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Mitkovic MM, Korunovic ND, Milenkovic SS, Stojiljkovic PM, Manic MT, Trajanovic MD. Forces required to dynamize sliding screws in gamma nail and selfdynamizable internal fixator. BMC Musculoskelet Disord 2024; 25:271. [PMID: 38589829 PMCID: PMC11000330 DOI: 10.1186/s12891-024-07392-3] [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: 09/13/2023] [Accepted: 03/28/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Single limb support phase of the gait-cycle in patients who are treated for a pertrochanteric fracture is characterized by transversal loads acting on the lag screw, tending to block its dynamization. If the simultaneous axial force overcomes transversal loads of the sliding screw, the dynamization can still occur. METHODS Biomechanical investigation was performed for three types of dynamic implants: Gamma Nail, and two types of Selfdynamizable Internal Fixators (SIF) - SIF-7 (containing two 7 mm non-cannulated sliding screws), and SIF-10 (containing one 10 mm cannulated sliding screw). Contact surface between the stem and the sliding screws is larger in SIF implants than in Gamma Nail, as the stem of Gamma Nail is hollow. A special testing device was designed for this study to provide simultaneous application of a controlled sliding screws bending moment and a controlled transversal load on sliding screws (Qt) without using of weights. Using each of the implants, axial forces required to initiate sliding screws dynamization (Qa) were applied and measured using a tensile testing machine, for several values of sliding screws bending moment. Standard least-squares method was used to present the results through the linear regression model. RESULTS Positive correlation between Qt and Qa was confirmed (p < 0.05). While performing higher bending moments in all the tested implants, Qa was higher than it could be provided by the body weight. It was the highest in Gamma Nail, and the lowest in SIF-10. CONCLUSIONS A larger contact surface between a sliding screw and stem results in lower forces required to initiate dynamization of a sliding screw. Patients treated for a pertrochanteric fracture by a sliding screw internal fixation who have longer femoral neck or higher body weight could have different programme of early postoperative rehabilitation than lighter patients or patients with shorter femoral neck.
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Affiliation(s)
- Milan M Mitkovic
- Clinic for Orthopaedics and Traumatology "Academician Prof. Dr. Milorad Mitkovic", University Clinical Center Nis, Nis, Serbia.
- Faculty of Medicine, University of Nis, Nis, Serbia.
| | | | - Sasa S Milenkovic
- Clinic for Orthopaedics and Traumatology "Academician Prof. Dr. Milorad Mitkovic", University Clinical Center Nis, Nis, Serbia
- Faculty of Medicine, University of Nis, Nis, Serbia
| | - Predrag M Stojiljkovic
- Clinic for Orthopaedics and Traumatology "Academician Prof. Dr. Milorad Mitkovic", University Clinical Center Nis, Nis, Serbia
- Faculty of Medicine, University of Nis, Nis, Serbia
| | - Miodrag T Manic
- Faculty of Mechanical Engineering, University of Nis, Nis, Serbia
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Chen P, Fan Z, Xu N, Wang H. A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures. J Orthop Surg Res 2023; 18:632. [PMID: 37641046 PMCID: PMC10463605 DOI: 10.1186/s13018-023-04112-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE The ideal approach for revision surgery following femoral head salvage treatments for an intertrochanteric fracture is still up for debate. A novel variety of proximal femoral bionic intramedullary nail (PFBN) has been created in clinical practice. We aimed to compare the biomechanical results of the novel implant to conventional intramedullary and extramedullary fixation in the treatment of intertrochanteric fracture following primary internal fixation failure. METHODS Using finite element analysis, we created a three-dimensional model of the intertrochanteric fracture's helical blade cut-out for this investigation. The PFBN 1 group, the PFBN 2 group, the PFNA group, and the DHS group were our four test groups. For each fracture group, the von Mises stress and displacements of the femur and internal fixation components were measured under 2100 N axial loads. RESULTS The values for the femoral displacement in the PFBN1 group, PFBN2 group, PFNA group, and DHS group were 6.802 mm, 6.716 mm, 8.080 mm, and 8.679 mm, respectively. The internal implant displacement values were 6.201 mm, 6.138 mm, 7.396 mm, and 8.075 mm in the PFBN1 group, PFBN2 group, PFNA group, and DHS group, respectively. The maximum von Mises Stress in the femoral was 187.2 MPa, 85.18 MPa, 106.6 MPa, and 386.2 MPa in the PFBN1 groups, PFBN2 groups, PFNA groups, and DHS groups, respectively. In the PFBN1 groups, PFBN2 groups, PFNA groups, and DHS groups, the maximum von Mises Stress in internal fixation was 586.7 MPa, 559.8 MPa, 370.7 MPa, and 928.4.8 MPa, respectively. CONCLUSION Our biomechanical research demonstrates that intramedullary fixation is more stable than extramedullary fixation when salvaging failed internal fixations in intertrochanteric fracture. Compared with PFNA and DHS, PFBN showed better biomechanical stability in the treatment of patients with revised intertrochanteric fractures. In light of this, we advocate PFBN fixation as the method of choice for intertrochanteric fracture revision. This result still has to be confirmed in more clinical research.
