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Wang W, Huang D, Xiong Z, Guo Y, Liu P, Li M, Mei H, Li Y, Canavese F, Chen S. Is there an alternative to the Delbet-Colonna classification? Introduction and reliability assessment of a new classification system for paediatric femoral neck fractures: preliminary results. INTERNATIONAL ORTHOPAEDICS 2024; 48:1507-1516. [PMID: 38081948 DOI: 10.1007/s00264-023-06051-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/23/2023] [Indexed: 05/08/2024]
Abstract
PURPOSE The purpose of this study was to introduce a new classification system for paediatric femoral neck fractures (PFNFs) and to evaluate its reliability. METHODS Two hundred and eight unilateral PFNFs (mean patient age: 9.0 ± 4.8 years) were included. Based on preoperative radiographs, the new classification system distinguished PFNFs without anterior or posterior translation (Type I), PFNFs with anterior (Type II) or posterior (Type III) translation, PFNFs with a comminuted medial or posterior column (Type IV), and subtrochanteric femoral fractures (SFFs; Type V). Radiographs were evaluated twice with an interval of two weeks by 19 raters with different specialties, experiences and geographical origins. The results were compared with a selection of 50 patient age-matched unilateral PFNFs and SFFs (mean patient age: 9.1 ± 4.9 years). These were graded twice by the same graders according to the Delbet-Colonna (D-C) classification. RESULTS Four radiologists and 15 paediatric orthopaedic surgeons from Europe and Asia graded the radiographs. Fair agreement was found between radiologists (κ = 0.296 ± 0.01) and surgeons (κ = 0.3 ± 0.005) (P = 0.17), although more experienced surgeons performed better than less experienced ones; a similar fair assessment was found for raters from Europe (κ = 0.309 ± 0.021) and Asia (κ = 0.3 ± 0.006) and for type II, III and IV fractures; the κ value in the first evaluation (0.309) was similar to that in the second evaluation (0.298). The overall κ value of the D-C classification subtypes was significantly higher (0.599 ± 0.217) than that of the new classification, 0.326 ± 0.162 (t = 3.190 P = 0.005). CONCLUSIONS The new classification system showed fair reliability relative to the D-C classification. The reliability of the new classification system was not affected by the specialty or geographic origin of the rater or the evaluation round, only by rater experience level. The concordance was worse for PFNFs with anterior or posterior translation or with a comminuted medial or posterior columns.
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Affiliation(s)
- WenTao Wang
- Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518107, Guangdong Province, China
| | - DianHua Huang
- Department of Pediatric Orthopedics, Fuzhou Second Hospital, Fuzhou, 350007, Fujian Province, China
| | - Zhu Xiong
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Shenzhen, 518034, Guangdong Province, China
| | - YueMing Guo
- Department of Pediatric Orthopaedics, Foshan Hospital of Traditional Chinese Medicine, Foshan, 528099, Guangdong Province, China
| | - PengRan Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
| | - Ming Li
- Department of Pediatric Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, 400015, China
| | - HaiBo Mei
- Department of Pediatric Orthopaedics, Hunan Children's Hospital, Changsha, 410007, Hunan Province, China
| | - YiQiang Li
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, GuangZhou Medical University, Guangzhou, 510623, Guangdong Province, China
| | - Federico Canavese
- Department of Pediatric Orthopaedics, Lille University Center, Jeanne de Flandre Hospital, Avenue Eugène Avinée, 59037, Lille Cedex, France
| | - ShunYou Chen
- Department of Pediatric Orthopedics, Fuzhou Second Hospital, Fuzhou, 350007, Fujian Province, China.
