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Belaïd D, Germaneau A, Vendeuvre T, Ben Brahim E, Aubert K, Severyns M. Varus malalignment of the lower limb increases the risk of femoral neck fracture: A biomechanical study using a finite element method. Injury 2022; 53:1805-1814. [PMID: 35489822 DOI: 10.1016/j.injury.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The understanding of the stresses and strains and their dependence on loading direction caused by an axial deformity is very important for understanding the mechanism of femural neck fractures. The hypothesis of this study is that lower limb malalignment is correlated with a substantial stress variation on the upper end of the femur. The purpose of this biomechanical trial using the finite element method is to determine the effect of the loading direction on the proximal femur regarding the malalignment of the lower limb, and also enlighten the relation between the lower limb alignment and the risk of a femoral neck fracture. METHODS Ten segmentations of CT scans were considered. An axial compression load was applied to the femoral head to digitally simulate the physiological configuration in neutral position as well as in different axial positions in varus/valgus alignment. RESULTS The stress at the proximal femur changes as the varus _valgus angle does. It can be observed the smaller absolute stress at angle 10° (valgus) and the higher absolute stress at angle -10° (varus). The mean maximum von Mises stress value was 14.1 (SD=±3.48) MPa for 0°, while the mean maximum von Mises stress value was 17.96 MPa (SD=4.87) for -10° in varus. The fracture risk indicator of the proximal femoral epiphyses changes inversely with angle direction. The FRI was the highest at -10° and the lowest at 10°. CONCLUSION Based on the biomechanical findings and the fracture risk indicator determined in this preliminary study, varus malalignment increases the risk of femoral neck fracture. Consideration of other parameters such as bone mineral density and morphological parameters should also help to plan preventive medical strategy in the elderly.
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Affiliation(s)
- D Belaïd
- Department of Mechanical Engineering, Faculty of Technology Sciences, University of Mentouri Brothers Constantine P.O Box 325 Ain-El-Bey Way, Constantine 25017, Algeria
| | - A Germaneau
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France
| | - T Vendeuvre
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France; Department of Orthopaedic Surgery and Traumatology, University Hospital, Poitiers France
| | - E Ben Brahim
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France; Department of Orthopaedic Surgery and Traumatology, University Hospital, Poitiers France
| | - K Aubert
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France
| | - M Severyns
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France; Department of Orthopaedic surgery and Traumatology, University Hospital, Martinique, France.
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Aubert K, Germaneau A, Rochette M, Ye W, Severyns M, Billot M, Rigoard P, Vendeuvre T. Development of Digital Twins to Optimize Trauma Surgery and Postoperative Management. A Case Study Focusing on Tibial Plateau Fracture. Front Bioeng Biotechnol 2021; 9:722275. [PMID: 34692655 PMCID: PMC8529153 DOI: 10.3389/fbioe.2021.722275] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background and context: Surgical procedures are evolving toward less invasive and more tailored approaches to consider the specific pathology, morphology, and life habits of a patient. However, these new surgical methods require thorough preoperative planning and an advanced understanding of biomechanical behaviors. In this sense, patient-specific modeling is developing in the form of digital twins to help personalized clinical decision-making. Purpose: This study presents a patient-specific finite element model approach, focusing on tibial plateau fractures, to enhance biomechanical knowledge to optimize surgical trauma procedures and improve decision-making in postoperative management. Study design: This is a level 5 study. Methods: We used a postoperative 3D X-ray image of a patient who suffered from depression and separation of the lateral tibial plateau. The surgeon stabilized the fracture with polymethyl methacrylate cement injection and bi-cortical screw osteosynthesis. A digital twin of the patient’s fracture was created by segmentation. From the digital twin, four stabilization methods were modeled including two screw lengths, whether or not, to inject PMMA cement. The four stabilization methods were associated with three bone healing conditions resulting in twelve scenarios. Mechanical strength, stress distribution, interfragmentary strains, and fragment kinematics were assessed by applying the maximum load during gait. Repeated fracture risks were evaluated regarding to the volume of bone with stress above the local yield strength and regarding to the interfragmentary strains. Results: Stress distribution analysis highlighted the mechanical contribution of cement injection and the favorable mechanical response of uni-cortical screw compared to bi-cortical screw. Evaluation of repeated fracture risks for this clinical case showed fracture instability for two of the twelve simulated scenarios. Conclusion: This study presents a patient-specific finite element modeling workflow to assess the biomechanical behaviors associated with different stabilization methods of tibial plateau fractures. Strength and interfragmentary strains were evaluated to quantify the mechanical effects of surgical procedures. We evaluate repeated fracture risks and provide data for postoperative management.