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Affiliation(s)
- Ping Chen
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Zhirong Fan
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Nengneng Xu
- Panyu Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 511401, China
| | - Haizhou Wang
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
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Jung CH, Cha Y, Chung JY, Park CH, Kim TY, Yoo JI, Kim JT, Jeon Y. Trajectory of bolt and length of plate in femoral neck system determine the stability of femur neck fracture and risk of subsequent subtrochanteric fracture : a finite element analysis. BMC Musculoskelet Disord 2023; 24:465. [PMID: 37280558 DOI: 10.1186/s12891-023-06579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/30/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND This study aimed to analyze the differences in the stability of fractures, stress distribution around the distal-most screw according to the length of the plate and the trajectory of the bolt in Pauwels type III femoral neck fracture using the femoral neck system (FNS). METHODS Finite element models of Pauwels type III femoral neck fractures were established with surgical variations in the trajectory of the bolt (central, inferior, valgus, and varus) and length of the lateral plate (1- and 2-hole plate). The models were subsequently subjected to normal walking and stair-climbing loads. RESULTS The screw-holding cortical bone in subtrochanter in the model with a 2-hole plate and the bolt in the inferior trajectory and the models with 1-hole or 2-hole plate and the bolt in valgus trajectory had shown greater maximum principal strain than the models with central or varus trajectories. The gap and sliding distance on the fracture surface were larger with inferior or varus trajectories of the bolt and smaller with the valgus trajectory of the bolt under both loads, compared to those of the central trajectory. CONCLUSION For the fixation of Pauwels type III femoral neck fracture, the trajectory of the FNS bolt and the length of the plate affect the mechanical stability of the fracture and the strain of cortical bone around the distal-most screw. The surgical target should stay on the central trajectory of the bolt and the 2-hole plate's mechanical benefits did not exceed the risk.
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Affiliation(s)
- Chang-Ho Jung
- Department of Mechanical Engineering, Ajou University, Suwon, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji university hospital, Daejeon, Korea
| | - Jun Young Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, New Daesung Hospital, Bucheon, Korea
| | - Tae Young Kim
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea
| | - Jun-Il Yoo
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Jung-Taek Kim
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea.