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Fischer CS, Ittermann T, Hannemann A, Schmidt CO, Mederake M, Schüll D, Histing T, Lange J, Haralambiev L. Are there associations between hip geometry and bone quality? An analysis on 3074 adults from a general population. Arch Orthop Trauma Surg 2024; 144:81-90. [PMID: 37646797 PMCID: PMC10774197 DOI: 10.1007/s00402-023-05031-5] [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: 04/24/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Patients with reduced bone mineral density and altered hip geometry are susceptible for hip pathologies. Knowledge on associations between bone properties and hip geometric parameters might facilitate identification of patients at risk for hip pathologies. The aim of the present study was to identify associations of bone properties assessed by quantitative ultrasound (QUS) at the heel and hip geometric parameters like center-edge angle (CE), neck-shaft angle (NSA) and alpha angle. MATERIALS AND METHODS Hip geometric parameters (CE, NSA and alpha angle) of 3074 participants from the population-based Study of Health in Pomerania were assessed on magnetic resonance imaging. QUS was performed on both calcanei providing broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness-index. Based on the stiffness-index the individual osteoporotic fracture risk (low, moderate or high) was determined. Associations between QUS-based and hip geometric parameters were calculated in linear regression models adjusted for age, sex, body height and weight. Interactions of QUS markers with age and sex on hip geometric parameters were tested. RESULTS Significant inverse associations between BUA (β = - 0.068), SOS (β = - 0.024) as well as stiffness-index (β = - 0.056) and CE were present, while fracture risk was positively associated with CE (β for high = 1.28 and moderate = 2.54 vs. low fracture risk). Interactions between BUA and sex as well as between SOS and age were detected in the models for CE. Furthermore, there was an inverse relation between fracture risk and NSA that was restricted to the moderate risk (β for moderate vs. low fracture risk = - 0.60). There were no significant associations between QUS parameters and alpha angle. CONCLUSIONS In the general population, several associations between QUS-based bone properties or fracture risk and hip geometry are present. Less dysplastic hips had a lower stiffness-index and a higher fracture risk, whereas more valgus hips had a lower fracture risk.
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Affiliation(s)
- Cornelius Sebastian Fischer
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübigen, Germany.
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine, Greifswald, Germany
| | | | - Moritz Mederake
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübigen, Germany
| | - Daniel Schüll
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübigen, Germany
| | - Tina Histing
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübigen, Germany
| | - Jörn Lange
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Lyubomir Haralambiev
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
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Pais A, Alves JL, Belinha J. Predicting trabecular arrangement in the proximal femur: An artificial neural network approach for varied geometries and load cases. J Biomech 2023; 161:111860. [PMID: 37948877 DOI: 10.1016/j.jbiomech.2023.111860] [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: 05/16/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
Machine learning (ML) and deep learning (DL) approaches can solve the same problems as the finite element method (FEM) with a high degree of accuracy in a fraction of the required time, by learning from previously presented data. In this work, the bone remodelling phenomenon was modelled using feed-forward neural networks (NN), by gathering a dataset of density distribution comprising several geometries and load cases. The model should output for some point in the domain the its apparent density, taking into consideration the geometric and loading parameters of the model . After training. the trabecular distribution obtained with the NN was similar to the FEM while the analysis was performed in a fraction of the time, having shown a reduction from 1020 s to 0.064 s. It is expected that the results can be extended to different structures if a different dataset is acquired. In summary, the ML approach allows for significant savings in computational time while presenting accurate results.
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Affiliation(s)
- Ana Pais
- INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, Portugal.
| | - Jorge Lino Alves
- INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, Portugal; Department of Mechanical Engineering, FEUP, University of Porto, Portugal.
| | - Jorge Belinha
- INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, Portugal; Department of Mechanical Engineering, ISEP, Polytechnic University of Porto, Portugal.
