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Sun X, Han Z, Cao D, Han C, Xie M, Zeng X, Dong Q. Finite Element Analysis of Six Internal Fixations in the Treatment of Pauwels Type III Femoral Neck Fracture. Orthop Surg 2024; 16:1695-1709. [PMID: 38747083 PMCID: PMC11216836 DOI: 10.1111/os.14069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVE The current investigation sought to utilize finite element analysis to replicate the biomechanical effects of different fixation methods, with the objective of establishing a theoretical framework for the optimal choice of modalities in managing Pauwels type III femoral neck fractures. METHODS The Pauwels type III fracture configuration, characterized by angles of 70°, was simulated in conjunction with six distinct internal fixation methods, including cannulated compression screw (CCS), dynamic hip screw (DHS), DHS with de-rotational screw (DS), CCS with medial buttress plate (MBP), proximal femoral nail anti-rotation (PFNA), and femoral neck system (FNS). These models were developed and refined using Geomagic and SolidWorks software. Subsequently, finite element analysis was conducted utilizing Ansys software, incorporating axial loading, torsional loading, yield loading and cyclic loading. RESULTS Under axial loading conditions, the peak stress values for internal fixation and the femur were found to be highest for CCS (454.4; 215.4 MPa) and CCS + MBP (797.2; 284.2 MPa), respectively. The corresponding maximum and minimum displacements for internal fixation were recorded as 6.65 mm for CCS and 6.44 mm for CCS + MBP. When subjected to torsional loading, the peak stress values for internal fixation were highest for CCS + MBP (153.6 MPa) and DHS + DS (72.8 MPa), while for the femur, the maximum and minimum peak stress values were observed for CCS + MBP (119.3 MPa) and FNS (17.6 MPa), respectively. Furthermore, the maximum and minimum displacements for internal fixation were measured as 0.249 mm for CCS + MBP and 0.205 mm for PFNA. Additionally, all six internal fixation models showed excellent performance in terms of yield load and fatigue life. CONCLUSION CCS + MBP had the best initial mechanical stability in treatment for Pauwels type III fracture. However, the MBP was found to be more susceptible to shear stress, potentially increasing the risk of plate breakage. Furthermore, the DHS + DS exhibited superior biomechanical stability compared to CCS, DHS, and PFNA, thereby offering a more conducive environment for fracture healing. Additionally, it appeared that FNS represented a promising treatment strategy, warranting further validation in future studies.
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Affiliation(s)
- Xiang Sun
- Department of Hip TraumaTianjin HospitalTianjinChina
| | - Zhe Han
- Department of Hip TraumaTianjin HospitalTianjinChina
| | - Dongdong Cao
- Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Chao Han
- Department of Hip TraumaTianjin HospitalTianjinChina
| | - Mengqi Xie
- Department of Hip TraumaTianjin HospitalTianjinChina
| | - Xiantie Zeng
- Department of Foot and Ankle SurgeryTianjin HospitalTianjinChina
| | - Qiang Dong
- Department of Hip TraumaTianjin HospitalTianjinChina
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Huang C, Xu W, Ye X, Hong W, Xu Y, Liu Z, Li J. Changes in nail position and antirotation blade angles on the risk of femoral head varus in PFNA fixed patients: a clinical review and comprehensive biomechanical research. Eur J Med Res 2024; 29:336. [PMID: 38890700 PMCID: PMC11186283 DOI: 10.1186/s40001-024-01892-7] [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: 02/29/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Femoral head varus triggers poor clinical prognosis in intertrochanteric fracture patients with proximal femoral nail antirotation (PFNA) fixation. Studies present that changes in nail position and screw insertion angles will affect fixation stability, but the biomechanical significance of these factors on the risk of femoral head varus has yet to be identified in PFNA fixed patients. METHODS Clinical data in PFNA fixed intertrochanteric fracture patients have been reviewed, the relative position of intermedullary nail has been judged in the instant postoperative lateral radiography. Regression analyses have been performed to identify the effect of this factor on femoral head varus. Corresponding biomechanical mechanism has been identified by numerical mechanical simulations. RESULTS A clinical review revealed that ventral side nail insertion can trigger higher risk of femoral head varus, corresponding numerical mechanical simulations also recorded poor fixation stability in models with ventral side nail insertion, and changes in the trajectory of anti-rotation blade will not obviously affect this tendency. CONCLUSIONS Ventral side insertion of intramedullary nail can trigger higher risk of femoral head varus in PFNA fixed patients by deteriorating the instant postoperative biomechanical environment, and changes in blade trajectory cannot change this tendency biomechanically. Therefore, this nail position should be adjusted to optimize patients' prognosis.
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Affiliation(s)
- Chenyi Huang
- Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China
| | - Wenqiang Xu
- Department of Orthopaedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu Province, People's Republic of China
| | - Xiong Ye
- Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China
| | - Wanying Hong
- Department of Orthopaedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, Jiangsu Province, People's Republic of China
| | - Yue Xu
- Department of Orthopaedics, Changshu Hospital of Traditional Chinese Medicine, Changshu, 215500, Jiangsu Province, People's Republic of China
| | - Zongchao Liu
- Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China.
| | - Jingchi Li
- Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, No. 182, Chunhui Road, Luzhou, 646000, Sichuan Province, People's Republic of China.
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Zhao G, Chen W, Wu J, Ma T, Wang S, Wei Y, Xia J, Huang G. Treatment of old femoral neck fractures in young adults with a medial buttress plate combined with three cannulated screws and iliac autograft: Surgical technique and preliminary results. Orthop Traumatol Surg Res 2024; 110:103853. [PMID: 38428485 DOI: 10.1016/j.otsr.2024.103853] [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: 06/01/2023] [Revised: 12/02/2023] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES Whether the application of MBP plus cannulated screws works for old femoral neck fractures (OFNF) is unknown. The purpose of this study is to present a case series of OFNF in young adults using calcar buttress plate and three cannulated screws with autologous iliac bone grafts. METHODS We conducted a retrospective study of eleven young patients (6 males and 5 females) with femoral neck fractures who were treated with open reduction and internal fixation at a single center between 2013 and 2021. The subjects had trauma-to-surgery intervals longer than 3weeks and all were fixed with a calcar buttress plate combined with three cannulated screws, which were supplemented by autologous iliac bone grafts. RESULTS All eleven cases achieved radiological union under the surgery technique, which occurred on average at 4.46±1.29months after surgery. Complications included femoral neck shortening in all cases, heterotopic ossification in three cases, and osteonecrosis of the femoral head in two cases. One patient with osteonecrosis of the femoral head received total hip arthroplasty. In follow-ups of 24-52months, the median Harris hip score was 81.64±15.39. CONCLUSIONS The medial buttress plate in combination with three cannulated screws and iliac autograft may be a good choice for treating old femoral neck fractures in young adults. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Guanglei Zhao
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China; Fudan University, 220th Handan Road, Yang'pu District, Shanghai, China
| | - Wenjun Chen
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China; Department of Orthopaedic Surgery, North Branch of Huashan Hospital Fudan University, 518th Jingpohu Road, Bao'shan District, Shanghai, China; Fudan University, 220th Handan Road, Yang'pu District, Shanghai, China
| | - Jianguo Wu
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China; Department of Orthopaedic Surgery, North Branch of Huashan Hospital Fudan University, 518th Jingpohu Road, Bao'shan District, Shanghai, China; Fudan University, 220th Handan Road, Yang'pu District, Shanghai, China
| | - Tiancong Ma
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China; Fudan University, 220th Handan Road, Yang'pu District, Shanghai, China
| | - Siqun Wang
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China; Fudan University, 220th Handan Road, Yang'pu District, Shanghai, China
| | - Yibing Wei
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China; Fudan University, 220th Handan Road, Yang'pu District, Shanghai, China
| | - Jun Xia
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China; Fudan University, 220th Handan Road, Yang'pu District, Shanghai, China
| | - Gangyong Huang
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China; Department of Orthopaedic Surgery, North Branch of Huashan Hospital Fudan University, 518th Jingpohu Road, Bao'shan District, Shanghai, China; Fudan University, 220th Handan Road, Yang'pu District, Shanghai, China.
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Cha X, Zhou Q, Li J, Xu H, Xu W, Li J. Extending the intermedullary nail will not reduce the potential risk of femoral head varus in PFNA patients biomechanically: a clinical review and corresponding numerical simulation. BMC Musculoskelet Disord 2024; 25:405. [PMID: 38783225 PMCID: PMC11112938 DOI: 10.1186/s12891-024-07334-z] [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: 01/15/2024] [Accepted: 03/05/2024] [Indexed: 05/25/2024] Open
Abstract
Femoral head varus is an important complication in intertrochanteric fracture patients treated with proximal femoral nail anti-rotation (PFNA) fixation. Theoretically, extending the length of the intramedullary nail could optimize fixation stability by lengthening the force arm. However, whether extending the nail length can optimize patient prognosis is unclear. In this study, a review of imaging data from intertrochanteric fracture patients with PFNA fixation was performed, and the length of the intramedullary nail in the femoral trunk and the distance between the lesser trochanter and the distal locking screw were measured. The femoral neck varus status was judged at the 6-month follow-up. The correlation coefficients between nail length and femoral neck varus angle were computed, and linear regression analysis was used to determine whether a change in nail length was an independent risk factor for femoral neck varus. Moreover, the biomechanical effects of different nail lengths on PFNA fixation stability and local stress distribution have also been verified by numerical mechanical simulations. Clinical review revealed that changes in nail length were not significantly correlated with femoral head varus and were also not an independent risk factor for this complication. In addition, only slight biomechanical changes can be observed in the numerical simulation results. Therefore, commonly used intramedullary nails should be able to meet the needs of PFNA-fixed patients, and additional procedures for longer nail insertion may be unnecessary.
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Affiliation(s)
- Xiaofeng Cha
- Department of Orthopaedics, Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan Province, 646000, P.R. China
| | - Qin Zhou
- Department of Orthopaedics, Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan Province, 646000, P.R. China
| | - Jujie Li
- Department of Orthopaedics, Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan Province, 646000, P.R. China
| | - Hong Xu
- Department of Orthopaedics, Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan Province, 646000, P.R. China
| | - Wenqiang Xu
- Department of Orthopaedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China.
| | - Jingchi Li
- Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan Province, P.R. China.
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Lang JJ, Li X, Micheler CM, Wilhelm NJ, Seidl F, Schwaiger BJ, Barnewitz D, von Eisenhart-Rothe R, Grosse CU, Burgkart R. Numerical evaluation of internal femur osteosynthesis based on a biomechanical model of the loading in the proximal equine hindlimb. BMC Vet Res 2024; 20:188. [PMID: 38730373 PMCID: PMC11084081 DOI: 10.1186/s12917-024-04044-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
Femoral fractures are often considered lethal for adult horses because femur osteosynthesis is still a surgical challenge. For equine femur osteosynthesis, primary stability is essential, but the detailed physiological forces occurring in the hindlimb are largely unknown. The objective of this study was to create a numerical testing environment to evaluate equine femur osteosynthesis based on physiological conditions. The study was designed as a finite element analysis (FEA) of the femur using a musculoskeletal model of the loading situation in stance. Relevant forces were determined in the musculoskeletal model via optimization. The treatment of four different fracture types with an intramedullary nail was investigated in FEA with loading conditions derived from the model. The analyzed diaphyseal fracture types were a transverse (TR) fracture, two oblique fractures in different orientations (OB-ML: medial-lateral and OB-AP: anterior-posterior) and a "gap" fracture (GAP) without contact between the fragments. For the native femur, the most relevant areas of increased stress were located distally to the femoral head and proximally to the caudal side of the condyles. For all fracture types, the highest stresses in the implant material were present in the fracture-adjacent screws. Maximum compressive (-348 MPa) and tensile stress (197 MPa) were found for the GAP fracture, but material strength was not exceeded. The mathematical model was able to predict a load distribution in the femur of the standing horse and was used to assess the performance of internal fixation devices via FEA. The analyzed intramedullary nail and screws showed sufficient stability for all fracture types.
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Affiliation(s)
- Jan J Lang
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany.
