1
|
Lee JW, Song MJ, Lee SJ, Song HS, Jung YS, Kim H. Biomechanical comparison between low profile 2.7 mm distal locking hook plate and 3.5 mm distal locking hook plate for acromioclavicular joint injury: A finite element analysis. Injury 2024; 55:111657. [PMID: 39002321 DOI: 10.1016/j.injury.2024.111657] [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: 03/02/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE Although hook plate fixation is popularly used, concerns exist regarding periprosthetic fractures and the necessity to remove the plate to prevent subacromial erosion and subsequent acromion fracture, due to its non-anatomical design. We hypothesized that a low profile 2.7 mm distal locking hook plate would provide comparable stability to a properly used 3.5 mm distal locking hook plate MATERIALS AND METHODS: A 3.5 mm distal locking plate (type 1) and a low profile 2.7 mm plate (type 2) were assessed by finite element analysis. Peak von Mises stress (PVMS) was calculated on the acromion's undersurface, clavicle shaft, and hook, focusing on how these stresses varied with the number and placement of distal locking screws. RESULTS Increased distal screws in both types led to lower PVMS on the acromion's undersurface and the hook, with the lowest acromion PVMS observed in type 2 with three distal screws, and on the hook in type 1 with two distal screws. Increasing the number of distal screws similarly reduced PVMS on the clavicle shaft, with the lowest in type 1 with two distal screws. In both plate types, the most posterior distal locking screw played a crucial role in distributing stress across the acromion and the hook. CONCLUSION The low profile 2.7 mm distal locking hook plate showed comparable biomechanical results to the 3.5 mm distal locking hook plate. Increasing the number of distal locking screws showed less stress concentration on the bone and hook in both models. The most posterior distal locking screw showed an essential role in stress distribution.
Collapse
Affiliation(s)
- Jeong-Woo Lee
- Department of Biomedical Engineering, Inje University, Gimhae, Korea
| | - Min-Jun Song
- Department of Biomedical Engineering, Inje University, Gimhae, Korea
| | - Sung-Jae Lee
- Department of Biomedical Engineering, Inje University, Gimhae, Korea
| | - Hyun Seok Song
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn-Sung Jung
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyungsuk Kim
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
2
|
Wang HR, Li J, Zhang LF, Li DM, Han B, Li B, Li JR, Li LG. Biomechanical analysis of fixation strength at different nailing angles for femoral neck fracture with insufficient reduction. Comput Methods Biomech Biomed Engin 2024; 27:1949-1959. [PMID: 37842737 DOI: 10.1080/10255842.2023.2265010] [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: 06/08/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/17/2023]
Abstract
To analyze the fixation strength of cannulated screws fixation in the treatment of femoral neck fracture with posterior tilt due to insufficient reduction. Two sets of digital models of anatomical reduction and 15° tilting reduction were established by CT data. Each group of models was modeled with two different fixation methods. One fixation method was fixed according to the standard cannulated screws recommended by AO. Another fixation method is to tilt the screw posterior tilt 15°. The final four groups of models were obtained: AO principle nailing posterior tilt model (Group A), posterior direction nailing posterior tilt model (Group B), AO principle nailing anatomic reduction model (Group C) and posterior direction nailing anatomic reduction model (Group D). The maximum displacement of the fracture end, the maximum Von-Mises stress and the stress distribution of the internal fixation were compared among the four groups. Four groups of models were established on artificial bone by 3D printing guide plate technology. The 600 N pressure test and yield test were performed on a biomechanical machine. The finite element and biomechanical models showed that groups B and C were more stable than groups A and D. The stability of group B was not worse than that of group C. When the femoral neck fracture produces a posterior tilt, a posterior reduction is allowed. The change of AO screw to posterior tilting screw fixation has more powerful advantages. No posterior tilt or posterior reduction, AO screw placement is still required.
Collapse
Affiliation(s)
- Hong-Run Wang
- Institute of Trauma Surgery, The Second Hospital of Tangshan, Tangshan, Hebei Province, China
| | - Ji Li
- Institute of Trauma Surgery, The Second Hospital of Tangshan, Tangshan, Hebei Province, China
| | - Li-Feng Zhang
- Institute of Trauma Surgery, The Second Hospital of Tangshan, Tangshan, Hebei Province, China
| | - Dong-Mei Li
- Institute of Trauma Surgery, The Second Hospital of Tangshan, Tangshan, Hebei Province, China
| | - Biao Han
- Institute of Trauma Surgery, The Second Hospital of Tangshan, Tangshan, Hebei Province, China
| | - Bin Li
- Institute of Trauma Surgery, The Second Hospital of Tangshan, Tangshan, Hebei Province, China
| | - Jun-Ran Li
- Institute of Trauma Surgery, The Second Hospital of Tangshan, Tangshan, Hebei Province, China
| | - Li-Geng Li
- Institute of Trauma Surgery, The Second Hospital of Tangshan, Tangshan, Hebei Province, China
| |
Collapse
|
3
|
Li SJ, Huang HJ, Li CT, Hu GJ, Yu F, Liu YB. Mechanical effect of changed femoral neck ante-version angles on the stability of an intertrochanteric fracture fixed with PFNA: A finite element analysis. Heliyon 2024; 10:e31480. [PMID: 38813167 PMCID: PMC11133928 DOI: 10.1016/j.heliyon.2024.e31480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024] Open
Abstract
Objective Change of femoral neck ante-version angle postoperatively due to inadequate reduction could result in unsatisfying treatment outcome of intertrochanteric fracture. However, the influence of increased or decreased femoral neck ante-version on the biomechanical stability of the bone-implant complex has rarely been studied. Methods A finite element model of a complete normal human femur with normal femoral neck ante-version as 13° was established accurately by scanning a 64 year old female femur. The models of 31-A1.1 intertrochanteric fractures with different femoral neck ante-version angles of 3°, 5.5°, 8°, 10.5°, 13°, 15.5°, 18°, 20.5°, 23° were created. They were assembled with a proximal femoral nail anti-rotation (PFNA) device. The biomechanical differences with varying femoral neck ante-version angles were compared using finite element analysis method. Results As the femoral neck ante-version angle gradually increased from 13° to 23°with a gradient of 2.5°, the peak von Mises stress was gradually increased from 137.82 MPa to 276.02 MPa. Similarly, the peak von Mises stress was gradually increased from 137.82 MPa to 360.12 MPa with the femoral neck ante-version angle decreased from 13° to 3°. When decreased ante-version angle of 7.5° and increased ante-version angle of 10° will exceed the yield strength of femoral (240.32 MPa), the risk of femoral fracture will increase significantly. The maximum displacement of the femur was significantly reduced for increased ante-version models than for decreased ante-version models, whether the changes of ante-version angles were 2.5°, 5°, 7.5° or 10°. The maximum stress of PFNA was found in the intersection of main nail and helical blade, and became greater gradually as the ante-version angle increased or decreased with a gradient of 2.5°. The maximum stress of PFNA was presented in the model 5.5° with the maximum stress of 724.42 MPa (near to the yield strength of titanium alloy of 700-1000 MPa), producing the breakage risk of PFNA. The maximum displacement of the PFNA was significantly reduced for increased ante-version models than for decreased ante-version models, whether the changes of ante-version angles were 2.5°, 5°, 7.5° or 10°. Conclusion Based on the results of present study, it was demonstrated that the anatomical reduction of femoral neck ante-version was vital to secure the optimal stability. Abnormal femoral ante-version could increase the potential risk of failure for intertrochanteric fracture after PFNA. The stability of increased femoral ante-version (less than 10°) was superior to the stability of decreased ante-version (less than 5°) for the cases of difficulty to acquire anatomical reduction. The clinical implication of the finding was that increased femoral neck ante-version had an advantage of mechanical stability towards the decreased femoral neck ante-version for the cases of comminuted intertrochanteric fracture and failure of anatomical reduction.