| | - Yongho Jeon
- Department of Mechanical Engineering, Ajou University, Suwon, Korea
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Salaha ZFM, Ammarullah MI, Abdullah NNAA, Aziz AUA, Gan HS, Abdullah AH, Abdul Kadir MR, Ramlee MH. Biomechanical Effects of the Porous Structure of Gyroid and Voronoi Hip Implants: A Finite Element Analysis Using an Experimentally Validated Model. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16093298. [PMID: 37176180 PMCID: PMC10179376 DOI: 10.3390/ma16093298] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/12/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
Total hip arthroplasty (THA) is most likely one of the most successful surgical procedures in medicine. It is estimated that three in four patients live beyond the first post-operative year, so appropriate surgery is needed to alleviate an otherwise long-standing suboptimal functional level. However, research has shown that during a complete THA procedure, a solid hip implant inserted in the femur can damage the main arterial supply of the cortex and damage the medullary space, leading to cortical bone resorption. Therefore, this study aimed to design a porous hip implant with a focus on providing more space for better osteointegration, improving the medullary revascularisation and blood circulation of patients. Based on a review of the literature, a lightweight implant design was developed by applying topology optimisation and changing the materials of the implant. Gyroid and Voronoi lattice structures and a solid hip implant (as a control) were designed. In total, three designs of hip implants were constructed by using SolidWorks and nTopology software version 2.31. Point loads were applied at the x, y and z-axis to imitate the stance phase condition. The forces represented were x = 320 N, y = -170 N, and z = -2850 N. The materials that were used in this study were titanium alloys. All of the designs were then simulated by using Marc Mentat software version 2020 (MSC Software Corporation, Munich, Germany) via a finite element method. Analysis of the study on topology optimisation demonstrated that the Voronoi lattice structure yielded the lowest von Mises stress and displacement values, at 313.96 MPa and 1.50 mm, respectively, with titanium alloys as the materials. The results also indicate that porous hip implants have the potential to be implemented for hip implant replacement, whereby the mechanical integrity is still preserved. This result will not only help orthopaedic surgeons to justify the design choices, but could also provide new insights for future studies in biomechanics.
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Affiliation(s)
- Zatul Faqihah Mohd Salaha
- Bone Biomechanics Laboratory (BBL), Department of Biomedical Engineering and Health Sciences, Faculty of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
| | - Muhammad Imam Ammarullah
- Department of Mechanical Engineering, Faculty of Engineering, Universitas Pasundan, Bandung 40153, West Java, Indonesia
- Biomechanics and Biomedics Engineering Research Centre, Universitas Pasundan, Bandung 40153, West Java, Indonesia
- Undip Biomechanics Engineering & Research Centre (UBM-ERC), Universitas Diponegoro, Semarang 50275, Central Java, Indonesia
| | - Nik Nur Ain Azrin Abdullah
- Bone Biomechanics Laboratory (BBL), Department of Biomedical Engineering and Health Sciences, Faculty of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
| | - Aishah Umairah Abd Aziz
- Bone Biomechanics Laboratory (BBL), Department of Biomedical Engineering and Health Sciences, Faculty of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
| | - Hong-Seng Gan
- School of AI and Advanced Computing, XJTLU Entrepreneur College (Taicang), Xi'an Jiaotong-Liverpool University, Suzhou 215400, China
| | - Abdul Halim Abdullah
- School of Mechanical Engineering, College of Engineering, Universiti Teknologi MARA, Shah Alam 40450, Selangor, Malaysia
| | - Mohammed Rafiq Abdul Kadir
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
- Medical Devices and Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
| | - Muhammad Hanif Ramlee
- Bone Biomechanics Laboratory (BBL), Department of Biomedical Engineering and Health Sciences, Faculty of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
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Zainal Abidin NA, Ramlee MH, Ab Rashid AM, Ng BW, Gan HS, Abdul Kadir MR. Biomechanical effects of cross-pin's diameter in reconstruction of anterior cruciate ligament - A specific case study via finite element analysis. Injury 2022; 53:2424-2436. [PMID: 35641332 DOI: 10.1016/j.injury.2022.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/09/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
For anterior cruciate ligament reconstruction (ACL-R), one of the crucial aspects of treatment is the fixator selection that could provide initial graft fixation post-operatively. Literature on biomechanical stabilities of different sizes of fixators as femoral graft fixation is limited. Therefore, this study aims to analyse the influence of different diameters of cross-pins on the stability of graft fixations after ACL-R via finite element analysis (FEA). In the methodology, three-dimensional (3D) models of three different diameters of cross-pins were developed, of which anterior tibial loads (ATL) were applied onto the tibia. From the findings, the cross-pin with a smaller diameter (4 mm) provided optimum stability than larger diameter cross-pins, whereby it demonstrated acceptable stresses at the fixators (both cross-pin and interference screw) with a different percentage of 28%, while the stresses at the corresponding bones were favourable for osseointegration to occur. Besides, the strains of the knee joint with 4 mm diameter cross-pin were also superior in providing a good biomechanical environment for bone healing, while the recorded strain values at fixators were comparable with a larger diameter of cross-pins without being inferior in terms of deformation. To conclude, the cross-pin with 4 mm diameter depicted the best biomechanical aspects in graft fixation for ACL-R since it allows better assistance for the osseointegration process and can minimise the possibility of the breakage and migration of fixators. This study is not only useful for medical surgeons to justify their choices of pin diameter to treat patients, but also for researchers to conduct future studies.
