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Mahapatra B, Pal B. Biomechanical analysis of various internal fracture fixation devices used for treating femoral neck fractures: A comparative finite element analysis. Injury 2024; 55:111717. [PMID: 39002322 DOI: 10.1016/j.injury.2024.111717] [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: 03/22/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION Several internal fixation devices are available for treating Pauwels type I, II and III femoral neck fractures. The present study compared various fixation implants for all Pauwels fracture types using a CT-based subject-specific finite element model of the femur and determined the most effective implant for each fracture type. MATERIALS AND METHODS The analysis included four different configurations of cannulated screw models, Femoral Neck System, Dynamic Hip Screw and Dynamic Condylar Screw (with and without anti-rotational screw). Ti-alloy was considered as the implant material. Heterogeneous bone material property was assigned based on CT grey value. Frictional contact was assumed in the contact interfaces. Peak loading corresponding to normal walking and stair-climbing were considered. Equivalent strain in bone, equivalent stress in the implants, femoral head deformation and rotation, micromotion in the contact interfaces, and strain-shielding in bone were evaluated for each implanted model. RESULTS Stresses generated in the implants were within the yield limit of the implant material. In Pauwels I and II, the micromotion predicted at the contact regions in all the implanted models was within 100 µm, which is suitable for bone integration. However, in Pauwels III fracture, most of the implanted models other than DHS with AR-screw model exhibited micromotion of more than 150 µm in the contact regions, which is expected to inhibit bone growth. CONCLUSIONS The DHS with AR-screw implanted model was identified as the most effective in treating Pauwels I and III fractures. However, for Pauwels type II, DCS with an AR-screw implant was deemed superior to the other configurations.
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Affiliation(s)
- Biswajit Mahapatra
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology, Shibpur, Howrah 711103, West Bengal, India
| | - Bidyut Pal
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology, Shibpur, Howrah 711103, West Bengal, India.
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Tang Z, Zhang Y, Huang S, Zhu Z, Zhou C, Zhu Z, Wang Y, Wang B. Biomechanical study of a biplanar double support screw (BDSF) technique based on Pauwels angle in femoral neck fractures: finite element analysis. Front Bioeng Biotechnol 2024; 12:1358181. [PMID: 38812913 PMCID: PMC11133638 DOI: 10.3389/fbioe.2024.1358181] [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: 12/19/2023] [Accepted: 04/19/2024] [Indexed: 05/31/2024] Open
Abstract
Objective The objective of the present study is to conduct a comparative analysis of the biomechanical advantages and disadvantages associated with a biplanar double support screw (BDSF) internal fixation device. Methods Two distinct femoral neck fracture models, one with a 30° angle and the other with a 70° angle, were created using a verified and effective finite element model. Accordingly, a total of eight groups of finite element models were utilized, each implanted with different configurations of fixation devices, including distal screw 150° BDSF, distal screw 165° BDSF, 3 CLS arranged in an inverted triangle configuration, and 4 CLS arranged in a "α" configuration. Subsequently, the displacement and distribution of Von Mises stress (VMS) in the femur and internal fixation device were assessed in each fracture group under an axial load of 2100 N. Results At Pauwels 30° Angle, the femur with a 150°-BDSF orientation exhibited a maximum displacement of 3.17 mm, while the femur with a 165°-BDSF orientation displayed a maximum displacement of 3.13 mm. When compared with the femoral neck fracture model characterized by a Pauwels Angle of 70°, the shear force observed in the 70° model was significantly higher than that in the 30° model. Conversely, the stability of the 30° model was significantly superior to that of the 70° model. Furthermore, in the 70° model, the BDSF group exhibited a maximum femur displacement that was lower than both the 3CCS (3.46 mm) and 4CCS (3.43 mm) thresholds. Conclusion The biomechanical properties of the BDSF internal fixation device are superior to the other two hollow screw internal fixation devices. Correspondingly, superior biomechanical outcomes can be achieved through the implementation of distal screw insertion at an angle of 165°. Thus, the BDSF internal fixation technique can be considered as a viable closed reduction internal fixation technique for managing femoral neck fractures at varying Pauwels angles.