- Chair of Non-destructive Testing, TUM School of Engineering and Design, Technical University of Munich, Munich, Germany.
| | - Xinhao Li
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Carina M Micheler
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Institute for Machine Tools and Industrial Management, TUM School of Engineering and Design, Technical University of Munich, Munich, Germany
| | - Nikolas J Wilhelm
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Munich Institute of Robotics and Machine Intelligence, Department of Electrical and Computer Engineering, Technical University of Munich, Munich, Germany
| | - Fritz Seidl
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Diagnostic and Interventional Neuroradiology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Dirk Barnewitz
- Equine Clinic of the Research Centre for Medical Technology and Biotechnology, Bad Langensalza, Germany
| | - Ruediger von Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian U Grosse
- Chair of Non-destructive Testing, TUM School of Engineering and Design, Technical University of Munich, Munich, Germany
| | - Rainer Burgkart
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
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Zhang J, Wan S, Luo X, Zhang C, Wu C, He L, Li J. Increasing the angle between caudal screw and the transverse plane may aggravate the risk of femoral head necrosis by deteriorating the fixation stability in patients with femoral neck fracture. Eur J Med Res 2024; 29:170. [PMID: 38475888 DOI: 10.1186/s40001-024-01737-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Necrosis of the femoral head is the main complication in femoral neck fracture patients with triangle cannulated screw fixation. Instant postoperative fixation instability is a main reason for the higher risk of femoral head necrosis. Biomechanical studies have shown that cross screw fixation can effectively optimize fixation stability in patients with proximal humerus fractures and pedicle screw fixation, but whether this method can also effectively optimize the fixation stability of femoral neck fractures and reduce the corresponding risk of femoral head necrosis has yet to be identified. In this study, a retrospective review of imaging data in femoral neck fracture patients was performed. The cross angle between the femoral neck and the caudal cannulated screw was reported; if the angle between the screw and the transverse plane increased, it was recorded as positive; otherwise, it was recorded as negative. Angle values and their corresponding absolute values were compared in patients with and without femoral head necrosis. Regression analysis identified potential risk factors for femoral head necrosis. Moreover, the biomechanical effect of the screw-femoral neck angle on fixation stability was also verified by numerical mechanical simulations. Clinical review presented significantly larger positive angle values in patients with femoral head necrosis, which was also proven to be an independent risk factor for this complication. Moreover, fixation stability progressively deteriorated with increasing angle between the caudal screw and the transverse plane. Therefore, increasing the angle between the caudal screw and the transverse plane may aggravate the risk of femoral head necrosis by deteriorating the fixation stability in patients with femoral neck fracture.
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Affiliation(s)
- Jian Zhang
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, People's Republic of China
| | - Shengyu Wan
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, People's Republic of China
| | - Xiaozhong Luo
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, People's Republic of China
| | - Caidong Zhang
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, People's Republic of China
| | - Chao Wu
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, People's Republic of China
| | - Lipeng He
- Department of Orthopaedics, Wuxi Hospital of Traditional Chinese Medicine, Wuxi, 214000, Jiangsu, People's Republic of China.
| | - Jingchi Li
- Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, NO.182, Chunhui Road, Longmatan District, Luzhou, 646000, Sichuan, People's Republic of China.
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Jung GH, Jeong SL. Reply to 'Letter to the Editor concerning "Structure-mechanical analysis of various fixation constructs for basicervical fractures of the proximal femur and clinical implications; finite element analysis"'. Injury 2024; 55:111380. [PMID: 38306879 DOI: 10.1016/j.injury.2024.111380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Affiliation(s)
- Gu-Hee Jung
- Institute of Medical Sciences (Medical ICT convergence research center), College of Medicine, Gyeongsang National University, Jinju, Republic of Korea; Department of Orthopaedic Surgery, Gyeongsang National University, College of Medicine and Gyeongsang National University Changwon Hospital, 1, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51472, Republic of Korea.
| | - Se-Lin Jeong
- Institute of Medical Sciences (Medical ICT convergence research center), College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
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Zhan S, Jiang D, Hu Q, Wang M, Feng C, Jia W, Hu H, Niu W. Single-plane osteotomy model is inaccurate for evaluating the optimal strategy in treating vertical femoral neck fractures: A finite element analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 245:108036. [PMID: 38244341 DOI: 10.1016/j.cmpb.2024.108036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND AND OBJECTIVES The conventional method for simulating vertical femoral neck fractures (vFNFs) is via a vertical single-plane osteotomy (SPO) across the entire femur. However, the accuracy of SPO for evaluating the optimal internal fixation strategy (IFS) and the appropriate assessment parameters is not clear. This study thus aimed to examine the accuracy of SPO in evaluating IFSs and to identify appropriate evaluation parameters using finite element analysis. METHODS Eighty patient-specific finite element models were developed based on CT images from eight vFNF patients. The natural fracture model was built using structural features of the affected side, while the SPO was simulated on the healthy side. Five different IFSs were applied to both the natural fracture and SPO groups. Thirteen parameters, including stress, displacement, and stiffness, were subjected to a two-way repeated measures ANOVA to determine the effect of IFSs and fracture morphology on stability. A Pearson correlation analysis was performed on varied parameters with various IFSs to identify independent parameters. Based on these independent parameters, the entropy evaluation method (EEM) score was used to rank the performance of IFSs for each patient. RESULTS Eight of the thirteen parameters were significantly influenced by IFSs (p < 0.05), two by fracture morphology (p < 0.01), and none by the interaction between IFS and fracture morphology. In the natural fracture group, parameters including screw stress and displacement, bone cut rate (BCR), and compression effects varied independently with distinct IFSs. In the SPO group, trunk displacement, BCR, cut-out risk, and compression effects parameters changed independently. The BCR of the Alpha strategy was significantly higher than that of the Inverted strategy in the natural fracture group (p = 0.002), whereas the opposite was observed in the SPO group (p = 0.016). Regarding compression effects, two IFS pairings in the natural fracture group and seven IFS pairings in the SPO group exhibited significant differences. None of the five IFSs achieved the optimal EEM score for each patient. CONCLUSIONS The single-plane osteotomy model may have limitations in assessing IFSs, particularly when the bone cut rate and compression effects are the main influencing factors. Parameters of the screw stress and displacement, BCR, and compression effects appear to be relevant in evaluating IFSs for natural fracture models. It indicates that individualized natural fracture models could provide more comprehensive insights for determining the optimal IFS in treating vFNFs.
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Affiliation(s)
- Shi Zhan
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, PR China; Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, PR China
| | - Dajun Jiang
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, PR China
| | - Qingxiang Hu
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, PR China
| | - Miao Wang
- College of Communication and Information Technology, Shanghai Technical Institute of Electronics Information, Shanghai, PR China
| | - Chenglong Feng
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, PR China
| | - Weitao Jia
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, PR China
| | - Hai Hu
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, PR China.
| | - Wenxin Niu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, PR China.
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Wang C, Duan N, Li Z, Ma T, Zhang K, Wang Q, Huang Q. Biomechanical evaluation of a new intramedullary nail compared with proximal femoral nail antirotation and InterTAN for the management of femoral intertrochanteric fractures. Front Bioeng Biotechnol 2024; 12:1353677. [PMID: 38464545 PMCID: PMC10920256 DOI: 10.3389/fbioe.2024.1353677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/19/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose: Surgical treatment is the main treatment method for femoral intertrochanteric fractures (FIFs), however, there are lots of implant-related complications after surgery. Our team designed a new intramedullary nail (NIN) to manage such fractures. The purpose of this study was to introduce this new implant and compare it with proximal femoral nail antirotation (PFNA) and InterTAN for treating FIFs. Methods: An AO/OTA 31-A1.3 FIF model was built and three fixation models were created via finite element method, comprising PFNA, InterTAN, and the NIN. Vertical, anteroposterior (A-P) bending, and torsional loads were simulated and applied to the three fixation models. Displacement and stress distribution were monitored. In order to compare PFNA and the NIN deeply, finite element testing was repeated for five times in vertical load case. Results: The finite element analysis (FEA) data indicated that the NIN possessed the most outstanding mechanical properties among the three fixation models. The NIN model had lower maximal stress at implants compared to PFNA and InterTAN models under three load conditions. The trend of maximal stress at bones was similar to that of maximal stress at implants. Besides, the NIN model showed smaller maximal displacement compared with PFNA and InterTAN models under vertical, A-P bending, and torsional load cases. The trend for maximal displacement of fracture surface (MDFS) was almost identical with that of maximal displacement. In addition, there was significant difference between the PFNA and NIN groups in vertical load case (p < 0.05). Conclusion: Compared with PFNA and InterTAN, the NIN displayed the best mechanical properties for managing FIFs, including the lowest von Mises stress at implants and bones, and the smallest maximal displacement and MDFS under vertical, A-P bending, and torsional load cases. Therefore, this study might provide a new choice for patients with FIFs.
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Affiliation(s)
| | | | | | | | | | - Qian Wang
- Department of Orthopedics, Hong Hui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Qiang Huang
- Department of Orthopedics, Hong Hui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Lu H, Tan X, Shen H. Letter to the editor concerning "structure-mechanical analysis of various fixation constructs for basicervical fractures of the proximal femur and clinical implications; finite element analysis". Injury 2024; 55:111246. [PMID: 38048676 DOI: 10.1016/j.injury.2023.111246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/25/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Hui Lu
- Department of Orthopedic, Chongqing University Jiangjin Hospital(Jiang Jin Central Hospital of Chongqing), 725 Jiangzhou Avenue, Jiang Jin District, Chongqing 402260, China
| | - Xi Tan
- Chongqing Huiqian Technology Co., Ltd., Chongqing, 401147 China
| | - Hongquan Shen
- Department of Orthopedic, Chongqing University Jiangjin Hospital(Jiang Jin Central Hospital of Chongqing), 725 Jiangzhou Avenue, Jiang Jin District, Chongqing 402260, China.
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Fan X, Zhou Y, Dai S, Lao K, Zhang Q, Yu T. Bio-mechanical effects of femoral neck system versus cannulated screws on treating young patients with Pauwels type III femoral neck fractures: a finite element analysis. BMC Musculoskelet Disord 2024; 25:83. [PMID: 38245678 PMCID: PMC10799488 DOI: 10.1186/s12891-023-07110-5] [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: 10/13/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION As a novel internal fixation for femoral neck fractures, the femoral neck system has some advantages for young Pauwels type III femoral neck fractures without clear biomechanical effects and mechanisms. Thus, the objection of the study is to realize the biomechanical effects and mechanism of FNS cannulated screws on treating young patients with Pauwels type III femoral neck fractures compared to cannulated screws which are commonly used for femoral neck fractures by finite element analysis. METHODS Firstly, the model of young Pauwels type III femoral neck fractures, femoral neck system (FNS), and three cannulated screws (CS) arranged in an inverted triangle were established, and the internal fixations were set up to fix young Pauwels type III femoral neck fractures. Under 2100 N load, the finite element was performed, and the deformation, peak von Mises stress (VMS), and contact at fracture segments were recorded to analyze the biomechanical effects and mechanism of FNS and three-CS fixing young Pauwels type III femoral neck fractures. RESULTS Compared to three-CS, the deformation of the whole model, internal fixation, and fracture segments after FNS fixation were lower, and the peak VMS of the whole model and the internal fixation after FNS were higher with lower peak VMS of the distal femur and the fracture segments. With a sticking contact status, the contact pressure at fracture segments after FNS fixation was lower than that of three-CS. CONCLUSIONS FNS can provide better mechanical effects for young patients with Pauwels type III femoral neck fractures, which may be the mechanical mechanism of the clinical effects of FNS on femoral neck fracture. Although there is high stress on FNS, it is still an effective and safe internal fixation for young patients with Pauwels type III femoral neck fractures.
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Affiliation(s)
- Xiao Fan
- Qingdao Municipal Hospital, Qingdao, Shandong, 266011, China
| | - Yimin Zhou
- Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine, Beijing, 100007, China
| | - Shiyou Dai
- Qingdao Municipal Hospital, Qingdao, Shandong, 266011, China
| | - Kecheng Lao
- Qingdao Municipal Hospital, Qingdao, Shandong, 266011, China
| | - Qiliang Zhang
- Qingdao Municipal Hospital, Qingdao, Shandong, 266011, China.
| | - Tengbo Yu
- Qingdao Municipal Hospital, Qingdao, Shandong, 266011, China.