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Huang Q, Zhang C, Bai H, Wang Q, Li Z, Lu Y, Ma T. Biomechanical evaluation of two modified intramedullary fixation system for treating unstable femoral neck fractures: A finite element analysis. Front Bioeng Biotechnol 2023; 11:1116976. [PMID: 36896014 PMCID: PMC9989215 DOI: 10.3389/fbioe.2023.1116976] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
Purpose: The existing implants for fixation of femoral neck fractures have poor biomechanical stability, so the failure rate is high. We designed two modified intramedullary implants for treating unstable femoral neck fractures (UFNFs). We tried to improve the biomechanical stability of fixation by shortening the moment and reducing stress concentration. Each modified intramedullary implant was compared with cannulated screws (CSs) through finite element analysis (FEA). Methods: Five different models were included: three cannulated screws (CSs, Model 1) in an inverted triangle configuration, the dynamic hip screw with an anti-rotation screw (DHS + AS, Model 2), the femoral neck system (FNS, Model 3), the modified intramedullary femoral neck system (IFNS, Model 4), and the modified intramedullary interlocking system (IIS, Model 5). Three-dimensional (3D) models of femur and implants were constructed by using 3D modelling software. Three load cases were simulated to assess the maximal displacement of models and fracture surface. The maximal stress at the bone and implants was also evaluated. Results: FEA data showed that Model 5 had the best performance in terms of maximum displacement while Model 1 had the worst performance for this index under axial load of 2100 N. With respect to Maximum stress, Model 4 had the best performance while Model 2 had the worst performance under axial load. The general trends under bending and torsion load were consistent with that under axial load. Our data demonstrated that the two modified intramedullary implants exhibited the best biomechanical stability, followed by FNS and DHS + AS, and then three cannulated screws in axial, bending, and torsion load cases. Conclusion: The two modified intramedullary designs showed the best biomechanical performance among the five implants included in this study. Therefore, this might provide some new options for trauma surgeons to deal with unstable femoral neck fractures.
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Affiliation(s)
- Qiang Huang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - CongMing Zhang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - HuanAn Bai
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qian Wang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhong Li
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yao Lu
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Teng Ma
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Wang W, Xiong Z, Li Y, Guo Y, Li M, Mei H, Canavese F, Chen S. Variables influencing radiological fracture healing in children with femoral neck fractures treated surgically: A review of 177 cases. Orthop Traumatol Surg Res 2022; 108:103052. [PMID: 34530130 DOI: 10.1016/j.otsr.2021.103052] [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: 12/28/2020] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE This study aimed: (1) to determine the probability of and the amount of time needed to achieve fracture healing in children with displaced femoral neck fractures (FNFs) treated surgically; and (2) to determine which factors can affect both the probability of and the amount of time needed to achieve radiological fracture healing in those patients. HYPOTHESIS Pediatric FNFs require longer time to achieve union than previously reported. METHODS We retrospectively reviewed the data of 177 children (mean age 10.5±3.9 years) with FNFs treated surgically. Risk factors, including age, sex, laterality, the mechanism of injury, the initial displacement severity, the type of fracture, the time to reduction, the reduction method, the fixation method and the reduction quality, were recorded. Furthermore, the presence of a comminuted medial or posterior cortex on anteroposterior (AP) or lateral radiographs was also recorded. RESULTS A total of 172 hips (97.2%) achieved radiological fracture healing during the follow-up period. Severe initial displacement, a comminuted cortex on the AP or lateral radiographs and poor reduction quality significantly increased the time needed to achieve radiological fracture healing (p<0.05). Cox regression analysis indicated that the cumulative probability of achieving fracture healing increased linearly during the first 6 months and then plateaued, with a monthly increase of less than 5%. The severity of initial displacement, presence/absence of comminution on the medial or posterior cortex, and reduction quality were factors influencing the probability of achieving fracture healing within the first 6 months after injury (p<0.05). CONCLUSIONS Radiological union of displaced pediatric FNFs treated surgically increases linearly during the first six month after surgery and then it tends to plateau. Risk factors for nonunion are severe initial displacement, poor reduction quality and the presence of comminuted medial or posterior cortex on AP or lateral radiographs; the same factors are associated with a longer time to achieve fracture healing. LEVEL OF EVIDENCE III.