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Affiliation(s)
- Kévin Aubert
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France.,Ansys France, Villeurbanne, France
| | - Arnaud Germaneau
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France
| | | | | | - Mathieu Severyns
- Department of Orthopedic and Trauma Surgery at the University Hospital Center of Fort-de-France, Fort-de-France, France
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Philippe Rigoard
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France.,PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France.,Department of Spine Surgery and Neuromodulation, Poitiers University Hospital, Poitiers, France
| | - Tanguy Vendeuvre
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France.,PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France.,Department of Spine Surgery and Neuromodulation, Poitiers University Hospital, Poitiers, France.,Department of Orthopedic Surgery and Traumatology, Poitiers University Hospital, Poitiers, France
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Aubert K, Vendeuvre T, Michel N, Rochette M, Brèque C, Rigoard P, Valle V, Germaneau A. Characterization of bone fragment displacement during minimally invasive surgical procedures by digital volume correlation (DVC). Comput Methods Biomech Biomed Engin 2020. [DOI: 10.1080/10255842.2020.1811495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Kévin Aubert
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- ANSYS FRANCE, Villeurbanne, France
| | - Tanguy Vendeuvre
- ABS Lab, Université de Poitiers, Poitiers, France
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU, Poitiers, France
| | - Nicolas Michel
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU, Poitiers, France
| | | | - Cyril Brèque
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- ABS Lab, Université de Poitiers, Poitiers, France
| | - Philippe Rigoard
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU, Poitiers, France
| | - Valéry Valle
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
| | - Arnaud Germaneau
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
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Aubert K, Germaneau A, Ye W, Rochette M, Rigoard P, Vendeuvre T. Patient-specific finite element model to evaluate the influence of the type of stabilization on the patient's continuation of life after tibial plateau fractures. Comput Methods Biomech Biomed Engin 2020. [DOI: 10.1080/10255842.2020.1811496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Kévin Aubert
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, France
- ANSYS FRANCE, Villeurbanne, France
| | - Arnaud Germaneau
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, France
| | | | | | - Philippe Rigoard
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, France
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU, Poitiers, France
| | - Tanguy Vendeuvre
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU, Poitiers, France
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Aubert K, Germaneau A, Rochette M, Billot M, Rigoard P, Vendeuvre T. Modèle éléments finis personnalisé de l’effort maximum pendant la marche après une fracture du plateau tibial. Neurophysiol Clin 2019. [DOI: 10.1016/j.neucli.2019.10.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Belaid D, Delmon R, Aubert K, Rigoard P, Germaneau A, Vendeuvre T. Biomechanical study between 4.5 mm and 3.5 mm distal locking screws in tibial plateau fractures. Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1714970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- D. Belaid
- Department of Mechanical Engineering, Faculty of Technology Sciences, University of Mentouri Brothers, Constantine, Algeria
| | - R. Delmon
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU, Poitiers, France
| | - K. Aubert
- Institut Pprime UPR 3346, CNRS – Université de Poitiers – ISAE-ENSMA, France Poitiers
| | - P. Rigoard
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU, Poitiers, France
- Institut Pprime UPR 3346, CNRS – Université de Poitiers – ISAE-ENSMA, France Poitiers
| | - A. Germaneau
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU, Poitiers, France
- Institut Pprime UPR 3346, CNRS – Université de Poitiers – ISAE-ENSMA, France Poitiers
| | - T. Vendeuvre
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU, Poitiers, France
- Institut Pprime UPR 3346, CNRS – Université de Poitiers – ISAE-ENSMA, France Poitiers
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Michel N, Aubert K, Germaneau A, Gayet LE, Valle V, Brèque C, Rigoard P, Vendeuvre T. Surface analysis during surgical balloon reduction of a tibial Plateau depression fracture. Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1714971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- N. Michel
- Pédiatrie - Chirurgie orthopédique, traumatologique et plastique, Hôpital des enfants, CHU Toulouse, Toulouse, France
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- Spine & Neuromodulation Function Unit. PRISMATICS Lab CHU – Poitiers, Poitiers, France
| | - K. Aubert
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
| | - A. Germaneau
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
| | - L.-E Gayet
- Chirurgie orthopédique-traumatologie, CHU Poitiers, Poitiers, France
| | - V. Valle
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
| | - C. Brèque
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
| | - P. Rigoard
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- Chirurgie orthopédique-traumatologie, CHU Poitiers, Poitiers, France
| | - T. Vendeuvre
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- Chirurgie orthopédique-traumatologie, CHU Poitiers, Poitiers, France
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Aubert K, Germaneau A, Rochette M, Rigoard P, Vendeuvre T. The interest of FE simulation for the reduction of tibial plateau fracture using balloon inflation. Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1714966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- K. Aubert
- Institut Pprime, CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- ANSYS FRANCE, Villeurbanne, France
| | - A. Germaneau
- Institut Pprime, CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
| | | | - P. Rigoard
- Institut Pprime, CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- Spine & Neuromodulation Function Unit. PRISMATICS Lab CHU – Poitiers, Poitiers, France
| | - T. Vendeuvre
- Institut Pprime, CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- Spine & Neuromodulation Function Unit. PRISMATICS Lab CHU – Poitiers, Poitiers, France
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Aubert K, Germaneau A, Rochette M, Rigoard P, Vendeuvre T. Personalized finite element model for full weight-bearing after tibial plateau fracture surgery. Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1714217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- K. Aubert
- Institut Pprime, UPR 3346 CNRS, Université de Poitiers, ISAE-ENSMA, Poitiers, France
- ANSYS FRANCE, Villeurbanne, France
| | - A. Germaneau
- Institut Pprime, UPR 3346 CNRS, Université de Poitiers, ISAE-ENSMA, Poitiers, France
| | | | - P. Rigoard
- Institut Pprime, UPR 3346 CNRS, Université de Poitiers, ISAE-ENSMA, Poitiers, France
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU – Poitiers, Poitiers, France
| | - T. Vendeuvre
- Institut Pprime, UPR 3346 CNRS, Université de Poitiers, ISAE-ENSMA, Poitiers, France
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU – Poitiers, Poitiers, France
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Deneuville JP, Germaneau A, Fradet L, Monnet T, Aubert K, Roulaud M, Nivole K, Vendeuvre T, Rigoard P. Assessment of movement and pain variation before and after a MDT treatment for patient with low back pain. Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1714991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- J.-P. Deneuville
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
| | - A. Germaneau
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
| | - L. Fradet
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
| | - T. Monnet
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
| | - K. Aubert
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- ANSYS FRANCE, Villeurbanne, France
| | - M. Roulaud
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU, Poitiers, France
| | - K. Nivole
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU, Poitiers, France
| | - T. Vendeuvre
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU, Poitiers, France
| | - P. Rigoard
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- Spine & Neuromodulation Function Unit, PRISMATICS Lab CHU, Poitiers, France
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