Collapse
Affiliation(s)
- Song-Jian Li
- Orthopedics Center, Department of Orthopedics and Traumatology, Zhujiang Hospital, Southern Medical University, China
| | - Hua-Jian Huang
- Orthopedics Center, Department of Orthopedics and Traumatology, Zhujiang Hospital, Southern Medical University, China
| | - Chen-Tian Li
- Orthopedics Center, Department of Orthopedics and Traumatology, Zhujiang Hospital, Southern Medical University, China
| | - Guo-Ju Hu
- Orthopedics Center, Department of Orthopedics and Traumatology, Zhujiang Hospital, Southern Medical University, China
| | - Fei Yu
- College of Management, Guangdong Polytechnic Normal University, China
| | - Yu-Bin Liu
- Orthopedics Center, Department of Orthopedics and Traumatology, Zhujiang Hospital, Southern Medical University, China
| |
Collapse
|
4
|
Liu J, Ge Y, Wang Y, Yang Q, Yibulayimu S, Wu X, Tian W, Shi C, Liu Y, Yang M. Sagittal support rather than medial cortical support matters in geriatric intertrochanteric fracture: A finite element analysis study. Heliyon 2024; 10:e28606. [PMID: 38571577 PMCID: PMC10988050 DOI: 10.1016/j.heliyon.2024.e28606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
Hip fracture, increasing exponentially with age, is osteoporosis's most severe clinical consequence. Intertrochanteric fracture, one of the main types of hip fracture, is associated with higher mortality and morbidity. The current research hotspots lay in improving the treatment effect and optimizing the secondary stability after intertrochanteric fracture surgery. Cortex buttress reduction is a widely accepted method for treating intertrochanteric fracture by allowing the head-neck fragment to slide and rigidly contact the femoral shaft's cortex. Medial cortical support is considered a more effective option in treating young patients. However, osteo-degenerations features, including bone weakness and cortical thickness thinning, affect the performance of cortex support in geriatric intertrochanteric fracture treatment. Literature focusing on the age-specific difference in cortex performance in the fractured hip is scarce. We hypothesized that this osteo-19 degenerative feature affects the performance of cortex support in treating intertrochanteric fractures between the young and the elderly. We established twenty models for the old and the young with intertrochanteric fractures and performed static and dynamic simulations under one-legged stance and walking cycle conditions. The von Mises stress and displacement on the femur, proximal femoral nail anti-rotation (PFNA) implant, fracture plane, and the cutting volume of cancellous bone of the femur were compared. It was observed that defects in the anterior and posterior cortical bone walls significantly increase the stress on the PFNA implant, the displacement of the fracture surface, and cause a greater volume of cancellous bone to be resected. We concluded that ensuring the integrity and alignment of the anterior and posterior cortical bones is essential for elderly patients, and sagittal support is recommended. This finding suggests that the treatment method for intertrochanteric fracture may differ, considering the patient's age difference.
Collapse
Affiliation(s)
- Jixuan Liu
- Institue of Medical Equipment Science and Engineering (IMESE), Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Yufeng Ge
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Yu Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Qing Yang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Sutuke Yibulayimu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Xinbao Wu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Wei Tian
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Chao Shi
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Yanzhen Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
5
|
Huang S, Zhu J, Xing H, Yang R, Ye J, Ye F, Wu Q, Lan S. Finite element analysis and a pilot study of different fixation constructs for Danis-Weber A and B lateral malleolus fractures. BMC Musculoskelet Disord 2023; 24:981. [PMID: 38114924 PMCID: PMC10729578 DOI: 10.1186/s12891-023-07115-0] [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: 05/26/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Displaced lateral malleolus fractures are typically stabilised through open reduction and internal fixation. The biomechanically and clinically efficacy of locking plates and lag screws, particularly in Weber A and B distal fibular fractures remains a subject of contention. This study examines two locking plate designs for lateral malleolus fractures, evaluating their performance with and without interfragmentary screws using finite element models. METHODS Utilising CT images of a healthy adult male volunteer, a three-dimensional finite element model was constructed. The Fibula-specific Flank Multiaxial Locking Anatomic Plate (FMLP) and the Conventional Locking Plate (CLP) were subjected to stabilisation, both with and without an interfragmentary screw, mimicking the Danis-Weber A and B lateral malleolus oblique fracture fixation. Loads of 140 N and 70 N, equivalent to 20% of the body weight, were applied to simulate the single-leg and two-leg standing conditions in the axial direction. The von Mises stress (VMS) distributions and element displacements were subsequently analyzed. RESULTS In the Danis-Weber A fracture model group, the FMLP with an interfragmentary screw fixation exhibited the lowest peak VMS values: 51.9 MPa in the fibula, 89.0 MPa in the plate, and 61.3 MPa in the screws for simulating single-leg conditions. Under two-leg standing conditions, these peak VMS values decreased to 25.9 MPa in the fibula, 44.5 MPa in the plate, and 30.6 MPa in the screws, respectively. Furthermore, the overall structural peak displacements during single-leg standing for both Weber-A and B fractures with different implants ranged from 1.61 to 2.54 mm. While standing on two feet, the ranged was from 0.80 to 1.27 mm. An interfragmentary screw at the oblique fracture site resulted in reduced the peak value of VMS in the fibula, plate, screws, consequently decreased the overall structural displacement for FMLP and CLP fixation in lateral malleolus fractures. CONCLUSIONS The current finite element analysis (FEA) demonstrates that FMLP exhibits superior mechanical characteristics in Danis-Weber A and B lateral malleolus fractures compared to CLP. The inclusion of an interfragmentary screw, combined with locking plate design, enhances stability for simple oblique distal fibular fractures. The FMLP presents itself as potential as an alternative for lateral malleolus fractures from a biomechanical perspective. Nevertheless, further verification of these results is imperative through subsequent clinical studies.
Collapse
Affiliation(s)
- Shuming Huang
- Department of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, People's Republic of China
| | - Junkun Zhu
- Department of Orthopedic Rehabilitation, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Zhejiang323000, Lishui, People's Republic of China
| | - Hailin Xing
- Department of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, People's Republic of China
| | - Ruifeng Yang
- Department of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, People's Republic of China
| | - Jifei Ye
- Department of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, People's Republic of China
| | - Fang Ye
- Department of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, People's Republic of China
| | - Quanzhou Wu
- Department of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, People's Republic of China
| | - Shuhua Lan
- Department of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, People's Republic of China.
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
She Z, Yang F, Zhang S, Yang L, Wang X. A novel intramedullary nail design of intertrochanteric fracture fixation improved by proximal femoral nail antirotation. Comput Methods Biomech Biomed Engin 2023:1-11. [PMID: 38006389 DOI: 10.1080/10255842.2023.2286917] [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: 07/07/2023] [Accepted: 11/18/2023] [Indexed: 11/27/2023]
Abstract
A proper and reliable fracture fixation is important for fracture healing. The proximal femoral intramedullary nail (IN), such as proximal femoral nail anti-rotation (PFNA) or Gamma nail, is widely used for intertrochanteric fracture fixation. However, it still suffers considerable stress concentrations, especially at the junction between the nail and the blade or lag screw. In this study, we propose a novel intramedullary nail design to enhance the intramedullary nail integrity by introducing a bolt screw to form a stable triangular structure composed of the nail, the lag screw, and the bolt screw (PFTN, Proximal femoral triangle nail). Systematic finite element numerical simulations were carried out to compare the biomechanical performances of PFTN and PFNA under both static and dynamic loads during the postures of ascending and descending stairs. The simulation results highlight the advantages of the proposed PFTN design with lower stresses, less stress concentration, and higher structure stability.
Collapse
Affiliation(s)
- Ze She
- School of Aerospace Engineering and Applied Mechanics, Tongji University, Shanghai, China
| | - Fan Yang
- School of Aerospace Engineering and Applied Mechanics, Tongji University, Shanghai, China
| | - Siyuan Zhang
- School of Aerospace Engineering and Applied Mechanics, Tongji University, Shanghai, China
| | - Liang Yang
- Tongji Hospital of Tongji University, Shanghai, China
- School of Medicine, Tongji University, Shanghai, China
| | - Xin Wang
- Tongji Hospital of Tongji University, Shanghai, China
- School of Medicine, Tongji University, Shanghai, China
| |
Collapse
|
8
|
Basirom I, Daud R, Ijaz MF, Rojan MA, Basaruddin KS. Stability Analysis of Plate-Screw Fixation for Femoral Midshaft Fractures. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5958. [PMID: 37687652 PMCID: PMC10489176 DOI: 10.3390/ma16175958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/25/2023] [Accepted: 08/04/2023] [Indexed: 09/10/2023]
Abstract
An understanding of the biomechanical characteristics and configuration of flexible and locked plating in order to provide balance stability and flexibility of implant fixation will help to construct and promote fast bone healing. The relationship between applied loading and implantation configuration for best bone healing is still under debate. This study aims to investigate the relationship between implant strength, working length, and interfragmentary strain (εIFM) on implant stability for femoral midshaft transverse fractures. The transverse fracture was fixed with a fragment locking compression plate (LCP) system. Finite element analysis was performed and subsequently characterised based on compression loading (600 N up to 900 N) and screw designs (conventional and locking) with different penetration depths (unicortical and bicortical). Strain theory was used to evaluate the stability of the model. The correlation of screw configuration with screw type shows a unicortical depth for both types (p < 0.01) for 700 N and 800 N loads and (p < 0.05) for configurations 134 and 124. Interfragmentary strain affected only the 600 N load (p < 0.01) for the bicortical conventional type (group BC), and the screw configurations that were influenced were 1234 and 123 (p < 0.05). The low steepness of the slope indicates the least εIFM for the corresponding biomechanical characteristic in good-quality stability. A strain value of ≤2% promotes callus formation and is classified as absolute stability, which is the minimum required value for the induction of callus and the maximum value that allows bony bridging. The outcomes have provided the correlation of screw configuration in femoral midshaft transverse fracture implantation which is important to promote essential primary stability.