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Affiliation(s)
- Zhongjian Tang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, China
- Graduate School of Xuzhou Medical University, Xuzhou, China
| | - Yazhong Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, China
| | - Shaolong Huang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, China
- Graduate School of Xuzhou Medical University, Xuzhou, China
| | - Zhexi Zhu
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, China
- Graduate School of Xuzhou Medical University, Xuzhou, China
| | - Chengqiang Zhou
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, China
- Graduate School of Xuzhou Medical University, Xuzhou, China
| | - Ziqiang Zhu
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, China
| | - Yunqing Wang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, China
| | - Bin Wang
- Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, China
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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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Ding K, Zhu Y, Zhang Y, Li Y, Wang H, Li J, Chen W, Zhang Q, Zhang Y. Proximal femoral bionic nail-a novel internal fixation system for the treatment of femoral neck fractures: a finite element analysis. Front Bioeng Biotechnol 2023; 11:1297507. [PMID: 38116197 PMCID: PMC10728673 DOI: 10.3389/fbioe.2023.1297507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction: Currently, cannulated screws (CSs) and dynamic hip screws (DHSs) are widely used for the treatment of femoral neck fractures, but the postoperative complications associated with these internal fixations remain high. In response to this challenge, our team proposes a new approach involving triangular-supported fixation and the development of the proximal femoral bionic nail (PFBN). The primary objective of this study is to investigate the biomechanical differences among CSs, DHSs, and the PFBN in their capacity to stabilize femoral neck fractures. Methods: A normal proximal femur model was constructed according to the CT data of a normal healthy adult. A femoral neck fracture model was constructed and fixed with CSs, DHSs, and the PFBN to simulate the fracture fixation model. Abaqus 6.14 software was used to compare the biomechanical characters of the three fracture fixation models. Results: The maximum stresses and displacements of the normal proximal femur were 45.35 MPa and 2.83 mm, respectively. Under axial loading, the PFBN was more effective than DHSs and CSs in improving the stress concentration of the internal fixation and reducing the peak values of von Mises stress, maximum principal stress, and minimum principal stress. The PFBN fixation model exhibits superior overall and fracture section stability in comparison to both the DHS fixation model and the CS fixation model under axial loading. Notably, the maximum stress and peak displacement of the PFBN and bone were lower than those of the DHS and CS fixation models under bending and torsional loading. Conclusion: The PFBN shows considerable improvement in reducing stress concentration, propagating stress, and enhancing the overall stability in the femoral neck fracture fixation model compared to DHSs and CSs. These enhancements more closely correspond to the tissue structure and biomechanical characteristics of the proximal femur, demonstrating that the PFBN has great potential for therapeutic purposes in treating femoral neck fractures.
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Affiliation(s)
- Kai Ding
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
| | - Yanbin Zhu
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
| | - Yifan Zhang
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
| | - Yonglong Li
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
| | - Haicheng Wang
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
| | - Jiaxing Li
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
| | - Wei Chen
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
| | - Qi Zhang
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
| | - Yingze Zhang
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
- Chinese Academy of Engineering, Bejing, China
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Sun X, Yi G, Ao L, Zhou X, Zhang T, Guan TY. Effect analysis of medial bracing plate combined with cannulated screw in unstable femoral neck fracture assisted by surgical hip dislocation: a retrospective study. J Orthop Surg Res 2023; 18:498. [PMID: 37452375 PMCID: PMC10347755 DOI: 10.1186/s13018-023-03991-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Unstable femoral neck fractures have a high likelihood of causing severe disruption to the blood supply. This study aimed to assess the therapeutic effect of surgical hip dislocation using a medial support plate combined with cannulated screw fixation for the treatment of unstable femoral neck fractures in young and middle-aged adults. METHODS We retrospectively analyzed the medical records of 68 young adults who underwent internal fixation of unstable femoral neck fractures. The observation group included 32 patients who had received medial support plate and cannulated screw fixation by the surgical hip dislocation method and 36 patients who had undergone anti-rotation screw composite compression system fixation comprised the comparison group. The amount of intraoperative bleeding, surgery duration, fracture recovery time and complications were recorded. The degree of femoral neck shortening and Garden index were assessed using the Zlowodzki method. Additionally, hip functionality was evaluated using the Harris score at 3 and 6 months and at the last follow-up. RESULTS All 68 patients in both groups were followed up for 12-42 months (mean, 22.4 months). The postoperative incision was well-aligned and no inflation was observed. The intraoperative blood loss and surgery duration in the comparison group were longer than those in the observation. Additionally, the observation group had a significantly shorter fracture recovery time and a higher Garden index than the comparison at 6 months postoperatively; however, there was no significant statistical discrepancy between the two groups at the remaining time points. The observation group had higher Harris scores than the comparison at 3 and 6 months postoperatively. CONCLUSION Surgical hip dislocation applied to the medial support plate combined with cannulated screw fixation has clinical application value in restoring the stability of femoral neck fractures while facilitating the maintenance of blood flow to the femoral head and neck.