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Affiliation(s)
- WenTao Wang
- Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Zhu Xiong
- Department of Pediatric Orthopedics, ShenZhen Children's Hospital, Shenzhen, China
| | - YiQiang Li
- Department of Pediatric Orthopaedics, GuangZhou Women and Children's Medical Center, GuangZhou Medical University, Guangzhou, China
| | - YueMing Guo
- Department of Pediatric Orthopaedics, FoShan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Ming Li
- Department of Pediatric Orthopaedics, Children's Hospital of ChongQing Medical University, Chongqing, China
| | - HaiBo Mei
- Department of Pediatric Orthopaedics, HuNan Children's Hospital, Hunan, China
| | - Federico Canavese
- Department of Pediatric Orthopaedics, Lille University Center, Jeanne-de-Flandre Hospital, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - ShunYou Chen
- Department of Pediatric Orthopedics,Fuzhou Second Hospital, Xiamen University, Fuzhou, China.
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Terryn PJ, Fernandes PR, João F, Veloso A, Baptista F. Modeling the musculoskeletal loading in bone remodeling at the hip of a child. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 210:106365. [PMID: 34455361 DOI: 10.1016/j.cmpb.2021.106365] [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: 03/03/2021] [Accepted: 08/16/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The mechanical load associated with physical activity affects the bone adaptation process. The bone adaptationeffect varies with age, being more effective during childhood and adolescence, particularly during pre-pubertal years. Bone-strengthening physical activity is recommended for children and adolescents. The number of time periods (bouts) per day of vigorous physical activity seems to be more important than the total cumulative time for optimal bone strength. So, the aim of this study was to evaluate the effects of weight-bearing physical activity on bone mineral density (BMD) of the proximal femur through computational simulation considering the intensity, exposure time (bouts) and regionalization of the results. METHODS For this purpose, a finite element model of a 7 year-old child femur was developed based on computed tomography images. Musculoskeletal loads were obtained from experimental kinematic data of weight-bearing physical activity performed by children of the same age (standing, walking, running, jumping). The effects of physical activity on BMD of several regions of interest of the femur were analyzed using a bone remodeling model. A daily accumulation of 400 min of physical activity (200 min walking and 200 min standing) was considered as reference, against with which the effects of additional 10 min loading bouts were compared: 10 min bouts of vigorous intensity physical activity vs. 10 min bouts of light to moderate intensity physical activity. RESULTS The simulations revealed greater increases in BMD associated with higher intensity and longer duration of physical activity. The largest BMD increases occurs during the first 10 min bout compared to longer durations and in less mineralized central regions compared to regions far from the neutral axis of the bone. CONCLUSION Weight bearing physical activity is more effective in bone remodeling when the musculoskeletal loading is more intense and of short duration and, under these conditions, less mineralized regions are more positively impacted.
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Affiliation(s)
- Pieter-Jan Terryn
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1, Lisboa 1049-001, Portugal
| | - Paulo R Fernandes
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1, Lisboa 1049-001, Portugal.
| | - Filipa João
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, Cruz-Quebrada, Dafundo 1499-002, Portugal
| | - António Veloso
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, Cruz-Quebrada, Dafundo 1499-002, Portugal
| | - Fátima Baptista
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, Cruz-Quebrada, Dafundo 1499-002, Portugal
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Jiang D, Zhan S, Wang L, Shi LL, Ling M, Hu H, Jia W. Biomechanical comparison of five cannulated screw fixation strategies for young vertical femoral neck fractures. J Orthop Res 2021; 39:1669-1680. [PMID: 33034914 PMCID: PMC8451753 DOI: 10.1002/jor.24881] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/18/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023]
Abstract
Vertical femoral neck fractures in patients younger than 65 years of age often require hip-conserving surgeries. However, traditional fixation strategies using three parallel cannulated screws often fail in such patients due to an unfavorable biomechanical environment. This study compared different cannulated screw fixation techniques in patients via patient-specific finite element analysis with linear tetrahedral (C3D4) elements. Forty vertical femoral neck fracture models were created based on computed tomography images obtained from eight healthy participants. Five different fixation strategies: alpha, buttress, rhomboid, inverted triangle, and triangle were assessed in walking status. Biomechanical parameters including stiffness, interfragmentary motion in two directions (detachment and shearing), compression force, and maximal implant stress were evaluated. The mean relative coefficient of strain distribution between the finite element analysis and experiment was from 0.78 to 0.94. Stiffness was highest (p < .05) in the buttress group (923.1 N/mm), while interfragmentary motion was lowest (p < .05) in the alpha group. Maximal stress was highest (p < .05) in the buttress group and lowest in the alpha group. Shearing values were significantly lower in the alpha group than in the rhomboid group (p = .004). Moreover, Shearing values were significantly higher (p = .027), while detachment values were significantly lower (p = .027), in the inverted triangle than in the triangle group. Clinical significance: Our results suggest that alpha fixation is the most reliable and biomechanically efficient strategy for young patients with vertical femoral neck fractures. Regular and inverted triangular fixation strategies may be suitable for fractures of different skeletal constructions due to antidetachment/shearing abilities.