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Affiliation(s)
- Nur Afikah Zainal Abidin
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia; Department of Orthopaedics, Hospital Pakar Kanak-Kanak, Universiti Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Muhammad Hanif Ramlee
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia; Department of Orthopaedics, Hospital Pakar Kanak-Kanak, Universiti Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Amir Mustakim Ab Rashid
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia; Department of Orthopaedics, Hospital Pakar Kanak-Kanak, Universiti Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Bing Wui Ng
- Department of Orthopaedics, Hospital Pakar Kanak-Kanak, Universiti Kebangsaan Malaysia, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Hong Seng Gan
- Department of Data Science, Universiti Malaysia Kelantan, 16100 UMK City Campus, Pengkalan Chepa, Kelantan, Malaysia
| | - Mohammed Rafiq Abdul Kadir
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia; Sports Innovation and Technology Centre (SITC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia
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Lee YK, Kim JT, Park CH, Song JU, Kim TY, Koo KH. Analysis of risk factor for nail breakage in patients with mechanical failures after proximal femoral nail antirotation in intertrochanteric fractures. Medicine (Baltimore) 2022; 101:e29436. [PMID: 35758379 PMCID: PMC9276385 DOI: 10.1097/md.0000000000029436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 04/20/2022] [Indexed: 11/26/2022] Open
Abstract
Breakage of the intramedullary nail is a rare complication after proximal femoral nail antirotation (PFNA) in intertrochanteric fracture treatment. The purpose of this study was (1) to investigate the frequency of nail breakage among the patients who were treated for mechanical failure after PFNA for intertrochanteric/pertrochanteric fracture, and (2) to determine the risk factors for nail breakage in PFNA treatment of intertrochanteric fracture.To identify mechanical failure after internal fixation using PFNA, we retrospectively reviewed the data of 35 patients (35 hips) who required reoperation after PFNA with a helical blade for intertrochanteric/pertrochanteric fracture between June 2005 and June 2018.We evaluated the frequency of breakage of PFNA and compared the demographic and radiologic parameters between the breakage and control (non-breakage) groups. We also compared the lever arm for the load of stress from the fulcrum according to the centrum-collum-diaphyseal (CCD) angle of blade by using reverse design technique.Among the 25 patients with mechanical failure after PFNA except 10 patients with peri-implant infection and osteonecrosis, 7 (28.0%) showed breakage of PFNA at average of 8 months (range, 5-13 months) after index surgery. A larger horizontal offset (the horizontal distance from the lateral surface of the IM nail and the medial tip of helical blade) was associated with an increased risk of nail breakage. A CCD angle of 130° has a shorter lever arm for the load of stress from the fulcrum, meaning a higher stress for nail breakage, although there was no association between CCD angle and breakage of the nail.Our study suggested that higher horizontal offset and a higher CCD angle can increase the risk of breakage of the PFNA nail at the aperture for the helical blade.