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Affiliation(s)
- Xin Sun
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
- College Of Integration Of Traditional Chinese And Western Medicine To Southwest Medical University, Luzhou, Sichuan, China
| | - Gang Yi
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Liang Ao
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xin Zhou
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Tao Zhang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Tai-Yuan Guan
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China.
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Ling W, Chen L. Research hotspots and trends in internal fixation of femoral neck fractures from 2010 to 2022: A 12-year bibliometric analysis. Medicine (Baltimore) 2023; 102:e34003. [PMID: 37335643 PMCID: PMC10256364 DOI: 10.1097/md.0000000000034003] [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: 03/05/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND This study endeavors to scrutinize the hotspots and trends in the literature concerning the internal fixation of femoral neck fractures (INFNF) through a comprehensive bibliometric analysis. Notably, this analytical process encompasses both qualitative and quantitative components. METHODS The present study has utilized the Science Citation Index-Expanded from the Web of Science Core Collection to extract datasets ranging from January 1, 2010, to August 31, 2022. Quantitative analysis was carried out using sophisticated analytical tools such as the Bibliographic Item Co-Occurrence Matrix Builder, the Online Analysis Platform of Literature Metrology, and CiteSpace software. Further, the major Medical Subject Headings terms and their subheading counterparts associated with INFNF were extracted from the PubMed2XL website using the corresponding PMIDs. These Medical Subject Headings terms were employed in conducting a co-word clustering analysis. Ultimately, the Graphical CLUstering TOolkit program was utilized to execute a co-word biclustering analysis to discern the prevailing hotspots in this domain. RESULTS Between January 1, 2010, and August 31, 2022, a total of 463 publications were issued on INFNF. The INJURY-INTERNAL JOURNAL OF THE CARE OF THE INJURED stood out as the most extensively perused journal in this area. Notably, China emerged as the foremost contributor to publishing articles within the last 12 years, followed by the United States and Canada. McMaster University was identified as the leading institution in INFNF research, while Bhandari M emerged as the most prolific author in this field. Moreover, the study identified five notable research hotspots within the domain of INFNF. CONCLUSIONS This study has identified five critical areas of research in the field of INFNF. It suggests that the primary focus of future research is likely to center on advancing internal fixation methods and robot-assisted instrumentation for femoral neck fractures. As such, this study provides valuable insights into future research directions and ideas for those working in this field.