Collapse
Affiliation(s)
- Izzawati Basirom
- Fracture and Damage Mechanics (FDM), Faculty of Mechanical Engineering Technology, University Malaysia Perlis, Arau 02600, Perlis, Malaysia; (I.B.); (R.D.); (M.A.R.); (K.S.B.)
| | - Ruslizam Daud
- Fracture and Damage Mechanics (FDM), Faculty of Mechanical Engineering Technology, University Malaysia Perlis, Arau 02600, Perlis, Malaysia; (I.B.); (R.D.); (M.A.R.); (K.S.B.)
| | - Muhammad Farzik Ijaz
- Mechanical Engineering Department, College of Engineering, King Saud University, P.O. Box 800, Riyadh 11421, Saudi Arabia
| | - Mohd Afendi Rojan
- Fracture and Damage Mechanics (FDM), Faculty of Mechanical Engineering Technology, University Malaysia Perlis, Arau 02600, Perlis, Malaysia; (I.B.); (R.D.); (M.A.R.); (K.S.B.)
| | - Khairul Salleh Basaruddin
- Fracture and Damage Mechanics (FDM), Faculty of Mechanical Engineering Technology, University Malaysia Perlis, Arau 02600, Perlis, Malaysia; (I.B.); (R.D.); (M.A.R.); (K.S.B.)
| |
Collapse
|
9
|
Aykanat F, Kose O, Guneri B, Celik HK, Cakar A, Tasatan E, Ulmeanu ME. Comparison of four different screw configurations for the fixation of Fulkerson osteotomy: a finite element analysis. J Orthop Traumatol 2023; 24:30. [PMID: 37358664 DOI: 10.1186/s10195-023-00714-6] [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: 09/23/2022] [Accepted: 06/04/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Conventionally, two 4.5 mm cortical screws inserted toward the posterior tibial cortex are usually advocated for the fixation of Fulkerson osteotomy. This finite element analysis aimed to compare the biomechanical behavior of four different screw configurations to fix the Fulkerson osteotomy. MATERIALS AND METHODS Fulkerson osteotomy was modeled using computerized tomography (CT) data of a patient with patellofemoral instability and fixed with four different screw configurations using two 4.5 mm cortical screws in the axial plane. The configurations were as follows: (1) two screws perpendicular to the osteotomy plane, (2) two screws perpendicular to the posterior cortex of the tibia, (3) the upper screw perpendicular to the osteotomy plane, but the lower screw is perpendicular to the posterior cortex of the tibia, and (4) the reverse position of the screw configuration in the third scenario. Gap formation, sliding, displacement, frictional stress, and deformation of the components were calculated and reported. RESULTS The osteotomy fragment moved superiorly after loading the models with 1654 N patellar tendon traction force. Since the proximal cut is sloped (bevel-cut osteotomy), the osteotomy fragment slid and rested on the upper tibial surface. Afterward, the upper surface of the osteotomy fragment acted as a fulcrum, and the distal part of the fragment began to separate from the tibia while the screws resisted the displacement. The resultant total displacement was 0.319 mm, 0.307 mm, 0.333 mm, and 0.245 mm from the first scenario to the fourth scenario, respectively. The minimum displacement was detected in the fourth scenario (upper screw perpendicular to the osteotomy plane and lower screw perpendicular to the posterior tibial cortex). Maximum frictional stress and maximum pressure between components on both surfaces were highest in the first scenario (both screws perpendicular to the osteotomy plane). CONCLUSIONS A divergent screw configuration in which the upper screw is inserted perpendicular to the osteotomy plane and the lower screw is inserted perpendicular to the posterior tibial cortex might be a better option for the fixation of Fulkerson osteotomy. Level of evidence Level V, mechanism-based reasoning.
Collapse
Affiliation(s)
- Faruk Aykanat
- Vocational School of Health Services, SANKO University, Gaziantep, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Varlık mah., Kazım Karabekir cd., Muratpasa, 07100, Antalya, Turkey.
| | - Bulent Guneri
- Department of Orthopedics and Traumatology, Adana City Education and Research Hospital, Adana, Turkey
| | - H Kursat Celik
- Agricultural Faculty, Department of Agricultural Machinery and Technology Engineering, Akdeniz University, Antalya, Turkey
| | - Albert Cakar
- Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ersin Tasatan
- Department of Orthopedics and Traumatology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Mihaela-Elena Ulmeanu
- Department of Manufacturing, Polytechnic University of Bucharest, Bucharest, Romania
| |
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Huang BX, Zhan SZ, Yang M, Zhang DY. Biomechanical effects of internal fixation with self-lock compression anti-rotation blade for Pauwels type III femoral neck fractures: a comparative finite element analysis. BMC Musculoskelet Disord 2023; 24:292. [PMID: 37059976 PMCID: PMC10103490 DOI: 10.1186/s12891-023-06386-x] [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: 12/07/2022] [Accepted: 03/30/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Self-lock compression anti-rotation blade (SCAB) is a novel internal fixation implant for femoral neck fractures (FNF). We conducted this finite element analysis study to evaluate the biomechanical performances of SCAB combined with a cannulated screw for fixation of Pauwels type III FNF. METHODS Three finite element models of Pauwels type III FNF treated with various internal fixations were established: a: the inverted triangular parallel cannulated screw (3CS) model, b: the biplane double-supported screw fixation (BDSF) model, c: the SCAB combined with a cannulated screw model. Displacement and Von Mises stress of femurs and internal fixations under increasing loads as well as the average stress on fracture surfaces and maximum displacements on the X and Z axis of proximal fracture fragments at maximum load were measured and compared. RESULT The SCAB-based internal fixation exhibited superior biomechanical performances compared with 3CS and BDSF configurations, as the former resulted in lower parameters including displacement of the femur, Von Mises stress of internal fixation, stress on fracture surfaces as well as X and Z axis displacement of fracture fragments. CONCLUSION Internal fixation using SCAB combined with a cannulated screw for Pauwels type III FNFs shows enough stability, with satisfied resistance to varus and shearing forces, which may provide a new option for the treatment of FNFs.
Collapse
Affiliation(s)
- Bo-Xuan Huang
- Department of Orthopedics and Trauma, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Si-Zheng Zhan
- Department of Orthopedics and Trauma, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Ming Yang
- Department of Orthopedics and Trauma, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China.
- National Center for Trauma Medicine, Beijing, 100044, China.
| | - Dian-Ying Zhang
- Department of Orthopedics and Trauma, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| |
Collapse
|
12
|
Yang AL, Mao W, Chang SM, He YQ, Li LL, Li HL, Long F, Dong YH. Computational evaluation of the axis-blade angle for measurements of implant positions in trochanteric hip fractures: A finite element analysis. Comput Biol Med 2023; 158:106830. [PMID: 37011432 DOI: 10.1016/j.compbiomed.2023.106830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 03/12/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Recently, a novel approach axis-blade angle (ABA) was developed to measure implant positions during trochanteric hip fracture surgery. It was defined as the sum of two angles α and β measured between the femoral neck axis and helical blade axis in anteroposterior and lateral X-ray films, respectively. Although its clinical practicability has been confirmed, the mechanism is yet to be investigated by means of finite element (FE) analysis. METHODS Computed tomography images of four femurs and dimensions of one implant at three angles were obtained to construct FE models. For each femur, 15 FE models in an arrangement (intramedullary nails at three angles multiplying five blade positions) were established. Under the simulation of normal walking loads, the ABA, von Mises stress (VMS), maximum/minimum principal strain and displacement were analyzed. RESULTS When the ABA increased, all outcome indicators initially decreased till reaching inferior-middle site and then increased while the blade positions within the femoral head shifted from the superior-anterior quadrant toward the inferior-posterior quadrant, where the ABA were higher. Only the peak VMS of implant models in the inferior-posterior quadrant (particularly the inferior-middle site within) with blades in did not reach the yielding (risky) cut-off. CONCLUSIONS From the perspective of angles, ABA, this study demonstrated the inferior-posterior quadrant as the relatively stable and safe regions, especially the inferior-middle site within. This was similar but more elaborate compared with previous studies and clinical practice. Therefore, ABA could be employed as a promising approach to anchor the implants into the optimal region.