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Chan Ho Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Ji-Ung Song
- Department of Orthopedic Surgery, Chamjoeun Hospital, Gwangju, Korea
| | - Tae-Young Kim
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Jung CH, Cha Y, Yoon HS, Park CH, Yoo JI, Kim JT, Jeon Y. Mechanical effects of surgical variations in the femoral neck system on Pauwels type III femoral neck fracture : a finite element analysis. Bone Joint Res 2022; 11:102-111. [PMID: 35168366 PMCID: PMC8882323 DOI: 10.1302/2046-3758.112.bjr-2021-0282.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS In this study, we aimed to explore surgical variations in the Femoral Neck System (FNS) used for stable fixation of Pauwels type III femoral neck fractures. METHODS Finite element models were established with surgical variations in the distance between the implant tip and subchondral bone, the gap between the plate and lateral femoral cortex, and inferior implant positioning. The models were subjected to physiological load. RESULTS Under a load of single-leg stance, Pauwels type III femoral neck fractures fixed with 10 mm shorter bolts revealed a 7% increase of the interfragmentary gap. The interfragmentary sliding, compressive, and shear stress remained similar to models with bolt tips positioned close to the subchondral bone. Inferior positioning of FNS provided a similar interfragmentary distance, but with 6% increase of the interfragmentary sliding distance compared to central positioning of bolts. Inferior positioning resulted in a one-third increase in interfragmentary compressive and shear stress. A 5 mm gap placed between the diaphysis and plate provided stability comparable to standard fixation, with a 7% decrease of interfragmentary gap and sliding distance, but similar compressive and shear stress. CONCLUSION Finite element analysis with FNS on Pauwels type III femoral neck fractures revealed that placement of the bolt tip close to subchondral bone provides increased stability. Inferior positioning of FNS bolt increased interfragmentary sliding distance, compressive, and shear stress. The comparable stability of the fixation model with the standard model suggests that a 5 mm gap placed between the plate and diaphysis could viably adjust the depth of the bolt. Cite this article: Bone Joint Res 2022;11(2):102-111.
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Affiliation(s)
- Chang-Ho Jung
- Department of Mechanical Engineering, Ajou University, Suwon, South Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Ha Seung Yoon
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Suwon, South Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, South Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, South Korea
| | - Jung-Taek Kim
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Suwon, South Korea
| | - Yongho Jeon
- Department of Mechanical Engineering, Ajou University, Suwon, South Korea
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Cho HM, Choi SM, Park JY, Lee Y, Bae JH. A finite element analysis and cyclic load experiment on an additional transcortical-type hole formed around the proximal femoral nail system's distal locking screw. BMC Musculoskelet Disord 2022; 23:92. [PMID: 35086522 PMCID: PMC8793818 DOI: 10.1186/s12891-022-05006-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/21/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A complication associated with the distal locking screw used in the proximal femoral nail (PFN) system is the formation of accidental additional holes. We hypothesized that an increase in stress around additional holes is a relevant factor contributing to fractures. This study aimed to evaluate stress changes in the cortical bone around additional screw holes using finite element analysis. METHODS Proximal femoral nail antirotation (PFNA)-II (Synthes, Solothurn, Switzerland) was inserted into a femur model. An additional 4.9-mm transcortical hole was made either anteriorly (anterior hole model) or posteriorly (posterior hole model) to the distal locking screw. Finite element analysis was used to calculate compression, tension, and load limits to investigate stress around additional holes with respect to the direction of screw penetration and degree of osteoporosis. The results were then compared with those of mechanical testing. A 31A-21 type intertrochanteric fracture was applied. As a control group, a model without additional holes (no-hole model) was developed. Repeated load-loading tests were performed on 10 model bones per model group. RESULTS Tensile stress was significantly greater in the no-hole model when additional screw holes were present, and the anterior hole showed a higher maximum stress value than the posterior hole, suggesting that the anterior hole was more susceptible to fracture. The change in tensile stress first appeared in the hole around the lateral cortical bone and proceeded to the medial side. Biomechanical testing showed that fractures around the distal locking screw occurred in 0 cases of the no-hole, 10 of the anterior hole, and 9 of the posterior hole models. CONCLUSIONS During PFN surgery for intertrochanteric fracture, holes with distal locking screws fixed and removed at the anterior and posterior of the nail can be a risk factor for fractures in the surrounding area.
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Affiliation(s)
- Hong Man Cho
- Department of Orthopedic Surgery, Gwangju Veterans Hospital, 99 Cheomdanwolbong-ro, Gwangsan-gu, Gwangju, 62284, South Korea.