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Affiliation(s)
- Wenkang Ling
- Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Leilei Chen
- Department of Orthopaedics, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
- Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
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Jiang D, Zhan S, Hai H, Wang L, Zhao J, Zhu Z, Wang T, Jia W. What makes vertical femoral neck fracture with posterior inferior comminution different? An analysis of biomechanical features and optimal internal fixation strategy. Injury 2023:110842. [PMID: 37296009 DOI: 10.1016/j.injury.2023.110842] [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: 12/11/2022] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND PURPOSE Fracture comminution occurs in 83.9%-94% of vertical femoral neck fractures (VFNFs), the majority of which were located in posterior-inferior region, and poses a clinical challenge in fixation stability. We conducted a subject-specific finite element analysis to determine the biomechanical features and optimal fixation selection for treating VFNF with posterior-inferior comminution. PATIENTS AND METHODS Eighteen models with three fracture types (VFNF without comminution [NCOM], with comminution [COM], with comminution + osteoporosis [COMOP]) and six internal fixation types (alpha [G-ALP], buttress [G-BUT], rhomboid [G-RHO], dynamic hip screw [G-DHS], invert triangle [G-ITR], femoral neck system (G-FNS)) were created based on the computed tomography data. By using the subject-specific finite element analysis method, stiffness, implant stress, yielding rate (YR) were compared. Additionally, in order to elucidate distinct biomechanical characters of different fracture types and fixation strategies, we calculated interfragmentary movement (IFM), detached interfragmentary movement (DIM), shear interfragmentary movement (SIM) of all fracture surface nodes. RESULTS Generally, in comparison with NCOM, COM showed a 30.6% reduction of stiffness and 1.46-times higher mean interfragmentary movement. Besides, COM had a 4.66-times (p = 0.002) higher DIM at the superior-middle position, but similar SIM across fracture line, which presented as varus deformation. In COM and COMOP, among all six fixation strategies, G-ALP had significantly the lowest IFM (p<0.001) and SIM (p<0.001). Although G-FNS had significantly highest IFM and SIM (p<0.001), it had the highest stiffness and lowest DIM (p<0.001). In COMOP, YR was the lowest in G-FNS (2.67%). CONCLUSIONS Posterior-inferior comminution primarily increases superior-middle detached interfragmentary movement in VFNF, which results in varus deformation. For comminuted VFNF with or without osteoporosis, alpha fixation has the best interfragmentary stability and anti-shear property among six current mainstream fixation strategies, but a relatively weaker stiffness and anti-varus property compared to fixed-angle devices. FNS is advantageous owing to stiffness, anti-varus property and bone yielding rate in osteoporosis cases, but is insufficient in anti-shear property.
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Affiliation(s)
- Dajun Jiang
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Shi Zhan
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Hu Hai
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Lingtian Wang
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Jinhui Zhao
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Ziyang Zhu
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR China
| | - Tao Wang
- Department of emergency trauma center, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Weitao Jia
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, PR 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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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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11
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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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12
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Nan C, Ma L, Liang Y, Li Y, Ma Z. Mechanical effects of sagittal variations on Pauwels type III femoral neck fractures treated with Femoral Neck System(FNS). BMC Musculoskelet Disord 2022; 23:1045. [PMID: 36457095 PMCID: PMC9714141 DOI: 10.1186/s12891-022-06016-y] [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: 09/21/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The spatial position of internal fixation play a role in determining the stability of internal fixations, both in clinical practice and research. Researchers have examined the stability of FNS (Femoral neck system) in the presence of coronal plane changes. In our knowledge, due to the biomechanical limitations of the specimens, there are no mechanical studies on the sagittal variation of FNS. This study aimed to investigate the biomechanical behavior of sagittal variations on Pauwels type III femoral neck fractures treated with FNS through finite element analysis. METHODS Finite element models including Pauwels type III femoral neck fracture and FNS were reconstructed. Five fracture models(superior, central, inferior, anterior, posterior) were created in accordance with the bolt location in the sagittal plane within the femoral head. Equivalent stress, shear stress, and total deformation of each model under the same physiological load were recorded. RESULTS According to the results, the central model exhibited the slightest stress and displacement, with the exception of the superior model. The internal fixation stress of the superior model was smaller than that of the central model. However, the maximum interfragmentary stress, total deformation and shear resistance area of the superior model was larger than that of the central model. CONCLUSIONS Central position of FNS in the sagittal plane allowed axial compression while reducing shear stress of internal fixation and interfragmentary equivalent stress. Off-axis fixation of the femoral neck increased the strain area and total displacement of the bone, raising the risk of fixation failure. Therefore, the central placement of FNS may be a better surgical target in the treatment of femoral neck fractures.
