1
|
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.
Collapse
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
| |
Collapse
|
2
|
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
| |
Collapse
|
3
|
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.
| |
Collapse
|
4
|
Cheng X, Yang Y, Zhu J, Li G, Chen W, Wang J, Zhang Q, Zhang Y. Finite element analysis of basicervical femoral neck fracture treated with proximal femoral bionic nail. J Orthop Surg Res 2023; 18:926. [PMID: 38053203 DOI: 10.1186/s13018-023-04415-y] [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: 10/23/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Dynamic hip screws (DHS) and proximal femoral nail anti-rotation (PFNA) were recommended for basicervical femoral neck fracture (BFNF), however, with high rate of postoperative femoral neck shortening. The proximal femoral bionic nail (PFBN) was designed to decrease the postoperative complications associated with DHS and PFNA. The aim of this study is to compare the biomechanical characters of DHS, PFNA, and PFBN for fixation of BFNF. METHODS Using finite element analysis, we created a three-dimensional model of the BFNF for this investigation. The PFBN group, the PFNA group and the DHS + DS group were our three test groups. For each fracture group, the von Mises stress and displacements of the femur and internal fixation components were measured under 2100 N axial loads. RESULTS The PFBN group demonstrated the lowest stress on the implants, significantly lower than the PFNA and DHS + DS groups. In terms of stress on the implants, the PFBN group exhibited the best performance, with the lowest stress concentration at 112.0 MPa, followed by the PFNA group at 124.8 MPa and the DHS + DS group at 149.8 MPa. The PFBA group demonstrated the smallest displacement at the fracture interface, measuring 0.21 mm, coupled with a fracture interface pressure of 17.41 MPa, signifying excellent stability. CONCLUSIONS Compared with DHS and PFNA, PFBN has advantages in stress distribution and biological stability. We believe the concept of triangle fixation will be helpful to reduce femoral neck shortening associated with DHS and PFNA and thus improve the prognosis of BFNF.
Collapse
Affiliation(s)
- Xiaodong Cheng
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yanjiang Yang
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Jian Zhu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Science, No. 99, Longcheng Street, Taiyuan, 030032, Shanxi Province, People's Republic of China
| | - Guimiao Li
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Wei Chen
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Juan Wang
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Qi Zhang
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
| | - Yingze Zhang
- Department of Orthopaedics, Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, 050051, People's Republic of China.
- Hebei Orthopaedic Clinical Research Center, Shijiazhuang, Hebei, 050051, People's Republic of China.
| |
Collapse
|
5
|
Kijima H, Yamada S, Kawano T, Komatsu M, Iwamoto Y, Konishi N, Kubota H, Tazawa H, Tani T, Suzuki N, Kamo K, Sasaki K, Fujii M, Nagahata I, Miura T, Igarashi S, Miyakoshi N. Characteristics and Treatment Strategies for Basicervical and Transcervical Shear Fractures of the Femoral Neck. J Clin Med 2023; 12:7024. [PMID: 38002638 PMCID: PMC10671904 DOI: 10.3390/jcm12227024] [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: 09/22/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
This study aimed to define basicervical and transcervical shear fractures using area classification and to determine the optimal osteosynthesis implants for them. The clinical outcomes of 1042 proximal femur fractures were investigated. A model of the proximal femur of a healthy adult was created from computed tomography images, and basicervical and transcervical shear fractures were established in the model. Osteosynthesis models were created using a short femoral nail with a single lag screw or two lag screws and a long femoral nail with a single lag screw or two lag screws. The minimum principal strains of the fracture surfaces were compared when the maximum loads during walking were applied to these models using finite element analysis software. Basicervical fractures accounted for 0.96% of all proximal femur fractures, 67% of which were treated with osteosynthesis; the failure rate was 0%. Transcervical shear fractures accounted for 9.6% of all proximal femur fractures, 24% of which were treated with osteosynthesis; the failure rate was 13%. Finite element analysis showed that transcervical shear fracture has high instability. To perform osteosynthesis, multiple screw insertions into the femoral head and careful postoperative management are required; joint replacement should be considered to achieve early mobility.
Collapse
Affiliation(s)
- Hiroaki Kijima
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita 010-8543, Japan (N.M.)
- Akita Hip Research Group, 1-1-1, Hondo, Akita 010-8543, Japan
| | - Shin Yamada
- Akita Hip Research Group, 1-1-1, Hondo, Akita 010-8543, Japan
| | - Tetsuya Kawano
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita 010-8543, Japan (N.M.)
- Akita Hip Research Group, 1-1-1, Hondo, Akita 010-8543, Japan
| | - Motoharu Komatsu
- Graduate School of Engineering Science, Akita University, 1-1 Tegatagakuen-machi, Akita 010-8502, Japan
| | - Yosuke Iwamoto
- Akita Hip Research Group, 1-1-1, Hondo, Akita 010-8543, Japan
| | - Natsuo Konishi
- Akita Hip Research Group, 1-1-1, Hondo, Akita 010-8543, Japan
| | - Hitoshi Kubota
- Akita Hip Research Group, 1-1-1, Hondo, Akita 010-8543, Japan
| | - Hiroshi Tazawa
- Akita Hip Research Group, 1-1-1, Hondo, Akita 010-8543, Japan
| | - Takayuki Tani
- Akita Hip Research Group, 1-1-1, Hondo, Akita 010-8543, Japan
| | - Norio Suzuki
- Akita Hip Research Group, 1-1-1, Hondo, Akita 010-8543, Japan
| | - Keiji Kamo
- Akita Hip Research Group, 1-1-1, Hondo, Akita 010-8543, Japan
| | - Ken Sasaki
- Akita Hip Research Group, 1-1-1, Hondo, Akita 010-8543, Japan
| | - Masashi Fujii
- Akita Hip Research Group, 1-1-1, Hondo, Akita 010-8543, Japan
| | - Itsuki Nagahata
- Akita Hip Research Group, 1-1-1, Hondo, Akita 010-8543, Japan
| | - Takanori Miura
- Akita Hip Research Group, 1-1-1, Hondo, Akita 010-8543, Japan
| | - Shun Igarashi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita 010-8543, Japan (N.M.)
- Akita Hip Research Group, 1-1-1, Hondo, Akita 010-8543, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita 010-8543, Japan (N.M.)
- Akita Hip Research Group, 1-1-1, Hondo, Akita 010-8543, Japan
| |
Collapse
|