| | - Seung Min Choi
- Department of Orthopedic Surgery, Inchon Veterans Hospital, Inchon, South Korea
| | - Ji Yeon Park
- Department of Orthopedic Surgery, Gwangju Veterans Hospital, 99 Cheomdanwolbong-ro, Gwangsan-gu, Gwangju, 62284, South Korea
| | - Young Lee
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, South Korea
| | - Jung Hyung Bae
- ENS Corp, Bio-medical Material and Component Service Center, Gwangju, South Korea
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Rogers MJ, King T, Kim J, Adeyemi TF, Higgins T, Maak TG. Femoral Neck Shaft Angle and Management of Proximal Femur Fractures: Is the Contralateral Femur a Reliable Template? J Orthop Trauma 2021; 35:529-534. [PMID: 33813545 PMCID: PMC10506416 DOI: 10.1097/bot.0000000000002069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To (1) assess interrater reliability of a novel technique for measurement of neck shaft angle (NSA); (2) use pelvic anteroposterior (AP) radiographs of unaffected hips to assess variability of NSA; and (3) evaluate the side-to-side variability of NSA to determine reliability of using the contralateral hip as a template. DESIGN Retrospective cohort study. SETTING Academic Level 1 regional trauma center. PATIENTS/PARTICIPANTS Four hundred six femora (203 patients) with standing AP pelvis radiographs were selected. Exclusions included lack of acceptable imaging, congenital abnormalities, or prior hip surgery. INTERVENTION An AP pelvis radiograph in the standing position. MAIN OUTCOME MEASUREMENTS Bilateral NSA measurements obtained in a blinded fashion between 2 reviewers. Pearson coefficients and coefficient of determination assessed correlations and variability between left and right NSA. Concordance correlation coefficients assessed the interrater reliability between measurements performed by the 2 reviewers. RESULTS Two hundred three patients (406 femora) were assessed. Male patients had a lower overall NSA mean of 131.56 degrees ± 4.74 than females with 133.61 degrees ± 5.17. There was no significant difference in NSA side-to-side in females (P = 0.18), 0.3 degrees [95% confidence interval (-0.15 to 0.75)], or males (P = 0.68), 0.19 degrees [95% confidence interval (-0.74 to 1.12)]. There was a strong linear relationship between left and right femora (r2 = 0.70). Forty-one percent of patients fell within the 131-135 degrees range bilaterally. Eighty-eight percent of patients had <5 degrees difference in NSA bilaterally and 0% had >10 degrees difference. CONCLUSIONS There is no significant variability between bilateral femora in males and females. Use of this measurement method and contralateral NSA for proximal femur fracture planning is supported.
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Affiliation(s)
- Miranda J. Rogers
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, 590 Wakara Way, Salt Lake City, Utah 84108, USA
| | - Taylor King
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, Utah 84132, USA
| | - Jaewhan Kim
- Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, Utah 84108, USA
| | - Temitope F. Adeyemi
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, 590 Wakara Way, Salt Lake City, Utah 84108, USA
| | - Thomas Higgins
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, 590 Wakara Way, Salt Lake City, Utah 84108, USA
| | - Travis G. Maak
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, 590 Wakara Way, Salt Lake City, Utah 84108, USA
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Migliorini F, Kader N, Eschweiler J, Tingart M, Maffulli N. Platelet-rich plasma versus steroids injections for greater trochanter pain syndrome: a systematic review and meta-analysis. Br Med Bull 2021; 139:86-99. [PMID: 34405857 DOI: 10.1093/bmb/ldab018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Greater trochanter pain syndrome (GTPS) is characterized by a persistent and debilitating pain around the greater trochanter. GTPS can be caused by a combination of gluteus medius or minimus tendinopathy, snapping hip or trochanteric bursitis. SOURCE OF DATA Recent published literatures identified from PubMed, EMBASE, Google Scholar, Scopus. AREAS OF AGREEMENT Platelet rich plasma (PRP) and corticosteroids (CCS) injections are useful options to manage symptoms of GTPS. AREAS OF CONTROVERSY Whether PRP leads to superior outcomes compared to CCS injections is unclear. GROWING POINTS A systematic review and meta-analysis comparing PRP versus CCS in the management of GTPS was conducted. AREAS TIMELY FOR DEVELOPING RESEARCH PRP injections are more effective than CCS at approximately 2 years follow-up.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital of Aachen, 52074 Aachen, Germany
| | - Nardeen Kader
- Department of Orthopedics, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Rd, Epsom KT18 7EG, UK
| | - Jörg Eschweiler