Collapse
|
13
|
Yang AL, Mao W, Chang SM, Dong YH. Relative instability ratios of bone wall defects in trochanteric hip fractures: A finite element analysis. Front Bioeng Biotechnol 2023; 11:1082613. [PMID: 36815902 PMCID: PMC9935934 DOI: 10.3389/fbioe.2023.1082613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
Background: For decades, medial and lateral wall fragments of trochanteric hip fractures were considered two pivotal factors that could influence the stability of postoperative femur-implant complex. However, most studies seemed to misunderstand the concept of the posteromedial fragment and equated it with the medial wall, which overlooked vital roles of the anteromedial wall. Roles of the posterior coronal bone fragment were also highlighted in some research. However, influences of the bone walls above the trochanteric fracture instability are yet to be investigated and quantified by means of finite element analysis. Methods: Eight trochanteric fracture fixation models with different wall defects were constructed. Outcome indicators were the von Mises stress of the implant models, the maximum/minimum principal strain, the risky tensile/compressive volume and the volume ratios of the bone models, the femoral head vertex displacement, and the fracture surface gap. Based on these indicator values, the relative instability ratios were computed. Results: Outcome indicators, absolute values, and nephograms of all models showed the same upward and concentrating trends with exerted hip contact loads shifting from static walking to dynamic climbing. Similarly, these indicators also exhibited the same trends when the eight models were solved in sequence. Moreover, the relative instability ratio of the medial wall (100%), particularly the anteromedial part (78.7%), was higher than the figure for the lateral wall (36.6%). Conclusion: The anteromedial wall played relatively pivotal stabilizing roles in trochanteric hip fractures compared with the posteromedial wall and the lateral wall, which indicated that orthopedic surgeons should attach more importance to the anteromedial cortex support in an operating theatre.
Collapse
Affiliation(s)
- Ao-Lei Yang
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China,Department of Orthopaedics, Fifth People’s Hospital of Shanghai, Fudan University, Shanghai, China
| | - Wei Mao
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China,Department of Orthopaedics, Fifth People’s Hospital of Shanghai, Fudan University, Shanghai, China
| | - Shi-Min Chang
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China,*Correspondence: Shi-Min Chang, ; You-Hai Dong,
| | - You-Hai Dong
- Department of Orthopaedics, Fifth People’s Hospital of Shanghai, Fudan University, Shanghai, China,*Correspondence: Shi-Min Chang, ; You-Hai Dong,
| |
Collapse
|
14
|
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.
Collapse
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,
| |
Collapse
|
15
|
Guneri B, Kose O, Celik HK, Cakar A, Tasatan E, Rennie AEW. How to fix a tibial tubercle osteotomy with distalisation: A finite element analysis. Knee 2022; 37:132-142. [PMID: 35779431 DOI: 10.1016/j.knee.2022.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/22/2022] [Accepted: 06/01/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Antero-medialisation osteotomy combined with a distalisation procedure may require a more stable fixation as the osteotomy fragment loses both proximal and distal support. This finite element analysis aimed to compare the mechanical behaviour of different fixation techniques in tibial tubercle antero-medialisation osteotomy combined with distalisation procedure. METHODS Tibial tubercle osteotomy combined with distalisation was modelled based on computerised tomography data, which were acquired from a patient with patellar instability requiring this procedure. Six different fixation configurations with two 3.5-mm cortical screws (1), two 4.5-mm cortical screws (2), three 3.5-mm cortical screws (3), three 4.5-mm cortical screws (4), three 3.5-mm screws with 1/3 tubular plate (5), and four 3.5-mm screws with 1/3 tubular plate (6) were created. A total of 1654 N of force was applied to the patellar tendon footprint on the tibial tubercle. Sliding, gap formation, and total deformation between the osteotomy components were analyzed. RESULTS Maximum sliding (0.660 mm), gap formation (0.661 mm), and displacement (1.267 mm) were seen with two 3.5-mm screw fixation, followed by two 4.5-mm screws, three 3.5-mm screws, and three 4.5-mm screws, respectively, in the screw-only group. Overall, the minimum displacement was observed with the four 3.5-mm screws with 1/3 tubular plate fixation model. CONCLUSIONS Plate fixation might be recommended for tibial tubercle antero-medialisation osteotomy combined with distalisation procedure because it might allow early active range of motion exercises and weight-bearing.
Collapse
Affiliation(s)
- Bulent Guneri
- Department of Orthopaedics and Traumatology, Adana City Education and Research Hospital, Adana, Turkey.
| | - Ozkan Kose
- Department of Orthopaedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - H Kursat Celik
- Department of Agricultural Machinery and Technology Engineering, Agricultural Faculty, Akdeniz University, Antalya, Turkey
| | - Albert Cakar
- Department of Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ersin Tasatan
- Department of Orthopaedics and Traumatology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | | |
Collapse
|
16
|
Wang Y, Chen W, Zhang L, Xiong C, Zhang X, Yu K, Ju J, Chen X, Zhang D, Zhang Y. Finite Element Analysis of Proximal Femur Bionic Nail (PFBN) Compared with Proximal Femoral Nail Antirotation and InterTan in Treatment of Intertrochanteric Fractures. Orthop Surg 2022; 14:2245-2255. [PMID: 35848160 PMCID: PMC9483054 DOI: 10.1111/os.13247] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 01/20/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To compare the biomechanical properties of proximal femur bionic nail (PFBN), proximal femoral nail antirotation (PFNA) and InterTan in the treatment of elderly intertrochanteric fractures AO/OTA 31‐A1.3 by finite element analysis. Methods We used Mimics, Unigraphics and other software to establish normal femur and AO/OTA 31‐A1.3 fracture models, and reconstructed PFBN, PFNA and InterTan intramedullary nail models, and assembled them on the fracture model. The ANSYS software was used to compare the femoral von Mises stress distribution, deformation distribution, and internal fixation stress distribution of each group under a load of 2100 N. Results It could be seen that the femoral maximum stress, femoral maximum displacement, and maximum stress of internal fixation of the PFBN group were lower than those in the PFNA group and the InterTan group. The maximum femoral stress of the PFBN was 190.25 MPa, while the maximum stress of the femur of the PFNA and InterTan groups were 238.41 Mpa and 226.97 Mpa. The maximum femoral displacement of each group were located at the top of the femoral head, and the maximum displacement of the PFBN group was 14.373 mm, and the maximum displacement values of the PFNA and InterTan groups were 19.49 and 15.225 mm. For the stress distribution of intramedullary nail, the maximum stress of the three kinds of internal fixation was located on the main nail. The maximum stress of PFBN was 1191.8 MPa, compared with 2142.8 MPa for PFNA and 1702.3 MPa for InterTan. And the maximum stress on the PFBN pressure nail was 345.35 MPa, compared with 868.6 MPa for the PFNA spiral blade and 545.5 MPa for InterTan interlocking twin nails. Conclusion Compared with PFNA and InterTan, PFBN has better mechanical properties. The biomechanical characteristics of PFBN are more advantageous than PFNA and InterTan internal fixation system in the treatment of femoral intertrochanteric fractures.