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Affiliation(s)
- Dajun Jiang
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
| | - Shi Zhan
- Orthopedic Biomechanical Laboratory, Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
| | - Lei Wang
- Orthopedic Biomechanical Laboratory, Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
| | - Lewis L. Shi
- Department of OrthopaedicsUniversity of Chicago Medical CenterChicagoIllinoisUSA
| | - Ming Ling
- Orthopedic Biomechanical Laboratory, Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
| | - Hai Hu
- Orthopedic Biomechanical Laboratory, Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
| | - Weitao Jia
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
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Zhan S, Jiang D, Xu J, Ling M, Yang K, Li Y, Jia W, Hu H, Zhang C. Influence of the proximal screws of buttress plates on the stability of vertical femoral neck fractures: a finite element analysis. BMC Musculoskelet Disord 2020; 21:842. [PMID: 33308185 PMCID: PMC7733615 DOI: 10.1186/s12891-020-03853-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022] Open
Abstract
Background The treatment of vertical femoral neck fractures (vFNFs) in young patients remains challenging, with a high complication rate by using traditional techniques. The use of cannulated screws (CSs) combined with a buttress plate represents an alternative approach for treating vFNFs. However, the biomechanical influence of the use or non-use of the proximal screws of buttress plates on vFNFs stability remains unclear. This study aims to analyse the biomechanics of buttress plate fixation with or without the use of proximal screws through finite element analysis (FEA) to further understand this approach. Methods We built five vFNFs (Pauwels angle 70°) finite element models treated using three cannulated screws (CS group) or three cannulated screws plus a locking buttress plate (buttress group). In the buttress group, use or non-use of proximal screws was carried out on two types of plates (4-hole & 6-hole). The following seven parameters were analysed to compare biomechanical properties of the five models: the stiffness; the maximal stress of the plate system (plate and screws), CSs and bone (MPS, MCS, MBS); the maximal displacement of internal fixations (plate system & CSs) and bone (MIFD, MBD); and the maximal relative displacement of interfragments (MID). Results Compared with CS model, the buttress models exhibited improved biomechanical properties, with increased stiffness and decreased MCS, MBS, MIFD, MBD and MID. The models fixed using buttress plates combined with a proximal screw showed greater stiffness (+ 3.75% & + 8.31% vs + 0.98% & + 4.57%) and MPS (795.6 & 947.2 MPa vs 294.9 & 556.2 MPa) values, and smaller MCS, MBS, MIFD, MBD and MID (− 3.41% to − 15.35% vs − 0.07% to − 4.32%) values than those using the same length plates without a proximal screw. Conclusions Based on the FEA results, buttress plates can improve construct mechanics, help to resist shear force and prevent varus collapse; under the modelling conditions, the use of a proximal screw on buttress plate may be a key technical feature in improving anti-shearing ability; additionally, this screw may be essential to reduce stress and prevent re-displacement of cannulated screws and fracture fragments.