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Bai H, Liu L, Duan N, Xue H, Sun L, Li M, Li Z, Zhang K, Wang Q, Huang Q. Biomechanical evaluation of three implants for treating unstable femoral intertrochanteric fractures: finite element analysis in axial, bending and torsion loads. Front Bioeng Biotechnol 2023; 11:1279067. [PMID: 38026862 PMCID: PMC10661970 DOI: 10.3389/fbioe.2023.1279067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose: How to effectively enhance the mechanical stability of intramedullary implants for unstable femoral intertrochanteric fractures (UFIFs) is challenging. The authors developed a new implant for managing such patients. Our aim was to enhance the whole mechanical stability of internal devices through increasing antirotation and medial support. We expected to reduce stress concentration in implants. Each implant was compared to proximal femoral nail antirotation (PFNA) via finite element method. Methods: Adult AO/OTA 31-A2.3 fracture models were constructed, and then the new intramedullary system (NIS), PFNA, InterTan nail models were assembled. We simulated three different kinds of load cases, including axial, bending, and torsion loads. For further comparison of PFNA and the NIS, finite element analysis (FEA) was repeated for five times under axial loads of 2100 N. Two types of displacement and stress distribution were assessed. Results: Findings showed that the NIS had the best mechanical stability under axial, bending, and torsion load conditions compared to PFNA and InterTan. It could be seen that the NIS displayed the best properties with respect to maximal displacement while PFNA showed the worst properties for the same parameter in axial loads of 2100 N. In terms of maximal stress, also the NIS exhibited the best properties while PFNA showed the worst properties in axial loads of 2100 N. For bending and torsion load cases, it displayed a similar trend with that of axial loads. Moreover, under axial loads of 2100 N, the difference between the PFNA group and the NIS group was statistically significant (p < 0.05). Conclusion: The new intramedullary system exhibited more uniform stress distribution and better biomechanical properties compared to the PFNA and InterTan. This might provide a new and efficacious device for managing unstable femoral intertrochanteric fractures.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Qian Wang
- Department of Orthopedics, Hong Hui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Qiang Huang
- Department of Orthopedics, Hong Hui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Zhang Q, Chen Z, Peng Y, Jin Z, Qin L. The novel magnesium-titanium hybrid cannulated screws for the treatment of vertical femoral neck fractures: Biomechanical evaluation. J Orthop Translat 2023; 42:127-136. [PMID: 37680903 PMCID: PMC10480783 DOI: 10.1016/j.jot.2023.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/14/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023] Open
Abstract
Background Conventional cannulated screws are commonly used for internal fixation in the treatment of vertical femoral neck fractures. However, the noticeably high rates of undesirable outcomes such as nonunion, malunion, avascular necrosis, and fixation failure still troubled the patients and surgeons. It is urgent to develop new cannulated screws to improve the above clinical problems. The purpose of this study was to design a novel magnesium-titanium hybrid cannulated screw and to further evaluate its biomechanical performance for the treatment of vertical femoral neck fractures. Methods A novel magnesium-titanium hybrid cannulated screw was designed, and the conventional titanium cannulated screw was also modeled. The finite element models for vertical femoral neck fractures with magnesium-titanium hybrid cannulated screws and conventional cannulated screws were respectively established. The hip joint contact force during walking gait calculated by a subject-specific musculoskeletal multibody dynamics model, was used as loads and boundary conditions for both finite element models. The stress and displacement distributions of the cannulated screws and the femur, the micromotion of the fracture surfaces of the femoral neck, and the overall stiffness were calculated and analyzed using finite element models. The biomechanical performance of the Magnesium-Titanium hybrid cannulated screws was evaluated. Results The maximum stresses of the magnesium-titanium hybrid cannulated screws and the conventional cannulated screws were 451.5 MPa and 476.8 MPa, respectively. The maximum stresses of the femur with the above different cannulated screws were 140.3 MPa and 164.8 MPa, respectively. The maximum displacement of the femur with the hybrid cannulated screws was 6.260 mm, lower than the femur with the conventional cannulated screws, which was 7.125 mm. The tangential micromotions in the two orthogonal directions at the fracture surface of the femoral neck with the magnesium-titanium hybrid cannulated screws were comparable to those with the conventional cannulated screws. The overall stiffness of the magnesium-titanium hybrid cannulated screw system was 490.17 N/mm, higher than that of the conventional cannulated screw system, which was 433.92 N/mm. Conclusion The magnesium-titanium hybrid cannulated screw had superior mechanical strength and fixation stability for the treatment of the vertical femoral neck fractures, compared with those of the conventional cannulated screw, indicating that the magnesium-titanium hybrid cannulated screw has great potential as a new fixation strategy in future clinical applications.The translational potential of this article: This study highlights an innovative design of the magnesium-titanium hybrid cannulated screw for the treatment of vertical femoral neck fractures. The novel magnesium-titanium hybrid cannulated screw not only to provide sufficient mechanical strength and fixation stability but also to contribute to the promotion of fracture healing, which could provide a better treatment for the vertical femoral neck fractures, beneficially reducing the incidence of nonunion and reoperation rates.
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Affiliation(s)
- Qida Zhang
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Zhenxian Chen
- Key Laboratory of Road Construction Technology and Equipment (Ministry of Education), School of Mechanical Engineering, Chang'an University, Xi'an, China
| | - Yinghu Peng
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences, Shenzhen, China
| | - Zhongmin Jin
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong
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Zhong Z, Lan X, Xiang Z, Duan X. Femoral neck system and cannulated compression screws in the treatment of non-anatomical reduction Pauwels type-III femoral neck fractures: A finite element analysis. Clin Biomech (Bristol, Avon) 2023; 108:106060. [PMID: 37536196 DOI: 10.1016/j.clinbiomech.2023.106060] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND High shear force is a major factor detrimental to the healing of vertical femoral neck fractures. In addition to firm fixation, reduction quality is crucial for postoperative stability. The present study aimed to compare the biomechanical stability of the newly invented femoral neck system and three inverted-triangle cannulated compression screws treatments for non-anatomical reduction of Pauwels type-III femoral neck fractures. METHODS A total of 18 non-anatomical reduction Pauwels type-III femoral neck fracture finite element models were fabricated and fixed using three inverted-triangle cannulated compression screws or the femoral neck system. A 1950-N force was applied to the femoral head to simulate the physiological load during a single-leg stance. Parameters of the maximum total deformation, the interfragmentary gap, and the maximum von Mises stress of the implants and the proximal femur were analyzed. FINDINGS The results of the maximum total deformation, interfragmentary gap, and maximum von Mises stress of the implants in the negative-negative buttress model fixed by the femoral neck system were the largest among all groups (3.58 mm, 0.252 mm, and 729.68 MPa, respectively). In contrast, the anatomical-anatomical reduction model fixed by three inverted-triangle cannulated compression screws demonstrated the minimum total deformation, interfragmentary gap, and minimum von Mises stress of implants (1.107 mm, 0.09 mm, and 189.83 MPa, respectively). INTERPRETATION Anatomical reduction or positive buttress in femoral neck fractures should be recommended during fracture reduction. The femoral neck system showed weaker biomechanical stability than three inverted-triangle cannulated compression screws in treating Pauwels type-III femoral neck fractures.
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Affiliation(s)
- Zhou Zhong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, China
| | - Xuejun Lan
- Department of Health Management Center, General Practice Center, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, China
| | - Zhou Xiang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, China.
| | - Xin Duan
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, China; Department of Orthopedic Surgery, Sichuan Fifth People's Hospital, Chengdu 610000, China.
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Luo B, Wang Y, Wang D. Effect of buttress plate in Herscovici type D vertical medial malleolar fractures and peripheral fractures: a retrospective comparative cohort study. J Orthop Surg Res 2023; 18:411. [PMID: 37280598 DOI: 10.1186/s13018-023-03889-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/29/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The purpose of current retrospective study was to review the surgical methods and to evaluate the clinical efficacy of supporting plate for the treatment of vertical medial malleolus fractures on the basis of stable fixation of ipsilateral fibula. METHODS This retrospective study included a total of 191 patients with vertical medial malleolus fractures. Patients enrolled were divided into simple vertical medial malleolus fractures and complex types of fractures. General demographic information and surgical information, including age, sex, surgical procedure and postoperative complications, were collected. The functional prognosis of patients was evaluated by American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS) and Visual Analog Scale (VAS). RESULT Among patients with simple vertical fractures, the respective incidence of internal fixation failure in screw group, buttress plate group, and screw combined buttress plate fixation group (combined fixation group) was 10/61 (16.4%),1/54 (7.4%) and 1 (1.9%), and the difference was statistically significant (P = 0.024). The incidence of abnormal fracture growth and healing in screw group, buttress plate group and combined fixation group was, respectively, 13/61 (21.3%), 6/54 (12.5%) and 2 (3.85%), with statistically significant difference (P = 0.019). In the patients with complex types of fractures, after 2 years of postoperative follow-up, the AOFAS score and VAS score of the following subgroups had good results: 91.18 ± 6.05 and 2.18 ± 1.08 in patients with joint surface collapse, and 92.50 ± 4.80 and 2.50 ± 1.29 in patients with tibial fractures, with 100% excellent and good rate. CONCLUSION For simple and complex vertical medial malleolus fractures, buttress plate showed excellent fixation. Despite poor wound healing and extensive soft tissue dissection with this approach, buttress plate may provide a novel insight into medial malleolar fractures, especially for extremely unstable medial malleolar fractures.
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Affiliation(s)
- Bing Luo
- Weifang Medical University, No. 7166 Baotong West Street, Weicheng District, Weifang, 261053, China
| | - Yuqi Wang
- Jinzhou Medical University, Jinzhou, China
| | - Dewei Wang
- Weifang Medical University, No. 7166 Baotong West Street, Weicheng District, Weifang, 261053, China.
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Nan C, Li Y, Liu Y, Ma L, Ma Z. Biomechanical comparison of femoral neck system and cannulated screws coupled with medial plate for treating Pauwels III femoral neck fractures. Technol Health Care 2023:THC220267. [PMID: 36872803 DOI: 10.3233/thc-220267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND The femoral neck system (FNS) has been considered as a novel strategy for femoral neck fracture. The diversity of internal fixation creates difficulties in choosing an effective option for Pauwels III type femoral neck fractures. Therefore, it is significant to investigate the biomechanical effects of FNS versus conventional approaches on bones. OBJECTIVE To evaluate the biomechanical characteristics of FNS versus cannulated screws coupled with medial plate (CSS+MP) for the treatment of Pauwels III type femoral neck fractures. METHODS Through three-dimensional computer software (Minics, Geomagic - Warp), the proximal femur model was rebuilt. Based on the present clinical characteristics, models of internal fixation were reconstructed in SolidWorks, including cannulated screws (CSS), medial plate (MP) and FNS. After parameter setting and meshing, boundary conditions and loads were set up for the final mechanical calculation in Ansys Software. Under identical experimental conditions, such as the same Pauwels angle and force loading, the peak values of displacement, shear stress and equivalent (von Mises) stress were recorded. RESULTS This study showed that the displacement of the models was CSS, CSS+MP, and FNS in descending order of magnitude. The shear stress and equivalent stress of the models was CSS+MP, FNS, and CSS in descending order. The principal shear stress of CSS+MP was concentrated on the medial plate. The equivalent stress of FNS was more dispersed and distributed from the proximal main nail to the distal locking screw. CONCLUSION CSS+MP and FNS exhibited better initial stability compared to CSS. However, the MP was subjected to more shear stress, which could increase the risk of internal fixation failure. Due to its unique design, FNS may be a good choice for the treatment of Pauwels III type femoral neck fractures.