Collapse
Affiliation(s)
- Yanhua Wang
- Department of Trauma and Orthopeadics, Peking University People's Hospital, Beijing, China
| | - Wei Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lijia Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Chen Xiong
- Department of Trauma and Orthopeadics, Peking University People's Hospital, Beijing, China
| | - Xiaomeng Zhang
- Department of Trauma and Orthopeadics, Peking University People's Hospital, Beijing, China
| | - Kai Yu
- Department of Orthopedics, Tianjin Fifth Central Hospital, Tianjin, China
| | - Jiabao Ju
- Department of Trauma and Orthopeadics, Peking University People's Hospital, Beijing, China
| | - Xiaofeng Chen
- Department of Trauma and Orthopeadics, Peking University People's Hospital, Beijing, China
| | - Dianying Zhang
- Department of Trauma and Orthopeadics, Peking University People's Hospital, Beijing, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
17
|
Yunus Emre T, Kursat Celik H, Arik HO, Rennie AEW, Kose O. Effect of coronal fracture angle on the stability of screw fixation in medial malleolar fractures: A finite element analysis. Proc Inst Mech Eng H 2022; 236:825-840. [DOI: 10.1177/09544119221089723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Malleolar screw fixation is the most widely used treatment method for medial malleolar (MM) fractures. Here, although buttress plate fixation is advocated for vertical MM fractures, the angular discrimination between oblique and vertical MM fractures is still not fully understood. The purpose of this study is to test the adequacy of screw fixation in MM fractures with different angles and determination of a ‘critical fracture angle’ to guide surgeons in the decision-making for screw fixation for MM fractures by utilizing an advanced engineering simulation approach. In addition to loading of the healthy tibia structure, various cases of the MM fracture double screw fixation (14 simulation scenarios in total with fracture angles between 30° and 90°, in 5° increments) were considered in this research and their static loading conditions just after fixation operation were simulated through nonlinear (geometric and contact nonlinearity) finite element analysis (FEA). Patient-specific computed tomography scan data, parametric three-dimensional solid modelling and finite element method (FEM) based engineering codes were employed in order to simulate the fixation scenarios. Visual and numerical outputs for the deformation and stress distributions, separation and sliding behaviours of the MM fracture fragments of various screw fixations were clearly exhibited through FEA results. Minimum and maximum separation distances (gap) of 3.75 and 150.34 µm between fracture fragments at fracture angles of 30° and 90° were calculated respectively against minimum and maximum sliding distances of 25.87 and 41.37 µm between fracture fragments at fracture angles of 90° and 35°, respectively. The FEA results revealed that while the separation distance was increasing, the sliding distance was decreasing and there were no distinct differences in sliding distances in the scenarios from fracture angles of 30°–90°. The limitations and errors in a FEA study are inevitable, however, it was interpreted that the FEA scenarios were setup in this study by utilizing acceptable assumptions providing logical outputs under pre-defined boundary conditions. Finally, the fracture healing threshold for separation and/or sliding distance between fracture fragments was assigned as 100 µm by referring to previous literature and it was concluded that the screws fixed perpendicular to the fracture in a MM fracture with more than 70° angle with the tibial plafond results in a significant articular separation (>100 µm) during single-leg stand. Below this critical angle of 70°, two screws provide sufficient fixation.
Collapse
Affiliation(s)
- Tuluhan Yunus Emre
- Orthopaedics and Traumatology Department, Medical Faculty, Biruni University, Istanbul, Turkey
| | - Huseyin Kursat Celik
- Department of Agricultural Machinery and Technology Engineering, Akdeniz University, Antalya, Turkey
| | - Hasan O Arik
- Orthopaedics and Traumatology Department, Antalya Training and Research Hospital, Antalya, Turkey
| | | | - Ozkan Kose
- Orthopaedics and Traumatology Department, Antalya Training and Research Hospital, Antalya, Turkey
| |
Collapse
|
18
|
Li J, Wang Y, Wei Y, Kong D, Lin Y, Wang D, Cheng S, Yin P, Wei M. The effect of talus osteochondral defects of different area size on ankle joint stability: a finite element analysis. BMC Musculoskelet Disord 2022; 23:500. [PMID: 35624444 PMCID: PMC9137113 DOI: 10.1186/s12891-022-05450-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 05/16/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Osteochondral lesion of the talus (OLT) is one of the most common ankle injuries, which will lead to biomechanical changes in the ankle joint and ultimately affect ankle function. Finite element analysis (FEA) is used to clarify the effect of talus osteochondral defects on the stability of the ankle joint at different depths. However, no research has been conducted on talus osteochondral defect areas that require prompt intervention. In this research, FEA was used to simulate the effect of the area size of talus osteochondral defect on the stress and stability of the ankle joint under a specific depth defect. METHODS Different area sizes (normal, 2 mm* 2 mm, 4 mm* 4 mm, 6 mm* 6 mm, 8 mm* 8 mm, 10 mm* 10 mm, and 12 mm* 12 mm) of the three-dimensional finite element model of osteochondral defects were established. The model was used to simulate and calculate joint stress and displacement of the articular surface of the distal tibia and the proximal talus when the ankle joint was in the heel-strike, midstance, and push-off phases. RESULTS When OLT occurred, the contact pressure of the articular surface, the equivalent stress of the proximal talus, the tibial cartilage, and the talus cartilage did not change significantly with an increase in the size of the osteochondral defect area when the heel-strike phase was below 6 mm * 6 mm. Gradual increases started at 6 mm * 6 mm in the midstance and push-off phases. Maximum changes were reached when the defect area size was 12 mm * 12 mm. The same patterns were observed in the talus displacement. CONCLUSIONS The effect of the defect area of the ankle talus cartilage on the ankle biomechanics is evident in the midstance and push-off phases. When the size of the defect reaches 6 mm * 6 mm, the most apparent change in the stability of the ankle joint occurs, and the effect does not increase linearly with the increase in the size of the defect.
Collapse
Affiliation(s)
- Jia Li
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Yezhou Wang
- Orthopedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu Wei
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Dan Kong
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yuan Lin
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Duanyang Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shi Cheng
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Pengbin Yin
- National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitation, Beijing, China.
- The Faculty of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China.
| | - Min Wei
- National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitation, Beijing, China.
- The Faculty of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China.
| |
Collapse
|
19
|
Levent A, Yapti M, Celik HK, Kose O, Kilicaslan OF, Rennie AEW. Comparison of Fixation Techniques in Oblique and Biplanar Chevron Medial Malleolar Osteotomies; a Finite Element Analysis. J Foot Ankle Surg 2022; 61:253-258. [PMID: 34456133 DOI: 10.1053/j.jfas.2021.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/30/2021] [Accepted: 07/10/2021] [Indexed: 02/03/2023]
Abstract
This study aimed to evaluate different fixation techniques and implants in oblique and biplanar chevron medial malleolar osteotomies using finite element analysis. Both oblique and biplanar chevron osteotomy models were created, and each osteotomy was fixed with 2 different screws (3.5 mm cortical screw and 4.0 mm malleolar screw) in 2 different configurations; (1) 2 perpendicular screws, and (2) an additional third transverse screw. Nine simulation scenarios were set up, including 8 osteotomy fixations and the intact ankle. A bodyweight of 810.44 N vertical loading was applied to simulate a single leg stand on a fixed ankle. Sliding, separation, frictional stress, contact pressures between the fragments were analyzed. Maximum sliding (58.347µm) was seen in oblique osteotomy fixed with 2 malleolar screws, and the minimum sliding (17.272 µm) was seen in chevron osteotomy fixed with 3 cortical screws. The maximum separation was seen in chevron osteotomy fixed with 2 malleolar screws, and the minimum separation was seen in oblique osteotomy fixed with 3 cortical screws. Maximum contact pressure and the frictional stress at the osteotomy plane were obtained in chevron osteotomy fixed with 3 cortical screws. The closest value to normal tibiotalar contact pressures was obtained in chevron osteotomy fixed with 3 cortical screws. This study revealed that cortical screws provided better stability compared to malleolar screws in each tested osteotomy and fixation configuration. The insertion of the third transverse screw decreased both sliding and separation. Biplanar chevron osteotomy fixed with 3 cortical screws was the most stable model.
Collapse
Affiliation(s)
- Ali Levent
- Assistant Professor, Department of Orthopedics & Traumatology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Health Sciences University, Şanlıurfa, Turkey
| | - Metin Yapti
- Orthopaedic Surgeon, Department of Orthopedics & Traumatology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Health Sciences University, Şanlıurfa, Turkey
| | - H Kursat Celik
- Associate Professor, Department of Agricultural Machinery & Technology Engineering, Akdeniz University, Antalya, Turkey
| | - Ozkan Kose
- Associate Professor, Department of Orthopedics and Traumatology, Antalya Training & Research Hospital, Antalya, Turkey.