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital of Aachen, 52074 Aachen, Germany
| | - Markus Tingart
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital of Aachen, 52074 Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, 01782 Stoke on Trent, UK.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
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Zainal Abidin NA, Abdul Wahab AH, Abdul Rahim RA, Abdul Kadir MR, Ramlee MH. Biomechanical analysis of three different types of fixators for anterior cruciate ligament reconstruction via finite element method: a patient-specific study. Med Biol Eng Comput 2021; 59:1945-1960. [PMID: 34392448 DOI: 10.1007/s11517-021-02419-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/26/2021] [Indexed: 01/11/2023]
Abstract
Complication rates of anterior cruciate ligament reconstruction (ACL-R) were reported to be around 15% although it is a common arthroscopic procedure with good outcomes. Breakage and migration of fixators are still possible even months after surgery. A fixator with optimum stability can minimise those two complications. Factors that affect the stability of a fixator are its configuration, material, and design. Thus, this paper aims to analyse the biomechanical effects of different types of fixators (cross-pin, interference screw, and cortical button) towards the stability of the knee joint after ACL-R. In this study, finite element modelling and analyses of a knee joint attached with double semitendinosus graft and fixators were carried out. Mimics and 3-Matic softwares were used in the development of the knee joint models. Meanwhile, the graft and fixators were designed by using SolidWorks software. Once the meshes of all models were finished in 3-Matic, simulation of the configurations was done using MSC Marc Mentat software. A 100-N anterior tibial load was applied onto the tibia to simulate the anterior drawer test. Based on the findings, cross-pin was found to have optimum stability in terms of stress and strain at the femoral fixation site for better treatment of ACL-R.
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Affiliation(s)
- Nur Afikah Zainal Abidin
- Medical Devices & Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia.,Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia
| | - Abdul Hadi Abdul Wahab
- Centre for Multimodal Signal Processing, Faculty of Engineering and Technology, Tunku Abdul Rahman Universiti College, Jalan Genting Kelang, 53300, Setapak, Kuala Lumpur, Malaysia.,Department of Electrical and Electronics Engineering, Faculty of Engineering and Technology, Tunku Abdul Rahman Universiti College, Jalan Genting Kelang, 53300, Setapak, Kuala Lumpur, Malaysia
| | - Rabiatul Adibah Abdul Rahim
- Medical Devices & Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia
| | - Mohammed Rafiq Abdul Kadir
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia.,Sports Innovation and Technology Centre (SITC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, UTM, 81310, Johor Bahru, Johor, Malaysia
| | - Muhammad Hanif Ramlee
- Medical Devices & Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia. .,Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia.
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ABIDIN NURAFIKAHZAINAL, KADIR MOHAMMEDRAFIQABDUL, RAMLEE MUHAMMADHANIF. BIOMECHANICAL EFFECTS OF DIFFERENT LENGTHS OF CROSS-PINS IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A FINITE ELEMENT ANALYSIS. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420500475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Complication rates of anterior cruciate ligament reconstruction (ACL-R) were reported to be around 15%. Although it is a very common arthroscopic surgery with good outcomes, breakage and migration of fixators are still possible to occur due to stability issue. One of the factors that affects the mechanical stability of fixators is its length. Therefore, the aim of this paper is to analyze the biomechanical effects of different lengths of fixators (cross-pin technique) towards the stabilities of the knee joint after ACL-R. Finite element analyses of knee joint with DST grafts and fixators were carried out. Mimics and 3-Matic were used in the development of knee joint models, while the grafts and fixators were designed by using SolidWorks software. All models were remeshed in the 3-Matic and numerical analysis was performed via MSC.Marc Mentat software. A 100 N anterior tibial load was applied onto the tibia to simulate the anterior drawer test after the surgery and proximal femur was fixed at all degrees of freedom. Based on the findings, cross-pin with 40[Formula: see text]mm in length provided the most favorable option for better treatment of ACL-R, where it could promote osseointegration and preventing fracture.