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Affiliation(s)
- Shi Zhan
- Orthopedic Biomechanical Laboratory of Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Rd., Shanghai, 200233, People's Republic of China
| | - Dajun Jiang
- Orthopedic Biomechanical Laboratory of Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Rd., Shanghai, 200233, People's Republic of China
| | - Jian Xu
- Orthopedic Biomechanical Laboratory of Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Rd., Shanghai, 200233, People's Republic of China
| | - Ming Ling
- Department of Orthopedic, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Kai Yang
- Radiology Department, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Yuehua Li
- Radiology Department, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Weitao Jia
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China.
| | - Hai Hu
- Orthopedic Biomechanical Laboratory of Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Rd., Shanghai, 200233, People's Republic of China. .,Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China.
| | - Changqing Zhang
- Orthopedic Biomechanical Laboratory of Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Rd., Shanghai, 200233, People's Republic of China. .,Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China.
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Initial displacement as a risk factor for avascular necrosis of the femoral head in pediatric femoral neck fractures: a review of one hundred eight cases. INTERNATIONAL ORTHOPAEDICS 2019; 44:129-139. [DOI: 10.1007/s00264-019-04429-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
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Marco M, Giner E, Caeiro-Rey JR, Miguélez MH, Larraínzar-Garijo R. Numerical modelling of hip fracture patterns in human femur. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 173:67-75. [PMID: 31046997 DOI: 10.1016/j.cmpb.2019.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Hip fracture morphology is an important factor determining the ulterior surgical repair and treatment, because of the dependence of the treatment on fracture morphology. Although numerical modelling can be a valuable tool for fracture prediction, the simulation of femur fracture is not simple due to the complexity of bone architecture and the numerical techniques required for simulation of crack propagation. Numerical models assuming homogeneous fracture mechanical properties commonly fail in the prediction of fracture patterns. This paper focuses on the prediction of femur fracture based on the development of a finite element model able to simulate the generation of long crack paths. METHODS The finite element model developed in this work demonstrates the capability of predicting fracture patterns under stance loading configuration, allowing the distinction between the main fracture paths: intracapsular and extracapsular fractures. It is worth noting the prediction of different fracture patterns for the same loading conditions, as observed during experimental tests. RESULTS AND CONCLUSIONS The internal distribution of bone mineral density and femur geometry strongly influences the femur fracture morphology and fracture load. Experimental fracture paths have been analysed by means of micro-computed tomography allowing the comparison of predicted and experimental crack surfaces, confirming the good accuracy of the numerical model.
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Affiliation(s)
- Miguel Marco
- Department of Mechanical Engineering, Universidad Carlos III de Madrid, Avda. de la Universidad 30, 28911 Leganés, Madrid, Spain.
| | - Eugenio Giner
- CIIM-Department of Mechanical and Materials Engineering, Universitat Politècnica de València Camino de Vera, 46022 Valencia, Spain
| | - José Ramón Caeiro-Rey
- Orthopedic Surgery and Traumatology Service, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa de Ramón Baltar, s/n, 15706 Santiago de Compostela, A Coruña, Spain
| | - M Henar Miguélez
- Department of Mechanical Engineering, Universidad Carlos III de Madrid, Avda. de la Universidad 30, 28911 Leganés, Madrid, Spain
| | - Ricardo Larraínzar-Garijo
- Orthopaedics and Trauma Department, Surgery Department, Hospital Universitario Infanta Leonor, Complutense University, Madrid, Spain
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11
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Skubich J, Piszczatowski S. Model of loadings acting on the femoral bone during gait. J Biomech 2019; 87:54-63. [PMID: 30850177 DOI: 10.1016/j.jbiomech.2019.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 11/25/2022]
Abstract
An evaluation of the model of loadings acting on the femoral bone during the whole gait cycle was the main aim of the paper. A computer simulation of the musculoskeletal system based on the gait data collected during gait was used to determine the muscle forces as well as the hip joint reaction. Kinematic parameters as well as the ground reaction force for ninety-nine healthy persons of both sexes (18-36 years old) who had no history of musculoskeletal disease were registered during normal gait with preferred speed and used as inputs for musculoskeletal modelling and numerical simulation with the use of the AnyBody software. Time waveforms of the values of force generated by 21 muscles having attachments on the femoral bone as well as the hip joint reaction force were obtained. Directions of particular forces were presented using a femoral coordinate system. Attachment points for all muscle forces were obtained on the basis of the unscaled standard model with the length of the femur equal to 0.41 m. The presented model of loadings acting on the femoral bone element can be useful for the biomechanical analysis of bone development and remodelling as well as for the optimisation of implant or bone stabilizer design and pre-clinical testing.