| | - O Faruk Kilicaslan
- Assistant Professor, Department of Orthopedics and Traumatology, Antalya Training & Research Hospital, Antalya, Turkey
| | - Allan E W Rennie
- Professor, Department of Engineering, Lancaster University, Lancaster, United Kingdom
| |
Collapse
|
20
|
Zhang RY, Li JT, Zhao JX, Zhao Z, Zhang LC, Yun C, Su XY, Tang PF. Comparison of oblique triangular configuration and inverted equilateral triangular configuration of three cannulated screws in treating unstable femoral neck fracture: A finite element analysis. Injury 2022; 53:353-361. [PMID: 34801246 DOI: 10.1016/j.injury.2021.10.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The cross-sectional area of three parallel screws might affect the stability of the internal fixation of femoral neck fractures. The screws fixed in the oblique-triangle configuration (OTC) were assumed to have a larger cross-sectional area, but the biomechanical stability has not yet been validated. In this study, finite element analyses were performed to compare the biomechanical properties of the internal fixation fixed by the OTC and the traditional Inverted Equilateral Triangle Configuration (IETC). METHOD Pauwels type III fracture was established on the three-dimensional femoral model and three cannulated screws with the OTC and traditional IETC methods were applied. The oblique-triangle configuration with the largest area inscribed the femoral neck isthmus by the three screws was determined, the area and circumference of the cross-section formed by the OTC and IETC model were compared. Stress, strain, and displacement peaks of the two configuration models under different loads were compared. Twelve pairs of nodes on the fracture ends were selected and the displacement of the fracture ends was evaluated through the displacement between these nodes. RESULTS The area and circumference of the cross-section formed by the OTC were larger than those in the IETC model. The degree of stress dispersion around the screw holes in the OTC model was better than that of the IETC, but the stress distribution order of the three screws in the two models was consistent. The maximum stress, strain, displacement, and displacement of the fracture end in the OTC model were smaller than those in the IETC model. The stress, strain, displacement, and fracture end displacement peaks of the two fixed models gradually increase with the increase of loads. CONCLUSION The oblique-triangle configuration showed superior mechanical properties than the IETC in finite element analyses. This study suggests that when three screws are fixed in parallel method, the larger the cross-sectional area of the screw configuration, the better stability of the internal fixation might be obtained. Furthermore, the biomechanical properties of various spatial configurations and screw holes of the three parallel screws need to be considered before clinical practice.
Collapse
Affiliation(s)
- Ru-Yi Zhang
- Department of Orthopaedics, Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, No. 24, Shijingshan Road, Beijing 100043, China
| | - Jian-Tao Li
- Department of orthopaedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China; National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Jing-Xin Zhao
- Department of orthopaedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China; National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Li-Cheng Zhang
- Department of orthopaedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China; National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Cai Yun
- Department of Orthopaedics, Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, No. 24, Shijingshan Road, Beijing 100043, China.
| | - Xiu-Yun Su
- Department of Orthopaedics, Southern University of Science and Technology Hospital, Shenzhen Guangdong 518055, China.
| | - Pei-Fu Tang
- Department of orthopaedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China; National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitation, Beijing 100853, China.
| |
Collapse
|
21
|
Chantarapanich N, Riansuwan K. Biomechanical performance of short and long cephalomedullary nail constructs for stabilizing different levels of subtrochanteric fracture. Injury 2022; 53:323-333. [PMID: 34969504 DOI: 10.1016/j.injury.2021.11.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/28/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to assess biomechanical performance of short and long Cephalomedullary nail constructs consisting of different number of distal screw for stabilizing different levels of subtrochanteric fracture. MATERIALS AND METHODS The femur obtained from computed tomography scanner was used to create a transverse fracture at 15 mm (level A), 35 mm (level B), and 55 mm (level C) below the lesser trochanter. Short and long Cephalomedullary nails were virtually inserted to the fractured femur. Four-node tetrahedral element was used to build up finite element (FE) models for biomechanical analysis. The analysis focused on post-operative stage of partial weight-bearing. RESULTS Stress on the implant localized at the surface between lag screw/nail and distal screw/nail. Short Cephalomedullary nail exhibited higher stress than long Cephalomedullary nail. The stress in short Cephalomedullary nail could be reduced by using two distal screws fixation and the fracture at level A produced less stress than that of level B and C. Either short or long nail with two distal screws is sufficient to withstand the stress magnitude produced from the physiologic load. When single dynamic distal screw was used, stress on implant, elastic strain at fracture gap, and bone stress reached the high values. Elastic strain of the fracture gap at level C were less than that of level A and B, but no statistically significant difference. There was no proximal cancellous bone damage observed from the FE analysis. CONCLUSIONS Long Cephalomedullary nail with at least two distal locking screws remains a proper implant for subtrochanteric fracture fixation in overall locations. However, short Cephalomedullary nail with two distal screws may be a candidate for a high subtrochanteric fracture. Single dynamic screw insertion is strongly not recommended with either short or long nail regarding implant failure.
Collapse
Affiliation(s)
- Nattapon Chantarapanich
- Digital Industrial Design and Manufacturing Research Unit, Department of Mechanical Engineering, Faculty of Engineering at Sriracha, Kasetsart University, Chonburi 20230, Thailand
| | - Kongkhet Riansuwan
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| |
Collapse
|
22
|
Lin S, Shang J, Xing B, Wu B, Peng R, Wang G, Lu HD. Modified F configuration in the treatment of Pauwels type III femoral neck fracture: a finite element analysis. BMC Musculoskelet Disord 2021; 22:758. [PMID: 34488708 PMCID: PMC8420054 DOI: 10.1186/s12891-021-04638-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 08/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background The optimal treatment of Pauwels type III femoral neck fracture (FNF) in young patients remains a worldwide challenge in orthopedic surgery. Methods Finite element models of four internal fixations were developed to treat Pauwels type III FNF: a: the traditional inverted triangular parallel cannulated screw (PCS) model, b: the F-technique cannulated screw model, c: the modified F-technique cannulated screw model using a fully threaded screw instead of a partially threaded distally, d: the dynamic hip screw coupled with derotational screw (DHS + DS) model. Under the same conditions, finite element analyses were carried out to compare the displacement and von Mises stress distribution of four internal fixations and femurs, the maximum crack distances of the fracture surfaces, Z axis displacements of four models as well as the stress distribution in the subtrochanteric region. Results The modified F-technique configuration resulted in a more stable fixation as compared to the other three configurations, with respect to the maximum displacement and stress peaks of femur and internal fixations, the maximum crack distances of the fracture surfaces, Z axis displacements of four configurations as well as the stress distribution in the subtrochanteric region. Conclusions Our results suggested that modified F-technique configuration show a better performance in resisting shearing and rotational forces in treating Pauwels type III FNF compared to those using traditional inverted triangular PCS, the F-technique configuration or DHS + DS, providing a new choice for the treatment of FNFs.
Collapse
Affiliation(s)
- Shiyuan Lin
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, No. 52, Meihua East Road, Zhuhai, 519000, Guangdong Province, China.,Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jie Shang
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, No. 52, Meihua East Road, Zhuhai, 519000, Guangdong Province, China
| | - Baizhou Xing
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, No. 52, Meihua East Road, Zhuhai, 519000, Guangdong Province, China
| | - Biao Wu
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, No. 52, Meihua East Road, Zhuhai, 519000, Guangdong Province, China
| | - Rong Peng
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, No. 52, Meihua East Road, Zhuhai, 519000, Guangdong Province, China
| | - Gang Wang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - Hua-Ding Lu
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, No. 52, Meihua East Road, Zhuhai, 519000, Guangdong Province, China.
| |
Collapse
|
23
|
Güngörürler M, Gürsan O, Havıtçıoğlu H. Computational analysis of the effects of interprosthetic distance on normal and reduced cortical thickness femur models. Proc Inst Mech Eng H 2021; 236:169-178. [PMID: 34425723 DOI: 10.1177/09544119211040998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Distal femoral fractures associated with the femoral stem in a well-fixed hip arthroplasty pose a risk of an interprosthetic fracture, the treatment of which is known as difficult. To effectively prevent and treat IP fractures, biomechanical effects must be demonstrated. We defined eight variations of the interprosthetic distance ranging from 48 mm overlap to 128 mm gap. Femoral geometries with normal and reduced cortical thickness were modeled to evaluate the effects of cortical thickness. In addition to the intact model, a total of 16 finite element models were analyzed under physiological boundary conditions. Maximum and minimum principal strains on the lateral and medial cortex surfaces were always found to be greater in models with reduced cortical thickness than in normal femurs. The model with 48 mm overlapping interprosthetic distance produced the least peak strain and the model with 16 mm interprosthetic gap produced the greatest strain with both normal and reduced cortical thickness. The screw holes produced local strain concentrations and increased the peak strains on the cortex surfaces, especially close to the stem tip. Statistically, a significant correlation (R2 = 0.9483) was found between strain shielding and interprosthetic distance. Axial stiffness, interfragmentary shear motion, and maximum von-Mises stress on the distal plate showed a high correlation with the interprosthetic distance. It was concluded that the overlapping structures are superior to other fixations we analyzed in that they offer better mechanical stability and eliminates the local strain concentrations.