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Affiliation(s)
- Chong Nan
- Department of Orthopedics, Baoding No.1 Central Hospital, Baoding, Hebei, China.,Department of Orthopedics, Baoding No.1 Central Hospital, Baoding, Hebei, China
| | - Yanjun Li
- Department of Orthopedics, Baoding No.1 Central Hospital, Baoding, Hebei, China.,Department of Orthopedics, Baoding No.1 Central Hospital, Baoding, Hebei, China
| | - Yuxiu Liu
- Department of Neurosurgery, Baoding No.1 Central Hospital, Baoding, Hebei, China
| | - Liang Ma
- Department of Orthopedics, Baoding No.1 Central Hospital, Baoding, Hebei, China
| | - Zhanbei Ma
- Department of Orthopedics, Baoding No.1 Central Hospital, Baoding, Hebei, China
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Fan Z, Chen P, Yu X, Li X, Su H, Chen H, Yang B, Qi J, Wang H. Biomechanical study of femoral neck system for young patients with nonanatomically reduced femoral neck fractures: a finite element. BMC Musculoskelet Disord 2023; 24:54. [PMID: 36681804 PMCID: PMC9862848 DOI: 10.1186/s12891-022-06124-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/30/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND A consensus regarding the optimal approach for treating femoral neck fractures is lacking. We aimed to investigate the biomechanical outcomes of Femoral Neck System (FNS) internal fixation components in the treatment of nonanatomically reduced femoral neck fractures. METHOD We constructed two types of femoral neck fractures of the Pauwels classification with angles of 30° and 50°, and three models of anatomic reduction, positive buttress reduction and negative buttress reduction were constructed. Subgroups of 1 to 4 mm were divided according to the distance of displacement in the positive buttress reduction and negative buttress reduction models. The von Mises stress and displacements of the femur and FNS internal fixation components were measured for each fracture group under 2100-N axial loads. RESULTS When the Pauwels angle was 30°, the positive 1-mm and 2-mm models had lower FNS stress than the negative buttress model. The positive 3- and 4-mm models showed FNS stress similar to that of the negative buttress model. But the four positive buttress models had similar stresses on the femur as the negative buttress model. When the Pauwels angle was 50°, the four positive buttress models had higher FNS stress than the negative buttress model. Three positive buttress models (2 mm, 3 and 4 mm) resulted in lower stress of the femur than the negative buttress model, though the 1-mm model did not. When the Pauwels angle was 30°, the positive buttress model had a lower displacement of the FNS than the negative buttress model and a similar displacement of the femur with the negative buttress model. When the Pauwels angle was 50°, the positive buttress model had a higher displacement of the FNS and femur than the negative buttress model. Our study also showed that the von Mises stress and displacement of the internal fixation and the femur increased as the fracture angle increased. CONCLUSION From the perspective of biomechanics, when the Pauwels angle was 30°, positive buttress was more stable to negative buttress. However, when the Pauwels angle was 50°, this advantage weakens. In our opinion, the clinical efficacy of FNS internal fixation with positive buttress may be related to the fracture angle, neck-shaft angle and alignment in the lateral view. This result needs verification in further clinical studies.
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Affiliation(s)
- Zhirong Fan
- grid.413402.00000 0004 6068 0570Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, 510006 Guangzhou, China
| | - Ping Chen
- grid.413402.00000 0004 6068 0570Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, 510006 Guangzhou, China
| | - Xiubing Yu
- grid.413402.00000 0004 6068 0570Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, 510006 Guangzhou, China
| | - Xing Li
- grid.413402.00000 0004 6068 0570Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, 510006 Guangzhou, China
| | - Haitao Su
- grid.413402.00000 0004 6068 0570Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, 510006 Guangzhou, China
| | - Haiyun Chen
- grid.413402.00000 0004 6068 0570Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, 510006 Guangzhou, China
| | - Bing Yang
- grid.413402.00000 0004 6068 0570Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, 510006 Guangzhou, China
| | - Ji Qi
- grid.413402.00000 0004 6068 0570Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, 510006 Guangzhou, China
| | - Haizhou Wang
- grid.413402.00000 0004 6068 0570Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, 510006 Guangzhou, China
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Xu G, Wang D, Zhang H, Xu C, Li H, Zhang W, Li J, Zhang L, Tang P. Prediction of osteoporosis from proximal femoral cortical bone thickness and Hounsfield unit value with clinical significance. Front Surg 2023; 9:1047603. [PMID: 36684322 PMCID: PMC9852615 DOI: 10.3389/fsurg.2022.1047603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/07/2022] [Indexed: 01/07/2023] Open
Abstract
Background Utilizing dual-energy x-ray absorptiometry (DXA) to assess bone mineral density (BMD) was not routine in many clinical scenarios, leading to missed diagnoses of osteoporosis. The objective of this study is to obtain effective parameters from hip computer tomography (CT) to screen patients with osteoporosis and predict their clinical outcomes. Methods A total of 375 patients with hip CT scans for intertrochanteric fracture were included. Among them, 56 patients possessed the data of both hip CT scans and DXA and were settled as a training group. The cortical bone thickness (CTh) and Hounsfield unit (HU) values were abstracted from 31 regions of interest (ROIs) of the proximal femur. In the training group, the correlations between these parameters and BMD were investigated, and their diagnostic efficiency of osteoporosis was assessed. Finally, 375 patients were divided into osteoporotic and nonosteoporotic groups based on the optimal cut-off values, and the clinical difference between subgroups was evaluated. Results The CTh value of ROI 21 and the HU value of ROI 14 were moderately correlated with the hip BMD [r = 0.475 and 0.445 (p < 0.001), respectively]. The best diagnostic effect could be obtained by defining osteoporosis as CTh value < 3.19 mm in ROI 21 or HU value < 424.97 HU in ROI 14, with accuracies of 0.821 and 0.883, sensitivities of 84% and 76%, and specificities of 71% and 87%, respectively. The clinical outcome of the nonosteoporotic group was better than that of the osteoporotic group regardless of the division criteria. Conclusion The CTh and HU values of specific cortex sites in the proximal femur were positively correlated with BMD of DXA at the hip. Thresholds for osteoporosis based on CTh and HU values could be utilized to screen osteoporosis and predict clinical outcomes.
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Affiliation(s)
- Gaoxiang Xu
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China,Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese PLA General Hospital, Beijing, China
| | - Daofeng Wang
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China,Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese PLA General Hospital, Beijing, China
| | - Hao Zhang
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese PLA General Hospital, Beijing, China
| | - Cheng Xu
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese PLA General Hospital, Beijing, China
| | - Hua Li
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese PLA General Hospital, Beijing, China
| | - Wupeng Zhang
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese PLA General Hospital, Beijing, China,School of Medicine, Nankai University, Tianjin, China
| | - Jiantao Li
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese PLA General Hospital, Beijing, China,Correspondence: Peifu Tang Licheng Zhang Jiantao Li
| | - Licheng Zhang
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese PLA General Hospital, Beijing, China,Correspondence: Peifu Tang Licheng Zhang Jiantao Li
| | - Peifu Tang
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese PLA General Hospital, Beijing, China,Correspondence: Peifu Tang Licheng Zhang Jiantao Li
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Wang F, Liu Y, Huo Y, Wang Z, Zhang J, Xu M, Ma K, Wang L, Lu Y, Cheng L, Zhao D. Biomechanical study of internal fixation methods for femoral neck fractures based on Pauwels angle. Front Bioeng Biotechnol 2023; 11:1143575. [PMID: 36937751 PMCID: PMC10020692 DOI: 10.3389/fbioe.2023.1143575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Objective: To select the most appropriate internal fixation method based on the Pauwels angle, in order to provide a new concept for clinical accurate treatment of femoral neck fractures (FNFs). Methods: FNFs models of Pauwels 30 ° ; 40 ° ; 50 ° ; 60 ° were created respectively. For Pauwels ≤ 50 ° , 1, 2 and 3 Cannulated Compression Screws (CCS) and Porous Tantalum Screws (PTS) were used to fix the fracture for the models. For Pauwels 60 ° , 3CCS and Medial Buttress Plate (MBP) combined with 1, 2 and 3CCS were used to fix the fracture. Based on the results of the finite element (FE) analysis, the biomechanical properties of each model were compared by analyzing and evaluating the following four parameters: maximal stress of the bone (MBS), maximal stress of the implants (MIS), maximal displacement of bone (MBD), interfragmentary motion (IFM). Results: At Pauwels 30 ° , the larger parameters were found in 1CCS, which was 94.8 MPa (MBS), 307.7 MPa (MIS), 0.86 mm (MBD) and 0.36 mm (IFM). In 2CCS group, the parameters were 86.1 MPa (MBS), 254.4 MPa (MIS), 0.73 mm (MBD) and 0.27 mm (IFM), which were similar to those of PTS. At Pauwels 40 ° ; 50 ° , with the increase of the number of used CCS, accordingly, the parameters decreased. Particularly, the MIS (Pauwels 50 ° ) of 1CCS was 1,195.3 MPa, but the other were less than the yield range of the materials. At Pauwels 60 ° , the MBS of 3CCS group was 128.6 Mpa, which had the risk of failure. In 2CCS + MBP group, the parameters were 124.2 MPa (MBS), 602.5 MPa (MIS), 0.75 mm (MBD) and 0.48 mm (IFM), The model stability was significantly enhanced after adding MBP. Conclusion: Pauwels type Ⅰ (< 30 ° ) fractures can reduce the number of CCS, and PTS is an appropriate alternative treatment. For Pauwels type Ⅱ fractures ( 30 ° ∼ 50 ° ), the 3CCS fixation method is still recommended. For Pauwels type Ⅲ fractures (> 50 ° ), it is recommended to add MBP to the medial femoral neck and combine with 2CCS to establish a satisfactory fracture healing environment.
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Affiliation(s)
- Fuyang Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yuchen Liu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yi Huo
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Ziming Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jinge Zhang
- Department of anesthesiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Minghao Xu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Kaiming Ma
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Linbao Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yongtao Lu
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Liangliang Cheng
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
- *Correspondence: Dewei Zhao, ; Liangliang Cheng,
| | - Dewei Zhao
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
- *Correspondence: Dewei Zhao, ; Liangliang Cheng,
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20
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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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21
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Fan ZY, Shu LY, Jin YZ, Sherrier MC, Yin BH, Liu CJ, Zhan S, Sun H, Zhang W. Biomechanical evaluation of compression buttress screw and medial plate fixation for the treatment of vertical femoral neck fractures. Injury 2022; 53:3887-3893. [PMID: 36195517 DOI: 10.1016/j.injury.2022.09.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the biomechanical properties of compression buttress screw (CBS) fixation with three plate fixation methods for the treatment of vertical femoral neck fractures (FNFs). METHODS A total of forty synthetic femoral models with simulated Pauwels type III fractures (angle of 70°) were equally assigned to one of four fixation groups: CBS fixation, anteromedial plate fixation (AMP), medial buttress plate fixation (MBP) and medial buttress plate fixation without proximal screw (MBPw). Within each group, half of the specimens were randomly assigned to two loading settings, an axial compression loading test and a hip-flexion torsion test. RESULTS There were no significant differences in axial load to failure, axial stiffness, torsional strength, or torsional stiffness when comparing CBS with MBP (p>0.05). In the axial compression loading test, both CBS and MBP showed higher load to failure and axial stiffness than MBPw (p<0.05). In torsional testing, AMP exhibited superior torsional strength and torsional stiffness than both MBPw and MBP (all p<0.05) and a higher torsional strength than CBS fixation (p<0.05). There were no significant differences in torsional stiffness between the CBS and AMP fixation groups (p>0.05). CONCLUSION The biomechanical parameters of CBS fixation are comparable to that of AMP and MBP, and demonstrate superior axial stiffness than MBPw fixation. Although the CBS method for surgical fixation of vertical FNF holds promise as a less invasive surgical technique than plate fixation with similar biomechanical assessments, further clinical evaluation is warranted.
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Affiliation(s)
- Zhi-Yuan Fan
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Lin-Yuan Shu
- Department of Emergency Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Ying-Zhe Jin
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Matthew C Sherrier
- Department of Orthopaedic and Physical Medicine, Medical University of South Carolina, Charleston, SC, 29425, United States of America
| | - Bo-Hao Yin
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Chen-Jun Liu
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Shi Zhan
- Orthopaedic Biomechanical Laboratory, Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
| | - Hui Sun
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China.
| | - Wei Zhang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China.