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Affiliation(s)
- Chong Nan
- Department of Orthopedic, Baoding No.1 Central Hospital, Baoding, 071000 Hebei Province China
| | - Liang Ma
- Department of Orthopedic, Baoding No.1 Central Hospital, Baoding, 071000 Hebei Province China
| | - Yuechuang Liang
- Department of Orthopedic, Baoding No.1 Central Hospital, Baoding, 071000 Hebei Province China
| | - Yanjun Li
- Department of Orthopedic, Baoding No.1 Central Hospital, Baoding, 071000 Hebei Province China ,Baoding Digital Orthopaedic Key Laboratory, Baoding, 071000 Hebei Province China
| | - Zhanbei Ma
- Department of Orthopedic, Baoding No.1 Central Hospital, Baoding, 071000 Hebei Province China ,Baoding Digital Orthopaedic Key Laboratory, Baoding, 071000 Hebei Province China
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Ding K, Zhu Y, Wang H, Li Y, Yang W, Cheng X, Zhang Y, Chen W, Zhang Q. A comparative Study of Novel Extramedullary Fixation and Dynamic Hip Screw in the Fixation of Intertrochanteric Fracture: A Finite-Element Analysis. Front Surg 2022; 9:911141. [PMID: 35693317 PMCID: PMC9174929 DOI: 10.3389/fsurg.2022.911141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/02/2022] [Indexed: 12/02/2022] Open
Abstract
Background Dynamic hip screw (DHS) is one of the most widely internal fixations for stabilizing intertrochanteric fracture, however, with a high risk of postoperative complications. The triangle support fixation plate (TSFP) is developed to reduce the postoperative complications. The purpose of study is to evaluate the biomechanical performance of the DHS and TSFP and demonstrate the rationality of triangular internal fixation for stabilizing intertrochanteric fractures. Methods The CT data of the proximal femur were used to establish finite-element models. Evans type I and IV intertrochanteric fracture were constructed and stabilized with the DHS and TSFP. The Von-Mises stress, maximum principal stress, minimum principal stress, and displacement were used to evaluate the biomechanical effect of two implants on intertrochanteric fracture. Results Under a 600N axial load, the maximum stress and displacement of an intact proximal femur were 13.78 MPa and 1.33 mm, respectively. The peak stresses of the bone in the TSFP were 35.41 MPa and 68.97 MPa for treating Evans type I and IV intertrochanteric fractures, respectively, which were lower than those in the DHS. The maximum overall displacement and relative distance of the fracture surface in the DHS fixation model were 1.66 mm and 0.10 mm for treating Evans type I intertrochanteric fracture, which was 29.59% and 150% higher than that in the TSFP, and were 2.24 mm and 0.75 mm for treating Evans type IV intertrochanteric fracture, which was 42.58% and 650% higher than that in the TSFP. Conclusions In conclusion, the TSFP has obvious advantages in stress distribution and stability than the DHS, providing a promising option for the treatment of intertrochanteric fractures.
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Affiliation(s)
- Kai Ding
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
| | - Yanbin Zhu
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
| | - Haicheng Wang
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
| | - Yonglong Li
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
| | - Weijie Yang
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
| | - Xiaodong Cheng
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
| | - Yingze Zhang
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, the third hospital of hebei medical university, Shijiazhuang, China
- Chinese Academy of Engineering, Bingjiaokou Hutong, Beijing, China
| | - Wei Chen
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, the third hospital of hebei medical university, Shijiazhuang, China
| | - Qi Zhang
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
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Jiang D, Zhan S, Hu H, Zhu H, Zhang C, Jia W. The Effect of Vertical and Oblique Inclinations on Fracture Stability and Reoperation Risks in Femoral-Neck Fractures of Nongeriatric Patient. Front Bioeng Biotechnol 2021; 9:782001. [PMID: 34805128 PMCID: PMC8595327 DOI: 10.3389/fbioe.2021.782001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/19/2021] [Indexed: 01/16/2023] Open
Abstract