Collapse
Affiliation(s)
- Musa Güngörürler
- Department of Biomechanics, School of Medicine Health Science Institute, Dokuz Eylul University, Izmir, Turkey
| | - Onur Gürsan
- Department of Orthopaedics and Traumatology, Dokuz Eylul University, Izmir, Turkey
| | - Hasan Havıtçıoğlu
- Department of Orthopaedics and Traumatology, Dokuz Eylul University, Izmir, Turkey
| |
Collapse
|
24
|
Mu JX, Xiang SY, Ma QY, Gu HL. Selection of internal fixation method for femoral intertrochanteric fractures using a finite element method. World J Clin Cases 2021; 9:6343-6356. [PMID: 34435000 PMCID: PMC8362576 DOI: 10.12998/wjcc.v9.i22.6343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/23/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Failure to fix unstable intertrochanteric fractures impairs return to daily activities.
AIM To simulate five different internal fixation methods for unstable proximal femoral fractures.
METHODS A three-dimensional model of the femur was established from sectional computed tomography images, and an internal fixation model was established. Finite element analysis of the femur model was established, and three intertrochanteric fracture models, medial defect, lateral defect, and medial-lateral defects, were simulated. Displacement and stress distribution after fixation with a proximal femoral anti-rotation intramedullary nail (PFNA), integrated dual-screw fixation (ITN), PFNA + wire, PFNA + plate, and PFNA + wire + plate were compared during daily activities.
RESULTS The maximum displacement and stress of PFNA and ITN were 3.51 mm/473 MPa and 2.80 mm/588 MPa for medial defects; 2.55 mm/288 MPa and 2.10 mm/307 MPa for lateral defects; and 3.84 mm/653 MPa and 3.44 mm/641 MPa for medial-lateral defects, respectively. For medial-lateral defects, reconstructing the medial side alone changed the maximum displacement and stress to 2.79 mm/515 MPa; reconstructing the lateral side changed them to 3.72 mm/608 MPa, when both sides were reconstructed, they changed to 2.42 mm/309 MPa.
CONCLUSION For medial defects, intramedullary fixation would allow early low-intensity rehabilitation exercise, and ITN rather than PFNA reduces the risk of varus and cut-out; for lateral wall defects or weakness, intramedullary fixation allows higher-intensity rehabilitation exercise, and ITN reduces the risk of varus. For both medial and lateral defects, intramedullary fixation alone will not allow early functional exercise, but locating lateral or medial reconstruction will. For defects in both the inner and outer sides, if reconstruction cannot be completed, ITN is more stable.
Collapse
Affiliation(s)
- Jia-Xuan Mu
- Department of Orthopedics, Shengjing Hospital, China Medical University, Shenyang 117004, Liaoning Province, China
| | - Shi-Yang Xiang
- Department of Orthopedics, Shengjing Hospital, China Medical University, Shenyang 117004, Liaoning Province, China
| | - Qing-Yu Ma
- Department of Orthopedics, Shengjing Hospital, China Medical University, Shenyang 117004, Liaoning Province, China
| | - Hai-Lun Gu
- Department of Orthopedics, Shengjing Hospital, China Medical University, Shenyang 117004, Liaoning Province, China
| |
Collapse
|
25
|
Jiang D, Zhan S, Wang L, Shi LL, Ling M, Hu H, Jia W. Biomechanical comparison of five cannulated screw fixation strategies for young vertical femoral neck fractures. J Orthop Res 2021; 39:1669-1680. [PMID: 33034914 PMCID: PMC8451753 DOI: 10.1002/jor.24881] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/18/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023]
Abstract
Vertical femoral neck fractures in patients younger than 65 years of age often require hip-conserving surgeries. However, traditional fixation strategies using three parallel cannulated screws often fail in such patients due to an unfavorable biomechanical environment. This study compared different cannulated screw fixation techniques in patients via patient-specific finite element analysis with linear tetrahedral (C3D4) elements. Forty vertical femoral neck fracture models were created based on computed tomography images obtained from eight healthy participants. Five different fixation strategies: alpha, buttress, rhomboid, inverted triangle, and triangle were assessed in walking status. Biomechanical parameters including stiffness, interfragmentary motion in two directions (detachment and shearing), compression force, and maximal implant stress were evaluated. The mean relative coefficient of strain distribution between the finite element analysis and experiment was from 0.78 to 0.94. Stiffness was highest (p < .05) in the buttress group (923.1 N/mm), while interfragmentary motion was lowest (p < .05) in the alpha group. Maximal stress was highest (p < .05) in the buttress group and lowest in the alpha group. Shearing values were significantly lower in the alpha group than in the rhomboid group (p = .004). Moreover, Shearing values were significantly higher (p = .027), while detachment values were significantly lower (p = .027), in the inverted triangle than in the triangle group. Clinical significance: Our results suggest that alpha fixation is the most reliable and biomechanically efficient strategy for young patients with vertical femoral neck fractures. Regular and inverted triangular fixation strategies may be suitable for fractures of different skeletal constructions due to antidetachment/shearing abilities.
Collapse
Affiliation(s)
- Dajun Jiang
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
| | - Shi Zhan
- Orthopedic Biomechanical Laboratory, Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
| | - Lei Wang
- Orthopedic Biomechanical Laboratory, Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
| | - Lewis L. Shi
- Department of OrthopaedicsUniversity of Chicago Medical CenterChicagoIllinoisUSA
| | - Ming Ling
- Orthopedic Biomechanical Laboratory, Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
| | - Hai Hu
- Orthopedic Biomechanical Laboratory, Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
| | - Weitao Jia
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiPeople's Republic of China
| |
Collapse
|
26
|
Jiang D, Zhan S, Cai Q, Hu H, Jia W. Enhanced interfragmentary stability and improved clinical prognosis with use of the off-axis screw technique to treat vertical femoral neck fractures in nongeriatric patients. J Orthop Surg Res 2021; 16:473. [PMID: 34332590 PMCID: PMC8325251 DOI: 10.1186/s13018-021-02619-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/13/2021] [Indexed: 12/26/2022] Open
Abstract
Background The optimal internal fixation strategy for vertical femoral neck fractures (VFNFs) in nongeriatric patients remains uncertain. Therefore, the purpose of this study was to compare the clinical prognoses and underlying mechanical characteristics of a novel off-axis screw technique with dynamic hip screws (DHSs) and three traditional parallel screws. Methods This study included a clinical investigation and a patient-specific finite element analysis (FEA). In the clinical investigation, VFNF patients were grouped by fixation type: (1) use of three parallel screws (G-TRI); (2) augmentation with an off-axis screw (G-ALP); and (3) DHS with an anti-rotational screw (G-DHS). Fixation failures (nonunion, femoral neck shortening (FNS), varus deformation, screw cut-out) and avascular necrosis (AVN) consequent to the three types of fixations were compared. In the FEA, twenty-four fixation models with the three fixation types were created based on the data of eight healthy volunteers. Models were assessed under walking conditions. Stiffness, interfragmentary motion (IFM), and implant stress were evaluated. Results In the clinical investigation, the fixation failure rate was significantly (p < 0.05) lower in G-ALP (18.5%) than in G-DHS (37.5%) and G-TRI (39.3%). No significant difference in AVN was observed among the three fixation groups. In the FEA, stiffness and implant stress in the G-DHS models were significantly (p < 0.05) higher, and the IFM of G-ALP was significantly (p < 0.05) lower among the groups. Conclusions Among fixation types for VFNFs, the off-axis screw technique exhibited better interfragmentary stability (lowest IFM) and a lower fixation failure rate (especially FNS). Analyzing interfragmentary stability in biomechanical experiments is more consistent with clinical prognosis than construct stability for VFNFs, suggesting that internal fixations should aim for this outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02619-8.
Collapse
Affiliation(s)
- Dajun Jiang
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Shi Zhan
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Qianying Cai
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Hai Hu
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Weitao Jia
- Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China.
| |
Collapse
|
27
|
Mühling M, Winkler M, Augat P. Prediction of interfragmentary movement in fracture fixation constructs using a combination of finite element modeling and rigid body assumptions. Comput Methods Biomech Biomed Engin 2021; 24:1752-1760. [PMID: 34152892 DOI: 10.1080/10255842.2021.1919883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The amount of interfragmentary movement has been identified as a crucial factor for successful fracture healing. The aim of our study was to combine finite element analysis with a rigid body assumption to efficiently predict interfragmentary movement in fixed tibial fractures. The interfragmentary movement in a transverse tibial shaft fracture (AO/OTA type 42-A3) fixed with a locked plating construct was simulated using finite element analysis. In order to assess the contribution of the components on the resulting interfragmentary movement, the tibia, screws and embedding was either simulated deformable or as rigid body. The rigid and the deformable model accurately predicted the interfragmentary movement (R2 = 0.99). The axial movement ranged between 0.1 mm and 1.3 mm and shear movements were between 0.2 mm and 0.5 mm. Differences between the two models were smaller than 73 μm (axial) and 46 μm (shear). The rigid body assumption reduced computation time and memory usage by up to 61% and 97%, respectively.