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22
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Zhang X, Duan X. Letter regarding "How to choose the suitable FNS specification in young patients with femoral neck fracture: A finite element analysis". Injury 2022; 53:4162-4163. [PMID: 36241489 DOI: 10.1016/j.injury.2022.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/28/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Xiang Zhang
- Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041 Sichuan, China
| | - Xin Duan
- Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041 Sichuan, China.
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23
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Qi L, Zhang W, Chang Z, Zuo Z, Li J, Li J, Chen H, Tang P. Is the reconstruction of medial support important for revision following failed treatment of femoral trochanteric fractures? a retrospective comparative study. BMC Musculoskelet Disord 2022; 23:1028. [PMID: 36447239 PMCID: PMC9707300 DOI: 10.1186/s12891-022-06004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hip-preserving revision in patients with failed treatment of femoral trochanteric fracture is still a major challenge. Whether the medial support reconstruction could benefit the patients and improve the success rate of hip-preserving revision is still controversial. Hence, the purpose of this study was to evaluate the clinical significance and prognosis of medial support reconstruction during the hip-preserving revision of failed femoral trochanteric fracture treatment. METHODS Patients with failed femoral trochanteric fractures treatments addressed by hip-preserving revision at our hospital from January 2014 to December 2020 were analyzed retrospectively. 31 patients were included and divided into a medial support group (n = 16) and a non-medial support group (n = 15). The fracture healing rate was the primary measurement. In addition, the differences in Oxford Hip Score (OHS), quality of life, surgical trauma, and complications were also evaluated. RESULTS The fracture healing rate (100%, 16/16 vs. 66.67%, 10/15), the OHS (42.06 ± 4.12 vs. 30.93 ± 11.56, M ± SD), and the mental component score of the 12-item Short-Form Survey (SF-12) (54.48 ± 5.38 vs. 47.90 ± 3.47, M ± SD), were significantly better and the incidence of complications [0(0/16) vs. 40%(6/15)] was significantly lower in the medial support group than the non-medial support group (p < 0.05). No significant differences in the physical component score of the SF-12, surgical trauma and reduction in collodiaphyseal angle of affected femur were observed between groups. CONCLUSIONS The reconstruction of medial support seems important for revision following failed treatment of femoral trochanteric fractures. Due to the medial augmentation and improvement of the mechanical stability for proximal femur, the patients might benefit from fracture healing prognosis and functional.
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Affiliation(s)
- Lin Qi
- grid.488137.10000 0001 2267 2324Chinese PLA Medical School, No.28 Fuxing Road, Haidian, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Wei Zhang
- grid.411614.70000 0001 2223 5394School of Sports Engineering, Beijing Sport University, No. 48 Information Road, Haidian District, Beijing, 100084 China
| | - Zuhao Chang
- grid.488137.10000 0001 2267 2324Chinese PLA Medical School, No.28 Fuxing Road, Haidian, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Zhaoxia Zuo
- National Clinical Center for Orthopedics, Sports Medicine & Rehabilitation, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Jiaqi Li
- grid.488137.10000 0001 2267 2324Chinese PLA Medical School, No.28 Fuxing Road, Haidian, Beijing, 100853 China ,grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Jiantao Li
- grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Hua Chen
- grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
| | - Peifu Tang
- grid.414252.40000 0004 1761 8894Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing, 100853 China
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24
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Ma J, Zhao Z, Zhi X, Wang H, Wang W. Finite element comparative analysis of three different internal fixation methods in the treatment of Pauwels type III femoral neck fractures. BMC Musculoskelet Disord 2022; 23:1030. [PMID: 36447275 PMCID: PMC9706946 DOI: 10.1186/s12891-022-06003-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Comparison of 4 cannulated lag screws (3 inverted triangular cannulated screws + anti-rotating screws;4 CLS), dynamic hip screws + derotational screws (DHS + DS), and femoral neck fixation system (FNS) in the treatment of Biomechanical properties of middle-aged Pauwels type III femoral neck fractures. METHODS The femur CT data of a healthy young volunteer was selected and imported into Mimics software to construct a three-dimensional model of a normal femur. Pauwels type III femoral neck fractures were simulated according to the 70° fracture line. Use Geomagic and SolidWorks software to optimize and build CLS, DHS + DS, and FNS fracture internal fixation models. Finally, Ansys software was used to analyze the stress distribution, peak value, and maximum displacement of the proximal fracture fragment and internal fixation; the displacement distribution, and peak value of the fracture surface at the fracture end. RESULTS ① The stress peaks of the proximal fracture fragments in the three groups were concentrated near the femoral calcar. The peak stress of the FNS group was the largest, and the DHS + DS group was the smallest. ②The displacement of the fracture fragments was all located at the top of the femur. The peak displacement of the FNS group was the largest, and the DHS + DS group was the smallest. ③ The internal fixation stress of the three groups is concentrated in the middle part of the device. The stress distribution of the first two groups of models is more uniform than that of FNS. The peak stress of FNS is the largest and the CLS is the smallest. ④ The internal fixed displacements are all located at the top of the model. The peak displacement of the CLS is the largest, and the DHS + DS is the smallest. ⑤ The displacement of the fracture surface is in the upper part of the fractured end. The peak displacement of the FNS group was the largest, and the DHS + DS group was the smallest. CONCLUSION Compared with the other two internal fixation methods, dynamic hip screw + derotational screw (DHS + DS) showed good biomechanical stability. When Pauwels type III femoral neck fracture occurs in young adults, DHS + DS can be given priority as the preferred treatment for this type of fracture.
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Affiliation(s)
- Ji Ma
- grid.452867.a0000 0004 5903 9161Department of Orthopedics, First Affiliated Hospital of Jinzhou Medical University, Liaoning Province 121000 Jinzhou, China
| | - Ziying Zhao
- grid.452867.a0000 0004 5903 9161Department of Endocrinology, First Affiliated Hospital of Jinzhou Medical University, 121000 Jinzhou, Liaoning Province China
| | - Xiaodong Zhi
- grid.452867.a0000 0004 5903 9161Department of Orthopedics, First Affiliated Hospital of Jinzhou Medical University, Liaoning Province 121000 Jinzhou, China ,Liaoning Key Laboratory of Medical Tissue Engineering, 121000 Jinzhou, Liaoning Province China
| | - Hao Wang
- grid.452867.a0000 0004 5903 9161Department of Orthopedics, First Affiliated Hospital of Jinzhou Medical University, Liaoning Province 121000 Jinzhou, China ,Liaoning Key Laboratory of Medical Tissue Engineering, 121000 Jinzhou, Liaoning Province China
| | - Wei Wang
- grid.452867.a0000 0004 5903 9161Department of Orthopedics, First Affiliated Hospital of Jinzhou Medical University, Liaoning Province 121000 Jinzhou, China ,Liaoning Key Laboratory of Medical Tissue Engineering, 121000 Jinzhou, Liaoning Province China ,grid.454145.50000 0000 9860 0426Institute of Orthopedics, Jinzhou Medical University, 121000 Jinzhou, Liaoning Province China
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25
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Yildirim C, Demirel M, Karahan G, Cetinkaya E, Misir A, Yamak F, Bozdağ E. Biomechanical comparison of four different fixation methods in the management of Pauwels type III femoral neck fractures: Is there a clear winner? Injury 2022; 53:3124-3129. [PMID: 35803747 DOI: 10.1016/j.injury.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cannulated screws augmented with the medial buttress plate could confer greater biomechanical stability and higher union rates than the screw fixation alone for treating young patients with Pauwels type III femoral neck fractures (FNFs). No study has evaluated the effects of distal bicortical screw fixation and biomechanical properties of buttress plate augmentation under simultaneous vertical and rotational forces, physiologically acting on the hip joint. This study aimed to compare the biomechanical properties of four methods of three cannulated screw fixation under the combined axial and torsional loading in a synthetic femur model of type III FNF. METHODS Twenty-four third-generation composite femora were divided into four groups (6 femora in each group) based on the screw fixation configuration: inverted triangle configuration (Group A), Pauwels' configuration (Group B), inverted triangle configuration combined with medial buttress plate using distal unicortical (Group C), and distal bicortical screw placement (Group D). A Pauwels type III FNF was simulated on the sawbones. Each model was subjected to the combined axial and torsional cyclic loading and subsequently tested to failure. RESULT Significant differences were determined in axial stiffness (AS) among the four groups (p = 0.024), whereas there was no significant difference in torsional stiffness (p = 0.147). The mean AS was higher in group D (639.5 ± 86.2 N/mm) than in group A (430.6 ± 94.8 N/mm), group B (426.2 ± 41.9 N/mm), and group C (451.2 ± 156.7 N/mm). Failure forces (FFs) were significantly different among four groups (p = 0.007), while there was no considerable difference in failure moment values (p = 0.555). The mean FF was significantly higher in group D (1307.1 ± 96.4 N) than in group A (1076.9 ± 371.2 N) and group B (1075.5 ± 348.3 N) (p = 0.014 and p = 0.018, respectively). There was no significant difference in the mean FF between groups D and C. CONCLUSION Regardless of the medial plate use, multiple cannulated systems could provide similar biomechanical results regarding torsional stiffness and failure moments. Bicortical placement of the most distal screw in medial buttress plate application could improve axial stability but not significantly affect the rotational stability of the inverted triangle screw fixation system in managing type III FNFs.
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Affiliation(s)
- Cem Yildirim
- Department of Orthopaedics and Traumatology, Başakşehir Çam ve Sakura City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Demirel
- Department of Orthopedics and Traumatology, Istanbul University, İstanbul School of Medicine, Istanbul, Turkey.
| | - Gökhan Karahan
- Department of Orthopaedics and Traumatology, Başakşehir Çam ve Sakura City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Engin Cetinkaya
- Department of Orthopaedics and Traumatology, Medicalpark Göztepe Hospital, Bahçeşehir University, Istanbul, Turkey
| | - Abdülhamit Misir
- Department of Orthopaedics and Traumatology, Medicana International Istanbul Hospital, Istanbul, Turkey
| | - Fatih Yamak
- Faculty of Mechanical Engineering, Strength of Materials and Biomechanics, Istanbul Technical University, Istanbul, Turkey
| | - Ergün Bozdağ
- Faculty of Mechanical Engineering, Strength of Materials and Biomechanics, Istanbul Technical University, Istanbul, Turkey
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26
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Jiang X, Liang K, Du G, Chen Y, Tang Y, Geng K. Biomechanical evaluation of different internal fixation methods based on finite element analysis for Pauwels type III femoral neck fracture. Injury 2022; 53:3115-3123. [PMID: 35999063 DOI: 10.1016/j.injury.2022.08.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVE The best internal fixation method for the treatment of Pauwels type III femoral neck fractures (FNFs) remains to be demonstrated. Through finite element analysis, this study explored whether dynamic hip screw (DHS) combined with anti rotation screw or medial buttress plate can improve the stability of internal fixation, and the femoral neck system (FNS) with similar structure to DHS and the traditional cannulated screw (CSs) were added for comparison. To evaluate their respective biomechanical advantages and disadvantages in the treatment of Pauwels type III FNFs. METHODS Six groups of internal fixation models for the treatment of FNFs were established, including CSs, DHS, DHS combined with single anti-rotation screw (DHS + SS), and DHS combined with both anti-rotation screw (DHS + BS), DHS combined with medial buttress plate (DHS + MBP), new femoral neck internal fixation system (Femoral Neck System, FNS). Four finite element analysis models were established for each group, evaluation of femoral displacement and internal fixation stress during stair climbing and walking conditions, and the contact force of the hip joint was used in two cases, dynamic and static. RESULTS The fracture plane motion and peak stress of internal fixators were the lowest with DHS + BS and CSs fixation, and the two results are very close, The peak value of DHS combined with anti rotation screw or medial buttress plate is much lower than that of DHS, indicating that the fixation effect of the combined model is enhanced, and there is no significant difference between FNS and DHS + SS. CONCLUSION Both the anti rotation screw and medial buttress plate can effectively reduce the movement of fracture section and share the shear force of DHS, FNS has the similar fixation stability to DHS + SS, DHS + BS has the biomechanical advantages of significantly reducing the risk of internal fixation failure and femoral yield. Therefore, the use of DHS + BS may be a more favorable choice in the case of Pauwels type III FNFs with higher fixation requirements.