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Affiliation(s)
- Justyna Skubich
- Bialystok University of Technology, Department of Biocybernetics and Biomedical Engineering, Bialystok, Poland.
| | - Szczepan Piszczatowski
- Bialystok University of Technology, Department of Biocybernetics and Biomedical Engineering, Bialystok, Poland.
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12
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Gee AH, Treece GM, Poole KES. How does the femoral cortex depend on bone shape? A methodology for the joint analysis of surface texture and shape. Med Image Anal 2018; 45:55-67. [PMID: 29414436 PMCID: PMC5842044 DOI: 10.1016/j.media.2018.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/24/2017] [Accepted: 01/12/2018] [Indexed: 11/19/2022]
Abstract
In humans, there is clear evidence of an association between hip fracture risk and femoral neck bone mineral density, and some evidence of an association between fracture risk and the shape of the proximal femur. Here, we investigate whether the femoral cortex plays a role in these associations: do particular morphologies predispose to weaker cortices? To answer this question, we used cortical bone mapping to measure the distribution of cortical mass surface density (CMSD, mg/cm2) in a cohort of 125 females. Principal component analysis of the femoral surfaces identified three modes of shape variation accounting for 65% of the population variance. We then used statistical parametric mapping (SPM) to locate regions of the cortex where CMSD depends on shape, allowing for age. Our principal findings were increased CMSD with increased gracility over much of the proximal femur; and decreased CMSD at the superior femoral neck, coupled with increased CMSD at the calcar femorale, with increasing neck-shaft angle. In obtaining these results, we studied the role of spatial normalization in SPM, identifying systematic misregistration as a major impediment to the joint analysis of CMSD and shape. Through a series of experiments on synthetic data, we evaluated a number of registration methods for spatial normalization, concluding that only those predicated on an explicit set of homologous landmarks are suitable for this kind of analysis. The emergent methodology amounts to an extension of Geometric Morphometric Image Analysis to the domain of textured surfaces, alongside a protocol for labelling homologous landmarks in clinical CT scans of the human proximal femur.
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Affiliation(s)
- A H Gee
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK.
| | - G M Treece
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK.
| | - K E S Poole
- Department of Medicine, University of Cambridge, Level 5, Addenbrooke's Hospital, Box 157, Hills Road, Cambridge CB2 2QQ, UK.
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13
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Heimkes B. [The great apophyses: Functional strain and relevance]. DER ORTHOPADE 2016; 45:206-212. [PMID: 26846411 DOI: 10.1007/s00132-016-3222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The structure of apophyses and apophyseal growth plates is not substantially different from those of epiphyses and epiphyseal growth plates. In contrast to epiphyseal growth plates, apophyses and apophyseal growth plates do not contribute to the longitudinal growth of the extremity. They are associated with their adjacent joints, triggering the lengths of their lever arms and influencing their external shape and internal architecture. The formative stimulus on apophyses is given by muscles and tendons inserting at the apophysis or canopying the apophsis. APOPHYSIS OF THE GREATER TROCHANTER The apophysis of the greater trochanter significantly contributes to the lever arm length of the hip joint. Its growth activity triggers the neck-shaft angle and finally the centration of the hip joint. TIBIAL APOPHYSIS The tibial apophysis interacts with the slope of the proximal tibia and hereby influences the sagittal stability of the knee joint. A damage to the growth plate of the tibial tubercle leads to an anteverted tibial slope and a genu recurvatum difficult to treat. CALCANEAL APOPHYSIS The calcaneal apophysis determines the length and position of the calcaneus and herewith influences the torque of the ankle joint. In a nutshell you may regard the apophyses as adjusting screws acting on their adjacent joints and influencing their growth, form and structure.