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Affiliation(s)
- NUR AFIKAH ZAINAL ABIDIN
- Medical Devices & Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
- Bioinspired Devices and Tissue Engineering Group (BIOINSPIRA), Faculty of Engineering, School of Biomedical Engineering and Health Sciences, Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
| | - MOHAMMED RAFIQ ABDUL KADIR
- Bioinspired Devices and Tissue Engineering Group (BIOINSPIRA), Faculty of Engineering, School of Biomedical Engineering and Health Sciences, Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
- Sports Innovation and Technology Centre (SITC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
| | - MUHAMMAD HANIF RAMLEE
- Medical Devices & Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
- Bioinspired Devices and Tissue Engineering Group (BIOINSPIRA), Faculty of Engineering, School of Biomedical Engineering and Health Sciences, Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
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Abstract
With the recent increase in the elderly population, many people suffer from spinal diseases, and, accordingly, spinal fusion surgery using pedicle screws has been widely applied to treat them. However, most research on pedicle screw design has been focused on the test results rather than the behavior of the screws and vertebrae. In this study, a design platform with a series of biomechanical tests and analyses were presented for pedicle screw improvement and evaluation. The platform was then applied to an alternative hybrid screw design with quadruple and double threads. An experimental apparatus was developed to investigate the bending strength of the screw, and several tests were performed based on the ASTM F1717 standard. In the experiments, it was confirmed that the alternative pedicle screw has the highest bending strength. To examine the stress distribution of pedicle screws, finite element models were established, through which it was found that the proposed pedicle screw has sufficient mechanical safety to make it acceptable for spinal fusion treatment. Finally, we conclude that the platform has good potential for the design and evaluation of pedicle screws, and the alternative dual screw design is one of the best options for spinal fusion surgery.
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Chen J, Ma JX, Wang Y, Bai HH, Sun L, Wang Y, Lu B, Dong BC, Tian AX, Ma XL. Finite element analysis of two cephalomedullary nails in treatment of elderly reverse obliquity intertrochanteric fractures: zimmer natural nail and proximal femoral nail antirotation-ΙΙ. J Orthop Surg Res 2019; 14:422. [PMID: 31823801 PMCID: PMC6902592 DOI: 10.1186/s13018-019-1468-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background More elderly patients are suffering from intertrochanteric fractures. However, the choice of internal fixation is still controversial, especially in the treatment of unstable intertrochanteric fracture; thus, previous implants continue to be improved, and new ones are being developed. The purpose of our study was to compare the biomechanical advantages between the zimmer natural nail (ZNN) and proximal femoral nail antirotation-II (PFNA-II) in the treatment of elderly reverse obliquity intertrochanteric fractures. Methods A three-dimensional finite element was applied for reverse obliquity intertrochanteric fracture models (AO31-A3.1) fixed with the ZNN or PFNA-II. The distribution, peak value and position of the von Mises stress and the displacement were the criteria for comparison between the two groups. Results The stresses of the internal fixation and femur in the ZNN model were smaller than those in the PFNA-II model, and the peak values of the two groups were 364.8 MPa and 171.8 MPa (ZNN) and 832.3 MPa and 1795.0 MPa (PFNA-II). The maximum amount of displacement of the two groups was similar, and their locations were the same, i.e., in the femoral head vertex (3.768 mm in the ZNN model and 3.713 mm in the PFNA-II model). Conclusions The displacement in the two models was similar, but the stresses in the implant and bone were reduced with the ZNN. Therefore, the ZNN implant may provide biomechanical advantages over PFNA-II in reverse obliquity intertrochanteric fractures, as shown through the finite element analysis. These findings from our study may provide a reference for the perioperative selection of internal fixations.
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Affiliation(s)
- Jian Chen
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Jian-Xiong Ma
- Institute of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300050, People's Republic of China
| | - Ying Wang
- Institute of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300050, People's Republic of China
| | - Hao-Hao Bai
- Institute of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300050, People's Republic of China
| | - Lei Sun
- Institute of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300050, People's Republic of China
| | - Yan Wang
- Institute of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300050, People's Republic of China
| | - Bin Lu
- Institute of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300050, People's Republic of China
| | - Ben-Chao Dong
- Institute of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300050, People's Republic of China
| | - Ai-Xian Tian
- Institute of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, 300050, People's Republic of China
| | - Xin-Long Ma
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China.
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