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Affiliation(s)
- Xianbao Jiang
- School of Mechanical Engineering, Guangxi University, Nanning 530004, China.
| | - Ke Liang
- School of Mechanical Engineering, Guangxi University, Nanning 530004, China.
| | - Gang Du
- The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530004, China.
| | - Yuan Chen
- School of Mechanical Engineering, Guangxi University, Nanning 530004, China.
| | - Yu Tang
- School of Mechanical Engineering, Guangxi University, Nanning 530004, China.
| | - Kuihua Geng
- School of Mechanical Engineering, Guangxi University, Nanning 530004, China.
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27
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Xu G, Li J, Xu C, Xiong D, Li H, Wang D, Zhang W, Zhang H, Zhang L, Tang P. Triangular Mechanical Structure of the Proximal Femur. Orthop Surg 2022; 14:3047-3060. [PMID: 36177864 PMCID: PMC9627078 DOI: 10.1111/os.13498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 12/01/2022] Open
Abstract
Objective The mechanical high modulus structure of the proximal femur could guide clinical surgical treatment and instrument design of proximal femoral fractures. The purpose of this study is to analyze and verify the mechanical structure of the proximal femur. Methods A total of 375 patients with intertrochanteric fractures were imaged using computed tomography (CT) scans. Patients were grouped according to age and sex. Cortical and medullary cavity parameters (cortical thickness [CTh], cortical mean density [CM], upper‐lower diameter length [ULL], and medial‐lateral diameter length [MLL]) were measured at eight planes. Six proximal femoral finite element models of different sexes and ages were constructed. To verify the measurement results, Abaqus was used to implement the force load to describe the von Mises stress distribution, and the maximum von Mises stress values of each wall of the proximal femur were compared. Results The CTh values of the lower and upper walls were higher than those of the anterior and posterior walls of the femoral neck (p < 0.05). The CM values of the lower and upper walls were higher than those of the anterior and posterior walls of the subcephalic and middle femoral neck (p < 0.05). The ULL value gradually increased from the subcephalic region to the bottom (p < 0.05). The CTh and CM values of the medial and lateral walls were higher than those of the anterior and posterior walls in the femoral trochanteric region (p < 0.05). The MLL value decreased gradually from the plane 20 mm above the upper edge to that 20 mm below the vertex of the femoral lesser trochanter (p < 0.05). The von Mises stress was concentrated on the upper and lower walls of the femoral neck and on the medial and lateral walls of the femoral trochanteric region. The maximum von Mises stress values of the upper and lower walls were higher than those of the anterior and posterior walls of the femoral neck. The maximum von Mises stress values of the medial and lateral walls were higher than those of the anterior and posterior walls in the femoral trochanteric region, except for the plane 20 mm above the upper edge of the femoral lesser trochanter. Conclusion The bone mass of the proximal femur presented a triangular high‐modulus distribution, which bore the main stress of the proximal femur. The triangular mechanical structure provides a guideline for the surgical strategy and instrument design of the proximal femur.
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Affiliation(s)
- Gaoxiang Xu
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitaion, Beijing, China
| | - Jiantao Li
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitaion, Beijing, China
| | - Cheng Xu
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitaion, Beijing, China
| | - Dou Xiong
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitaion, Beijing, China
| | - Hua Li
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitaion, Beijing, China
| | - Daofeng Wang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitaion, Beijing, China
| | - Wupeng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitaion, Beijing, China
| | - Hao Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitaion, Beijing, China
| | - Licheng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitaion, Beijing, China
| | - Peifu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitaion, Beijing, China
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28
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Teng Y, Zhang Y, Guo C. Finite element analysis of femoral neck system in the treatment of Pauwels type III femoral neck fracture. Medicine (Baltimore) 2022; 101:e29450. [PMID: 35839002 PMCID: PMC11132412 DOI: 10.1097/md.0000000000029450] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 04/22/2022] [Indexed: 11/26/2022] Open
Abstract
The optimal treatment strategy for femoral neck fractures remained controversial, especially the Pauwels type III femoral neck fracture of young patients was a challenge. Femoral neck system (FNS) was a newly developed internal fixation for treating femoral neck fracture and this study aimed to compare the biomechanical advantages and disadvantages between FNS and 3 cannulated configuration screws (CCS) with or without an additional medial buttress plate (MBP). In this study, Pauwels type III femoral neck fracture model with an angle of 70° was constructed and 3 different fixation models, FNS, CCS + MBP, CCS alone, were developed. A vertical force of 2100N was applied on the femoral head, then the maximum von Mises stress of whole model, distal femur, femoral head, and internal fixation was recorded, as well as the stress distribution of whole model, proximal fracture section, and internal fixation of the 3 models. Moreover, the maximum displacement of the whole model, distal femur, femoral head, internal fixation, and the relative displacement of the proximal and distal portion was also compared. The maximum von Mises stress value was 318.302 MPa in FNS, 485.226 MPa in CCS + 1/3 plate, and 425.889 MPa in CCS. The FNS showed lowest maximum von Mises stress values in distal part, femoral head, and internal implant. All fixation configurations were observed stress concentrated at the posteroinferior area of cross-section of femoral head and at the fracture section area of implant; however, FNS had more uniform stress distribution. For displacement, the maximum displacement value was 8.5446 mm in FNS, 8.2863 mm in CCS + 1/3 plate, and 8.3590 mm in CCS. However, FNS had higher maximum displacement in femoral head and internal implant, but lower maximum displacement in the distal part of fracture model. The FNS represented a significantly higher relative displacement between the femoral head and distal femur when compared with the other 2 fixation configurations. The newly developed FNS could achieve the dual effect of angular stability and sliding compression for the treatment of Pauwels type III femoral neck fractures, which provided superior biomechanical stability than CCS alone and CCS with additional MBP.
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Affiliation(s)
- Yanbin Teng
- Yanbin Teng, Department of Orthopedics and Trauma Weifang People’s Hospital, Shandong province, People’s Republic of China, Yan Zhang, Department of Nephrology, Weifang People’s Hospital, Shandong province, People’s Republic of China
| | - Yan Zhang
- Yanbin Teng, Department of Orthopedics and Trauma Weifang People’s Hospital, Shandong province, People’s Republic of China, Yan Zhang, Department of Nephrology, Weifang People’s Hospital, Shandong province, People’s Republic of China
| | - Chaowei Guo
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Henan Province, People’s Republic of China
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Huang ZY, Su YH, Huang ZP, Wang YB, Du GC, Huang YP, Chen G, Xu C, Zhu QA. Medial Buttress Plate and Allograft Bone-Assisted Cannulated Screw Fixation for Unstable Femoral Neck Fracture with Posteromedial Comminution: A Retrospective Controlled Study. Orthop Surg 2022; 14:911-918. [PMID: 35445587 PMCID: PMC9087460 DOI: 10.1111/os.13273] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 12/21/2022] Open
Abstract
Objective To investigate the outcomes of open reduction and internal fixation combined with medial buttress plate (MBP) and allograft bone‐assisted cannulated screw (CS) fixation for patients with unstable femoral neck fracture with comminuted posteromedial cortex. Methods In a retrospective study of patients operated on for unstable femoral neck fractures with comminuted posteromedial cortex from March 2016 to August 2020, the clinical and radiographic outcomes of 48 patients treated with CS + MBP were compared with the outcomes of 54 patients treated with CS only. All patients in the CS + MBP group were fixed by three CS and MBP (one‐third tubular plates or reconstructive plates) with bone allografts. The surgery‐related outcomes and complications were evaluated, including operative time, blood loss, union time, femoral head necrosis, femoral neck shortening, and other complications after the operation. The Harris score was evaluated at 12 months after the operation. Results All patients were followed up for 12–40 months. The average age of patients in the CS‐only group (54 cases, 22 females) and CS + MBP group (48 cases, 20 females) was 48.46 ± 7.26 and 48.73 ± 6.38 years, respectively. More intraoperative blood loss was observed in the CS + MBP group than that of patients in CS‐only group (153.45 ± 64.27 vs 21.86 ± 18.19 ml, t = 4.058, P = 0.015). The average operative time for patients in the CS + MBP group (75.35 ± 27.67 min) was almost double than that of patients in the CS‐only group (36.87 ± 15.39 min) (t = 2.455, P < 0.001). The Garden alignment index of patients treated by CS + MBP from type I to type IV was 79%, 19%, 2%, and 0%, respectively. On the contrary, they were 31%, 43%, 24% and 2% for those in the CS‐only group, respectively. The average healing times for the CS‐only and CS + MBP groups were 4.34 ± 1.46 and 3.65 ± 1.85 months (t = 1.650, P = 0.102), respectively. Femoral neck shortening was better in the CS + MBP group (1.40 ± 1.73 mm, 9/19) than that in the CS‐only group (4.33 ± 3.32 mm, 24/44). Significantly higher hip function was found in the CS + MBP group (85.60 ± 4.36 vs 82.47 ± 6.33, t = 1.899, P = 0.06). There was no statistical difference between femoral head necrosis (4% vs 11%, χ2 = 1.695, P = 0.193) and nonunion (6% vs 9%, χ2 = 0.318, P = 0.719). Conclusion For unstable femoral neck fractures with comminuted posteromedial cortex, additional MBP combined with bone allografts showed better reduction quality and neck length control than CS fixation only, with longer operative time and more blood loss.
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Affiliation(s)
- Zhe-Yuan Huang
- Nan Fang Hospital of Southern Medical University, Guangzhou, China.,Department of Orthopaedics, The 73st Group Army Hospital of PLA (Key Orthopaedic Specialties Specialties of Xiamen City 2015347), Xiamen, China
| | - Yu-Hui Su
- Department of Orthopaedics, The 73st Group Army Hospital of PLA (Key Orthopaedic Specialties Specialties of Xiamen City 2015347), Xiamen, China
| | - Zhi-Ping Huang
- Nan Fang Hospital of Southern Medical University, Guangzhou, China
| | - Yi-Bei Wang
- Nan Fang Hospital of Southern Medical University, Guangzhou, China
| | - Gui-Cheng Du
- Department of Anatomy, Xiamen Medical College, Xiamen, China
| | - Yan-Peng Huang
- Department of Orthopaedics, The 73st Group Army Hospital of PLA (Key Orthopaedic Specialties Specialties of Xiamen City 2015347), Xiamen, China
| | - Gang Chen
- Department of Orthopaedics, The 73st Group Army Hospital of PLA (Key Orthopaedic Specialties Specialties of Xiamen City 2015347), Xiamen, China
| | - Chun Xu
- Department of Orthopaedics, The 73st Group Army Hospital of PLA (Key Orthopaedic Specialties Specialties of Xiamen City 2015347), Xiamen, China
| | - Qing-An Zhu
- Nan Fang Hospital of Southern Medical University, Guangzhou, China
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Qi L, Zhang W, Chen H. Treatment of ipsilateral femoral neck and shaft fracture by augmented fixation via modified anterior approach: A case report. Trauma Case Rep 2022; 39:100650. [PMID: 35571578 PMCID: PMC9092491 DOI: 10.1016/j.tcr.2022.100650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 11/28/2022] Open
Abstract
Case A 39-year-old man with obsolete fracture of the left femoral neck (AO/OTA31B2.3, Pauwels III) and segmental fracture of the ipsilateral shaft (AO/OTA32C2) caused by traffic accident was treated by a hybrid augmented fixation technique, long reconstruction intramedullary nail combined with medial anatomical buttress plate and poller screws. All procedures were carried out via the modified anterior approach with a good exposure of the fracture site. Conclusion The hybrid augmented fixation technique via the modified anterior approach could improve fracture reduction and mechanical stability for ipsilateral femoral neck and shaft fractures.
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Affiliation(s)
- Lin Qi
- Chinese PLA Medical School, No.28 Fuxing Road, Haidian, Beijing 100853, China
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing 100853, China
| | - Wei Zhang
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing 100853, China
| | - Hua Chen
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing 100853, China
- Corresponding author at: No.28 Fuxing Road, Haidian, Beijing 100853, China.
