), respectively. All samples were tested under incremental, cyclical loading, and loading to failure. In clinic, 80 consecutive VOFNFs in 78 patients were treated with DHS plus AS. The patients were divided into 2 groups, including 48 fractures in parallel group (TA ≤10°) and 32 in angular group (TA >10°). RESULTS Group A and B survived during incremental and cyclical loading and endured longer than group C. Axial stiffness and failure loads were not different between group A and B, and greater than group C. Fracture gaps compressive stress was highest in group A, followed by group B and C. Forty-one fractures in parallel group and 23 in angular group healed at final follow-up. Nonunion and osteonecrosis occurred in 3 and 4 of parallel group, and 4 and 5 of angular group. CONCLUSION The construction with TA ≤10° between DHS and AS showed superior biomechanical performance and clinical results than those with TA >10°.
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Affiliation(s)
- Hang Xian
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China; Institute of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi'an 710032, China
| | - Weike Cheng
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China; Department of Orthopedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Wei Xie
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China
| | - Lei Wang
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China; Institute of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi'an 710032, China
| | - Deqing Luo
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China
| | - Hui Liu
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China
| | - Kejian Lian
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China
| | - Dasheng Lin
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China; Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, 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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