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Affiliation(s)
- B Heimkes
- Klinik für Kinderchirurgie, Sektion Kinderorthopädie, Klinikum Dritter Orden, München-Nymphenburg, Menzinger Str. 48, 80638, München, Deutschland.
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
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Gee AH, Treece GM, Tonkin CJ, Black DM, Poole KES. Association between femur size and a focal defect of the superior femoral neck. Bone 2015; 81:60-66. [PMID: 26142930 PMCID: PMC4640978 DOI: 10.1016/j.bone.2015.06.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 06/10/2015] [Accepted: 06/29/2015] [Indexed: 11/26/2022]
Abstract
Within each sex, there is an association between hip fracture risk and the size of the proximal femur, with larger femurs apparently more susceptible to fracture. Here, we investigate whether the thickness and density of the femoral cortex play a role in this association: might larger femurs harbour focal, cortical defects? To answer this question, we used cortical bone mapping to measure the distribution of cortical mass surface density (CMSD, mg/cm(2)) in cohorts of 308 males and 125 females. Principal component analysis of the various femoral surfaces led to a measure of size that is linearly independent from shape. After mapping the data onto a canonical femur surface, we used statistical parametric mapping to identify any regions where CMSD depends on size, allowing for other confounding covariates including shape. Our principal finding was a focal patch on the superior femoral neck, where CMSD is reduced by around 1% for each 1% increase in proximal-distal size (p<0.000005 in the males, p<0.001 in the females). This finding appears to be consistent with models of functional adaptation, and may help with the design of interventional strategies for reducing fracture risk.
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Affiliation(s)
- A H Gee
- University of Cambridge Department of Engineering, Trumpington Street, Cambridge CB2 1PZ, UK.
| | - G M Treece
- University of Cambridge Department of Engineering, Trumpington Street, Cambridge CB2 1PZ, UK.
| | - C J Tonkin
- University of Cambridge Department of Medicine, Level 5, Addenbrooke's Hospital (Box 157), Hills Road, Cambridge CB2 2QQ, UK.
| | - D M Black
- University of California, San Francisco, Department of Epidemiology and Biostatistics, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107, USA.
| | - K E S Poole
- University of Cambridge Department of Medicine, Level 5, Addenbrooke's Hospital (Box 157), Hills Road, Cambridge CB2 2QQ, UK.
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15
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Souza CGD, Souza MPGD, Jorgetti V, Reis LMD. Histomorphometric bone assessment in patients with fracture of the proximal end of the femur. ACTA ORTOPEDICA BRASILEIRA 2015; 23:103-6. [PMID: 27069410 PMCID: PMC4813410 DOI: 10.1590/1413-78522015230201056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To determine whether there is a difference on the bone architecture in patients with femoral neck fracture compared to patients with intertrochanteric fractures and assess the importance of aging on bone microarchitecture in patients with proximal femoral fracture. METHODS: Biopsy of the iliac crest was made in seventeen patients between 55 and 90 years old who were admitted to the emergency room with fractures of the proximal end of the femur. After a small fragment was removed, we made a histomorphometric analysis of it. RESULTS: There was no significant difference between patients with femoral neck fracture and trochanteric fracture in structural parameters, formation and resorption. Comparing age groups we also did not find any significant change between the groups in the parameters volume and trabecular separation. CONCLUSION: There are no difference in the morphometric parameters analyzed between the different types of fracture and age is not a significant factor in the alteration of these parameters. Level of Evidence II, Diagnostic Studies.
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