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Liu J, Li Z, Ding J, Huang B, Piao C. Biomechanical analysis of two medial buttress plate fixation methods to treat Pauwels type III femoral neck fractures. BMC Musculoskelet Disord 2022; 23:49. [PMID: 35031036 PMCID: PMC8760813 DOI: 10.1186/s12891-022-05014-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Femoral neck fractures in young people are usually Pauwels Type III fractures. The common treatment method are multiple parallel cannulated screws or dynamic hip screw sliding compression fixation. Due to the huge shear stress, the rate of complications such as femoral head necrosis and nonunion is still high after treatment. The aim of our study was to compare the stabilities of two fixation methods in fixating pauwels type III femoral neck fractures. Methods All biomimetic fracture samples are fixed with three cannulated screws combined with a medial buttress plate. There were two fixation groups for the buttress plate and proximal fracture fragment: Group A, long screw (40 mm); Group B, short screw (6 mm). Samples were subjected to electrical strain measurement under a load of 500 N, axial stiffness was measured, and then the samples were axially loaded until failure. More than 5 mm of displacement or synthetic bone fracture was considered as construct failure. Results There were no significant differences in failure load (P = 0.669), stiffness (P = 0.842), or strain distribution (P > 0.05) between the two groups. Conclusions Unicortical short screws can provide the same stability as long screws for Pauwels Type III Femoral Neck Fractures.
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Affiliation(s)
- Jichao Liu
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Nanguan Street, Changchun, 130041, Jilin Province, China
| | - Zhengwei Li
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Nanguan Street, Changchun, 130041, Jilin Province, China
| | - Jie Ding
- Department of Stomatology, The Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Bingzhe Huang
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Nanguan Street, Changchun, 130041, Jilin Province, China
| | - Chengdong Piao
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Nanguan Street, Changchun, 130041, Jilin Province, China.
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Zhang RY, Li JT, Zhao JX, Zhao Z, Zhang LC, Yun C, Su XY, Tang PF. The oblique triangle configuration of three parallel screws for femoral neck fracture fixation using computer-aided design modules. Sci Rep 2022; 12:325. [PMID: 35013408 PMCID: PMC8748644 DOI: 10.1038/s41598-021-03666-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 11/29/2021] [Indexed: 11/09/2022] Open
Abstract
Closed reduction and internal fixation with three cannulated compression screws is a common method for treating femoral neck fractures in young and middle-aged patients. Protocols including the inverted triangle configuration and dispersion of the screws still needed further supports. The purpose of this study was to explore a novel oblique triangle configuration (OTC) of three screws in fixing femoral neck fractures based on the morphology of the femoral neck isthmus (FNI). The computer-aided design modules were used to explore the ideal spatial configuration with largest triangle by three parallel screws. A univariate evaluation model was established based on the oval-like cross-section of the FNI. When the three screws were positioned by the OTC, Inverted Equilateral Triangle Configuration (IETC), and the Maximum Area Inverted Isosceles Triangle Configuration (MA-IITC) respectively, the proportion of area and circumference in the cross-section of FNI and the changing trend of proportion were compared under various torsion angles, eccentricity, and cross-sectional area of FNI. The area and circumference ratios of the parallel screws using the OTC method were significantly higher than in the IETC and MA-IITC groups. In the univariate evaluation model, the OTC area ratio and circumference ratio remained stable under the different femoral neck torsion angles, FNI cross-sectional area, and eccentricity. The OTC method provided an ideal spatial configuration for the FNA fixation with the largest area using three parallel screws. The position of the posterior screw was also away from the metaphyseal artery, potentially reducing the possibility of vascular injury and screw penetrating.
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Affiliation(s)
- Ru Yi Zhang
- Department of Orthopaedics, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, No. 24, Shijingshan Road, Beijing, 100043, China
| | - Jian Tao Li
- Department of orthopedics, The fourth medical center, General Hospital of Chinese PLA, Beijing, China.,National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, 100853, China
| | - Jing Xin Zhao
- Department of orthopedics, The fourth medical center, General Hospital of Chinese PLA, Beijing, China.,National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, 100853, China
| | - Zhe Zhao
- Department of Orthopaedics, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, China
| | - Li Cheng Zhang
- Department of orthopedics, The fourth medical center, General Hospital of Chinese PLA, Beijing, China.,National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, 100853, China
| | - Cai Yun
- Department of Orthopaedics, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, No. 24, Shijingshan Road, Beijing, 100043, China.
| | - Xiu Yun Su
- Department of Orthopaedics, Zouthern University of Science and Technology Hospital, Shenzhen, 518055, Guangdong, China.
| | - Pei Fu Tang
- Department of orthopedics, The fourth medical center, General Hospital of Chinese PLA, Beijing, China. .,National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, 100853, China.
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Xia Y, Zhang W, Hu H, Yan L, Zhan S, Wang J. Biomechanical study of two alternative methods for the treatment of vertical femoral neck fractures - A finite element analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 211:106409. [PMID: 34560605 DOI: 10.1016/j.cmpb.2021.106409] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND No consensus has been reached for the treatment of vertical femoral neck fractures (vFNFs). Recently, two alternative methods were invented to treat vFNFs, one of which is a new plate with a sliding groove, which was designed as a substitution of the medial buttress locking plate to combine with cannulated compression screws (CCS) for reducing the breakage possibility of the proximal locking screw during the bone healing. Another one is the femoral neck system (FNS), which was believed with biomechanical superiority. This study aims to compare the biomechanics of these two new implants with three previous methods via finite element analysis (FEA) to validate whether they are suitable for the treatment of vFNFs. METHODS Five 70-degree Pauwels type III transcervical FNFs (vFNFs, AO/OTA 31B2.3r) models were built and fixed by CCS augmented with the newly designed sliding groove buttress plate (CCS+BS) and FNS. For comparison, models fixed by three parallel cannulated compression screws (CCS), biplane double-supported screw fixation (BDSF), CCS augmented with a medial buttress locking plate (CCS+BL) were also built. A 2100N load was applied along with the mechanical axis. Parameters of the maximal stress as well as the maximal displacement of the implants and bone, the maximal relative displacement of interfragments, and the stiffness, were analyzed to compare the biomechanical characteristics of the five models. RESULTS CCS+BS and CCS+BL showed stronger fixation strength with improved stiffness (1012.05N/mm, 1092.04N/mm), reduced maximal displacement of the implants (1.976mm, 1.838mm) and bone (2.075mm, 1.923mm), when compared with CCS (925.11N/mm, 2.158mm and 2.270mm) and BDSF (842.36N/mm, 2.299mm and 2.493mm). While FNS showed the weakest stiffness (593.22N/mm) and largest maximal displacement of the implants (3.234mm) and bone (3.540mm) among the five models. CONCLUSIONS CCS+BS has a better biomechanical performance than CCS and BDSF, which offers a new choice to deal with vFNFs. The construction stability of FNS is weaker than CCS, BDSF, and CCS+BL, indicating that this method may not as stable as reported in the previous study.
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Affiliation(s)
- Yutong Xia
- Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Wendong Zhang
- Department of Orthopedics, Subei People's Hospital of Jiangsu Province, Yangzhou 225001, Jiangsu Province, China
| | - Hai Hu
- Orthopedic Biomechanical Laboratory of Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Lianqi Yan
- Department of Orthopedics, Subei People's Hospital of Jiangsu Province, Yangzhou 225001, Jiangsu Province, China.
| | - Shi Zhan
- Orthopedic Biomechanical Laboratory of Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
| | - Jingcheng Wang
- Dalian Medical University, Dalian 116044, Liaoning Province, China; Department of Orthopedics, Subei People's Hospital of Jiangsu Province, Yangzhou 225001, Jiangsu Province, China.
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Liu J, Li Z, Ding J, Huang B, Piao C. Femoral neck fracture combined with anterior dislocation of the femoral head: injury mechanism and proposed novel classification. BMC Musculoskelet Disord 2021; 22:810. [PMID: 34548069 PMCID: PMC8456574 DOI: 10.1186/s12891-021-04703-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Femoral neck fracture combined with anterior dislocation of the femoral head is very rare. To our knowledge, there is no classification system yet for this rare form of injury, and the injury mechanism of femoral neck fracture combined with obturator head dislocation has not been described in the literature. In this study, we systematically reviewed the literature and the cases treated in our hospital, and identified and classified all injury types according to the injury mechanism of femoral neck fracture combined with anterior dislocation of the femoral head. Further, based on the experience of treating a patient with femoral neck fracture and obturator dislocation of the femoral head, a theoretical hypothesis was proposed for the injury mechanism of this rare type of injury. METHODS A comprehensive search was conducted on PubMed, WOS, CNKI database. These fractures were classified according to the dislocation site and injury mechanism (one injury or two injuries). RESULTS 1891 articles were initially identified through PubMed and other databases, and after bibliographic research, study screening, and removing duplicates, 1455 articles were selected. After applying the exclusion criteria, a total of 18 full-text articles describing femoral neck fractures combined with anterior dislocation of the femoral head. Different dislocation sites have different injury mechanisms. Our classification system, to the best of the authors' knowledge, allowed us to include all types of femoral neck fractures combined with anterior dislocation of the femoral head from the literature. According to the proposed classification system, the morphological features of femoral neck fracture combined with anterior dislocation of the femoral head can be accurately conveyed between doctors. CONCLUSIONS All injury patterns can likely be identified using the proposed classification system. This can help avoid confusion in the nomenclature of femoral neck fractures combined with anterior dislocation of the femoral head and help surgeons to more accurately detect lesions, thereby guiding surgical treatment.
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Affiliation(s)
- Jichao Liu
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Nanguan Street, Changchun, 130041, Jilin Province, China
| | - Zhengwei Li
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Nanguan Street, Changchun, 130041, Jilin Province, China
| | - Jie Ding
- Department of Stomatology, The Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China
| | - Bingzhe Huang
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Nanguan Street, Changchun, 130041, Jilin Province, China
| | - Chengdong Piao
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Nanguan Street, Changchun, 130041, Jilin Province, China.
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Abstract
PURPOSE OF REVIEW Fracture fixation aims to provide stability and promote healing, but remains challenging in unstable and osteoporotic fractures with increased risk of construct failure and nonunion. The first part of this article reviews the clinical motivation behind finite element analysis of fracture fixation, its strengths and weaknesses, how models are developed and validated, and how outputs are typically interpreted. The second part reviews recent modeling studies of the femur and proximal humerus, areas with particular relevance to fragility fractures. RECENT FINDINGS There is some consensus in the literature around how certain modeling aspects are pragmatically formulated, including bone and implant geometries, meshing, material properties, interactions, and loads and boundary conditions. Studies most often focus on predicted implant stress, bone strain surrounding screws, or interfragmentary displacements. However, most models are not rigorously validated. With refined modeling methods, improved validation efforts, and large-scale systematic analyses, finite element analysis is poised to advance the understanding of fracture fixation failure, enable optimization of implant designs, and improve surgical guidance.
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Affiliation(s)
- Gregory S Lewis
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, PA, USA.
| | | | - Hwabok Wee
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, PA, USA
| | - J Spence Reid
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, PA, USA
| | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
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Fan Z, Huang Y, Su H, Jiang T. How to choose the suitable FNS specification in young patients with femoral neck fracture: A finite element analysis. Injury 2021; 52:2116-2125. [PMID: 34154816 DOI: 10.1016/j.injury.2021.05.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Consensus regarding the optimal approach for the treatment of femoral neck fractures remains lacking. A new internal fixation femoral neck system (FNS) was developed and used in clinical practice. We aimed to investigate the biomechanical outcomes of different types of FNS in the treatment of unstable femoral neck fractures. METHOD In this study, we constructed three different types of unstable femoral neck fractures of Pauwels classification with angles of 50°, 60°, and 70°. We set up four test groups, namely, the one-hole plated FNS group, two-hole plated FNS group, inverted cannulated screw group and triangle cannulated screw group. Under 2100 N axial loads, displacements and the von Mises stress of the femur and internal fixation components were measured for each fracture group. RESULTS When the Pauwels angle was 50°or 60°, the one-hole locking plated FNS was as superior as the two-hole plated FNS in terms of femur and internal fixation displacement, and the inverted cannulated screw had slightly better stability than the triangular cannulated screw. However, when the angle increases to 70°, the two-hole locking plate has the minimum displacement, followed by the triangular cannulated screw and inverted cannulated screw, which is the worst displacement for the single-hole locking plate. Regardless of the angle, the two sets of FNS have higher internal fixation stress than the two sets of cannulated screws, which is approximately 1.6-3.0 times that of the cannulated screw group. CONCLUSION From the perspective of biomechanics, we suggest that when the angle of the fracture line is less than 60°, both single-hole locking plated or double-hole locking plated FNS can be used to treat unstable femoral neck fractures. However, when the angle of the fracture line is greater than 70°, we recommend using a double-hole locking plated FNS. This result needs further verification in further clinical studies.