Background: For nongeriatric patients with femoral neck fractures (FNFs), preoperative evaluation of fracture three-dimensional inclination is essential to identify fracture stability, select appropriate fixation strategies, and improved clinical prognoses. However, there is lack of evaluation system which takes into account both vertical and oblique inclinations. The purpose of this study was to comprehensively investigate the effect of vertical and oblique inclinations on fracture stability and reoperation risks. Methods: We retrospectively reviewed the medical records of 755 FNFs patients with over 2 years follow-up. The 3-D inclination angle in vertical (α) and oblique plane (β) were measured based on CT images. The optimal threshold for unstable 3-D inclination were identified by seeking the highest Youden Index in predicting reoperation and validated in the biomechanical test. According to the cut-off value proposed in the diagnostic analysis, forty-two bone models were divided into seven groups, and were all fixed with traditional three parallel screws. Interfragmentary motion (IFM) was used for comparison among seven groups. The association between reoperation outcome and 3-D inclination was analysed with a multivariate model. Results and Conclusion: The overall reoperation rate was 13.2%. Unstable 3-D inclination angles with an optimally determined Youden index (0.39) included vertical (α > 70°) and oblique (50°<α < 70° and β > 20°/β < −20°) types. Biomechanical validation showed these fractures had significantly greater (p < 0.05) interfragmentary motion (1.374–2.387 mm vs. 0.330–0.681 mm). The reoperation rate in 3-D unstable group (32.7%) is significantly (p < 0.001) higher than that in 3-D stable group (7.9%). Multivariate analysis demonstrated that 3-D inclination angle was significantly (OR = 4.699, p < 0.001) associated with reoperation. FNFs with α > 70°; 50°<α < 70° and β > 20°/β < −20° are real unstable types with significantly worse interfragmentary stability and higher reoperation risks. Fracture inclination in vertical and oblique planes is closely related to reoperation outcomes and may be a useful complement to the way FNFs are currently evaluated.
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Affiliation(s)
- Dajun Jiang
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shi Zhan
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hai Hu
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hongyi Zhu
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Changqing Zhang
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weitao Jia
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Zhan S, Jiang D, Ling M, Ding J, Yang K, Duan L, Tsai TY, Feng Y, van Trigt B, Jia W, Zhang C, Hu H. Fixation effects of different types of cannulated screws on vertical femoral neck fracture: A finite element analysis and experimental study. Med Eng Phys 2021; 97:32-39. [PMID: 34756336 DOI: 10.1016/j.medengphy.2021.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/21/2022]
Abstract
Femoral neck fractures (FNFs) in young patients usually result from high-energy violence, and the vertical transcervical type is typically challenging for its instability. FNFs are commonly treated with three cannulated screws (CS), but the role of screws type on fixation effects (FE) is unclear. The purpose of this study was to evaluate the FE of ten types of CS with different diameters, lengths, depths, and pitches of thread via finite element analysis which was validated by a biomechanical test. Ten vertical FNF models were grouped, fixed by ten types of CS, respectively, all in a parallel, inverted triangular configuration. Their FE were scored comprehensively from six aspects via an entropy evaluation method, as higher scores showed better results. For partial-thread screws, thread length and thread shape factor (TSF) are determinative factors on stability of FNF only if thread depth is not too thick, and they have less cut-out risk, better compression effects and better detached resistance of fracture than full-thread screws, whereas full-thread screws appear to have better shear and shortening resistance. A combination of two superior partial-thread screws and one inferior full-thread screw for vertical FNF may get optimal biomechanical outcomes. The type of cannulated screw is important to consider when treating vertical FNF.
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Affiliation(s)
- Shi Zhan
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Dajun Jiang
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Ming Ling
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Jian Ding
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Kai Yang
- Radiology Department, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Lei Duan
- State Key Laboratory of Ocean Engineering, School of Naval Architecture, Ocean & Civil Engineering, Shanghai Jiao Tong University, Shanghai, 200240, PR China
| | - Tsung-Yuan Tsai
- Engineering Research Center of Clinical Translational Digital Medicine, Ministry of Education of P.R. China, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, PR China
| | - Yong Feng
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China
| | - Bart van Trigt
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 4, 2628 CD Delft, the Netherlands
| | - Weitao Jia
- Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China.
| | - Changqing Zhang
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR China.
| | - Hai Hu
- Biomechanical Laboratory of Orthopedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, PR 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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