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Affiliation(s)
- Zhirong Fan
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Yongquan Huang
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Haitao Su
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Tao Jiang
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
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Li J, Chen H, Li J, Wang J, Yin P, Zhang L, Tang P. [Effectiveness of triangular stabilization system for patients with postoperative nonunion of femoral neck fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:795-800. [PMID: 34308583 DOI: 10.7507/1002-1892.202012056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness of triangular stabilization system in the treatment of postoperative nonunion of femoral neck fracture. Methods The clinical data of 30 patients with postoperative nonunion of femoral neck fracture who met the selection criteria between December 2014 and December 2019 were retrospectively analyzed. There were 21 males and 9 females with an average age of 40.7 years (range, 15-65 years). The Pauwels angle at the time of injury was 51°-79°, with an average of 63.6°. According to the Pauwels classification, they were all type Ⅲ. The time from the first operation to this revision operation was 5-24 months, with an average of 9.7 months. The preoperative visual analogue scale (VAS) score was 4.2±1.3, the Harris score was 31.2±5.3, the neck-shaft angle was (116.3±7.9)°, and the lower limb shortening length was (1.73±0.53) cm. Triangular stabilization system, which was made of dynamic condylar screw and medial anatomical buttress plate, combined with the window bone grafting at the fracture site was used for bone nonunion revision. The postoperative lower limb shortening length, neck-shaft angle, fracture healing time, and complications were recorded; the Harris score was used to evaluate the hip joint function, and the VAS score was used to evaluate the pain improvement before and after operation. Results All patients were followed up 12-60 months, with an average of 27.7 months. There was no clear sign of femoral head necrosis and collapse after operation; 1 patient developed infection at 4 months after operation, and the incision healed after debridement and removal of internal fixator. All patients achieved bone healing, and the healing time was 2.8-6.0 months, with an average of 3.9 months. At last follow-up, the lower limb shortening length was (0.30±0.53) cm, which was significantly corrected when compared with preoperative one ( t=16.721, P=0.000); the neck-shaft angle was (133.9±5.7)°, which was significantly recovered when compared with preoperative one ( t=-11.239, P=0.000). The VAS score was 0.7±0.9, the Harris score was 88.3±5.9, both of which were significantly improved when compared with preoperative scores ( t=16.705, P=0.000; t=-40.138, P=0.000). Conclusion Triangular stabilization system combined with window bone grafting can provide a stable and balanced mechanical environment, promote fracture healing, and achieve satisfactory effectiveness in the treatment of postoperative nonunion of femoral neck fracture.
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Affiliation(s)
- Jia Li
- Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Hua Chen
- Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Jiantao Li
- Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Junsong Wang
- Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Pengbin Yin
- Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Licheng Zhang
- Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
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Zhao G, Liu M, Li B, Sun H, Wei B. Clinical observation and finite element analysis of cannulated screw internal fixation in the treatment of femoral neck fracture based on different reduction quality. J Orthop Surg Res 2021; 16:450. [PMID: 34256786 PMCID: PMC8276405 DOI: 10.1186/s13018-021-02580-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/24/2021] [Indexed: 02/04/2023] Open
Abstract
Objective Femoral neck fracture is one of the most common bone types. The effect of reduction quality on hip joint function and complications after screw internal fixation is not fully understood. To investigate the clinical efficacy and mechanical mechanism of positive buttress, anatomical reduction, and negative buttress in the treatment of femoral neck fracture after cannulated screw fixation. Methods Retrospective analysis of patients with femoral neck fracture treated with three cannulated screws internal fixation in our hospital from January 2013 to December 2018. According to the quality of fracture reduction, the patients were divided into positive buttress group, anatomical reduction group, and negative buttress group. Basic information such as injury mechanism, time from injury to surgery, Garden classification and Pauwels classification was collected, Harris scores were performed at 3 months, 6 months, and 12 months after surgery, and postoperative complications (femoral head necrosis, femoral neck shortening, and femoral neck nonunion) were collected. At the same time, three groups of finite element models with different reduction quality were established for stress analysis, their stress clouds were observed and the average displacement and stress of the three groups of models were compared. P < 0.05 was used to represent a statistically significant difference. Results A total of 225 cases of unilateral femoral neck fractures were included and followed up for an average of 4.12 ± 0.69 years. There was no significant difference in age, gender, side, injury mechanism, time from injury to surgery, BMI, Garden classification, Pauwels classification, and follow-up time among the three groups (P > 0.05). However, there was significant difference in Harris score at 6 and 12 months after operation among the three groups (P < 0.05), which was higher in the positive buttress group and anatomical reduction group than in the negative buttress group. In addition, the incidence of osteonecrosis of the femoral head in the negative buttress group (32.2%) was greater than that in the anatomical reduction group (13.4%) and the positive buttress group (5.4%) (P < 0.05). In addition, the incidence of femoral neck nonunion and femoral neck shortening in the negative buttress group was also higher than that in the anatomical reduction positive buttress group (P < 0.05). The finite element results showed that the stress and fracture end displacement in the negative buttress group were greater than those in the positive buttress group (P < 0.05). Conclusion Both positive buttress and anatomical reduction in the treatment of femoral neck fracture with cannulated screw internal fixation can obtain better clinical effect and lower postoperative complications. Positive brace support and anatomic reduction can limit the restoration of femoral stress conduction. Therefore, it is not necessary to pursue anatomical reduction too deliberately during surgery, while negative buttress reduction should be avoided.
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Affiliation(s)
- Gan Zhao
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,Department of Sports Medicine, Linyi Traditional Chinese Medicine Hospital, Linyi, 276000, Shandong, China
| | - Ming Liu
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,Department of Pain, Linyi People's Hospital, Linyi, 276000, Shandong Province, China
| | - Bin Li
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Haizhong Sun
- Department of Orthopedic, Linyi People's Hospital, Linyi, 276000, Shandong Province, China
| | - Biaofang Wei
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China. .,Department of Orthopedic, Linyi People's Hospital, Linyi, 276000, Shandong Province, China.
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Nonanatomical Reduction of Femoral Neck Fractures in Young Patients (≤65 Years Old) with Internal Fixation Using Three Parallel Cannulated Screws. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3069129. [PMID: 33490267 PMCID: PMC7801101 DOI: 10.1155/2021/3069129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/20/2020] [Accepted: 12/23/2020] [Indexed: 11/18/2022]
Abstract
Purpose The study is aimed at investigating the association between different reduction classifications (anatomic reduction, positive buttress position reduction, and negative buttress position reduction) and two end points (complications and reoperations). Methods The study retrospectively analyzed 110 patients undergoing internal fixation with three parallel cannulated screws from January 2012 to January 2019 in Huashan Hospital. Based on the principles of the “Gotfried reduction,” all enrolled patients were divided into three groups: anatomic reduction, positive buttress position reduction, and negative buttress position reduction intraoperatively or immediately after surgery. Clinical characteristics including age, sex, side, Garden classification, Pauwels classification, fracture level, reduction classification, Garden alignment index angles, cortical thickness index (CTI), tip-caput distance (TCD), angle of the inferior screw, and the two ending points (complications and reoperations) were included in the statistical analysis. The Mann-Whitney U-test, the chi-square test, Fisher's exact test, and multiple logistic regression analysis were used in the study. Results Of the 110 patients included in our study, the mean ± standard deviation (SD) of age was 51.4 ± 10.4 years; 41 patients showed anatomic reduction, 35 patients showed positive buttress position reduction, and 34 patients showed negative buttress position reduction. For the outcomes, 24 patients (anatomic reduction: 6 [14.6%]; positive buttress position reduction: 5 [14.3%]; negative buttress position reduction: 13 [38.2%]) had complications, while 18 patients (anatomic reduction: 5 [12.2%]; positive buttress position reduction: 3 [8.6%]; negative buttress position reduction: 10 [29.4%]) underwent reoperations after surgery. In the multivariate logistic regression analysis of complications, negative buttress position reduction (negative buttress position reduction vs. anatomic reduction, OR = 4.309, 95%CI = 1.137 to 16.322, and p = 0.032) was found to be correlated with higher risk of complications. The same variable (negative buttress position reduction vs. anatomic reduction, OR = 5.744, 95%CI = 1.177 to 28.042, and p = 0.031) was also identified as risk factor in the multivariate logistic regression analysis of reoperations. However, no significant difference between positive reduction and anatomical reduction was investigated in the analysis of risk factors for complications, not reoperations. Conclusion Positive buttress position reduction of femoral neck fractures in young patients showed a similar incidence of complications and reoperations compared with those of anatomic reduction. For irreversible femoral neck fractures, if positive buttress position reduction has been achieved intraoperatively, it is not necessary to pursue anatomical reduction; however, negative reduction needs to be avoided.
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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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Ni M, Sun W, Ye Y. [Research progress of medial buttress plate assisted fixation for femoral neck fractures in young adults]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1454-1457. [PMID: 33191705 DOI: 10.7507/1002-1892.202004141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the research progress of medial buttress plate assisted fixation for femoral neck fractures in young adults. Methods The literature about buttress plate assisted fixation for femoral neck fractures in young adults was widely reviewed and analyzed. The design principle, background, biomechanical characteristics, and clinical results of buttress plate were summarized. Results Medial buttress plate assisted fixation is the latest treatment of femoral neck fractures in young adults, which can convert the shear force at the fracture sides into compression force and promote fracture healing. Medial buttress plate can improve the biomechanical stability of femoral neck fractures and reduce the maximum stress of fixation implants. In clinical, the medial buttress plate can maintain fracture reduction, reduce the incidences of nonunion and surgical failure, and improve hip joint function. Conclusion Medial buttress plate assisted fixation can achieve good effectiveness for femoral neck fractures in young adults. However, due to the preliminary application, its indications, fixation implants, and long-term effectiveness need to be further studied and improved.
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Affiliation(s)
- Ming Ni
- Department of Orthopedics, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, 201299, P.R.China
| | - Wanju Sun
- Department of Orthopedics, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, 201299, P.R.China
| | - Ye Ye
- Hip Injury Center, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou Henan, 471002, P.R.China
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A new proximal femoral nail antirotation design: Is it effective in preventing varus collapse and cut-out? Jt Dis Relat Surg 2020; 31:426-431. [PMID: 32962571 PMCID: PMC7607958 DOI: 10.5606/ehc.2020.75113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives
This study aims to compare the mechanical features of the existing proximal femoral nail antirotation (PFNA) system and the new PFNA system that we designed using three-dimensional (3D) finite element analysis. Materials and methods
This experimental study was conducted between 2019 and 2020. We constructed two femur models with Arbeitsgemeinschaft für Osteosynthesefragen (AO) type A1 fractures using 3D computed tomography scans. The new and standard PFNA designs were inserted into the femur models and subsequently transferred to the program. We investigated the distribution of stress on the tip of the lag screw, the calcar region, lag screw-nail junction, and the additional screw inserted through the greater trochanter (only present in the new PFNA design) using 3D finite element analysis. Results
When the von Mises stress distributions in our models were examined, the maximum stress at the lag screw-nail junction was 18 mpa in the new design PFNA, while it was 20 mpa in the classic PFNA model. The maximum stress at the junction of the additional screw that had greater trochanter inlet with the nail was found as 42.5 mpa. The maximum stress on the calcar region was found to be 10 mpa at the new design PFNA, while it was 13 mpa with 30% increase in the classic PFNA. The stress on the tip of the lag screw was found to be 49 mpa in the classic PFNA design, while in the new design PFNA it was found as 28 mpa with a decrease of more than 40%. Conclusion As per our findings, the new PFNA design leads to reduced stress on the lag screw-nail junction, the calcar region, and the tip of the lag screw.
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