Collapse
Affiliation(s)
- M Mühling
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany.,Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - M Winkler
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
| | - P Augat
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany.,Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
28
|
Kılıçaslan ÖF, Levent A, Çelik HK, Tokgöz MA, Köse Ö, Rennie AEW. Effect of cartilage thickness mismatch in osteochondral grafting from knee to talus on articular contact pressures: A finite element analysis. Jt Dis Relat Surg 2021; 32:355-362. [PMID: 34145811 PMCID: PMC8343842 DOI: 10.52312/jdrs.2021.41] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/26/2021] [Indexed: 12/16/2022] Open
Abstract
Objectives
The aim of this study was to investigate the effect of cartilage thickness mismatch on tibiotalar articular contact pressure in osteochondral grafting from femoral condyles to medial talar dome using a finite element analysis (FEA). Materials and methods
Flush-implanted osteochondral grafting was performed on the talar centromedial aspect of the dome using osteochondral plugs with two different cartilage thicknesses. One of the plugs had an equal cartilage thickness with the recipient talar cartilage and the second plug had a thicker cartilage representing a plug harvested from the knee. The ankle joint was loaded during a single-leg stance phase of gait. Tibiotalar contact pressure, frictional stress, equivalent stress (von Mises values), and deformation were analyzed. Results
In both osteochondral grafting simulations, tibiotalar contact pressure, frictional stress, equivalent stress (von Mises values) on both tibial and talar cartilage surfaces were restored to near-normal values. Conclusion
Cartilage thickness mismatch does not significantly change the tibiotalar contact biomechanics, when the graft is inserted flush with the talar cartilage surface.
Collapse
Affiliation(s)
| | | | | | | | - Özkan Köse
- Sağlık Bilimleri Üniversitesi, Antalya Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji Kliniği, 07100 Muratpaşa, Antalya, Türkiye.
| | | |
Collapse
|
29
|
Ahirwar H, Gupta VK, Nanda HS. Finite element analysis of fixed bone plates over fractured femur model. Comput Methods Biomech Biomed Engin 2021; 24:1742-1751. [PMID: 34097536 DOI: 10.1080/10255842.2021.1918123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The development of prosthetic bioimplants for fracture fixation using curved bone plates has been used as an established procedure for treatment in orthopedic. Here-in, we propose a novel curved bone plate fixation strategy to fix the designed biocompatible plates in different fracture models. Various biocompatible metallic biomaterials such as Ti-alloy (Ti-6Al-4V), stainless steel (SS 316L), and Co-alloy (Co-Cr) were created in SOLID works and used for the design of the bone plates. The typical fracture models (transverse and oblique) were created over a standard femur bone (models created using Materialize MIMIC/MAGIC) and two bone plates of similar materials were fixed side-by-side over the fractured femur using the screws made from Ti-6Al-4V. The finite element analysis (FEA) was carried out to evaluate the interface deformation, stress, and strain generated at the bone-bioimplant interface. The results from FEA demonstrated that the interface deformation and stress for a bone-bioimplant assembly are significantly reduced when natural anisotropic condition (functionally graded materials properties) of the human femur was well considered. Based on the analysis, Ti-6AL-4V and SS 316L were found as the best fit metallic biomaterials for the design and development of bone plate prosthetic bioimplants for fixation of an oblique fracture and transverse fracture respectively.
Collapse
Affiliation(s)
- Harbhajan Ahirwar
- Biomedical Engineering and Technology Laboratory, Discipline of Mechanical Engineering, Indian Institute of Information Technology Design and Manufacturing, Jabalpur, MP, India
| | - Vijay Kumar Gupta
- Design and Vibrations Laboratory, Discipline of Mechanical Engineering, Indian Institute of Information Technology Design and Manufacturing, Jabalpur, MP, India
| | - Himansu Sekhar Nanda
- Biomedical Engineering and Technology Laboratory, Discipline of Mechanical Engineering, Indian Institute of Information Technology Design and Manufacturing, Jabalpur, MP, India
| |
Collapse
|
30
|
Civan O, Ugur L, Yildiz G. Comparison of two surgical techniques for the treatment of transverse olecranon fractures: A finite element study. Int J Med Robot 2021; 17:e2265. [PMID: 33855772 DOI: 10.1002/rcs.2265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/31/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND In this study, we aimed to compare the stability of traditional tension band wiring (TBW) and screw combined TBW (SC-TBW) fixation methods performed for a transverse olecranon osteotomy-fracture during different degrees of elbow movement by using finite element analysis. METHODS Three-dimensional solid modeling of the olecranon was obtained by computed tomography images. Transverse olecranon fracture was created and fixed by TBW and SC-TBW with respect to triceps muscle force. Opening angle, twisting angle and interplanar translation occurring on the fracture line were evaluated at 45° and 90° elbow flexion. RESULTS Opening angle: 0.71°, 0.87° at 45° and 0.64°, 0.67° at 90° elbow flexion for TBW and SC-TBW, respectively. Twisting angle: -0.01°, -0.19° at 45° flexion and 0.19°, 0.30° at 90° flexion for TBW and SC-TBW, respectively. Interplanar translation: 1.93 mm, 4.65 mm at 45° flexion and 1.78 mm, 3.95 mm at 90° flexion for TBW and SC-TBW, respectively. CONCLUSION TBW fixation provides more stability than SC-TBW fixation model.
Collapse
Affiliation(s)
- Osman Civan
- Department of Orthopedics, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Levent Ugur
- Department of Mechanical Engineering, Amasya University, Amasya, Turkey
| | - Gurkan Yildiz
- Clinic of Orthopedics and Traumatology, Tire State Hospital, İzmir, Turkey
| |
Collapse
|
31
|
Wang C, Li X, Chen W, Wang C, Guo Y, Guo H. Three-dimensional finite element analysis of intramedullary nail with different materials in the treatment of intertrochanteric fractures. Injury 2021; 52:705-712. [PMID: 33139034 DOI: 10.1016/j.injury.2020.10.102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/27/2020] [Indexed: 02/02/2023]
Abstract
Intramedullary nails are the common treatment options for femoral intertrochanteric fractures. However, aseptic loosening is considered to be one of the primary forms of failure that can be caused by the stress shielding between the bone and implants. The matching in mechanical properties of implant and bone is a key issue to prevent this failure. Polyetheretherketone (PEEK) and Function-graded (FG) materials are widely used in clinical because of their excellent mechanical properties. In this study, to investigate the biomechanical behaviors of intramedullary nails made of Ti-6Al-4V alloy, Stainless Steel (SS), PEEK and two FG materials, three-dimensional finite element models of intertrochanteric fracture femur with intramedullary nail were constructed with ABAQUS. The maximum von Mises stress on the femoral fracture surface fixed by PEEK intramedullary nail was the largest, followed by FG intramedullary nail, which help stimulate bone growth and subsequently reduce fracture healing time. Compared with traditional metal intramedullary nails, PEEK and FG implants might increase von Mises stress along the same path in the proximal femur. The results showed that PEEK and FG intramedullary nails obviously changed the stress distributions in the bone and reduced stress shielding. This finding indicated that PEEK and FG intramedullary nails have the potential to become alternatives to the conventional metal intramedullary nails.
Collapse
Affiliation(s)
- Chenyan Wang
- College of Biomedical Engineering, Taiyuan University of Technology, No.79, Yingze West Road, Taiyuan, Shanxi, 030024, China
| | - Xiaona Li
- College of Biomedical Engineering, Taiyuan University of Technology, No.79, Yingze West Road, Taiyuan, Shanxi, 030024, China
| | - Weiyi Chen
- College of Biomedical Engineering, Taiyuan University of Technology, No.79, Yingze West Road, Taiyuan, Shanxi, 030024, China.
| | - Changjiang Wang
- School of Engineering and Informatics, University of Sussex, Brighton BN1 9QJ, UK
| | - Yuan Guo
- College of Biomedical Engineering, Taiyuan University of Technology, No.79, Yingze West Road, Taiyuan, Shanxi, 030024, China
| | - Hongmei Guo
- College of Biomedical Engineering, Taiyuan University of Technology, No.79, Yingze West Road, Taiyuan, Shanxi, 030024, China
| |
Collapse
|
32
|
Lee WC, Chou SM, Tan CW, Chng LS, Yam GJM, Chua THI. Intertrochanteric fracture with distal extension: When is the short proximal femoral nail antirotation too short? Injury 2021; 52:926-932. [PMID: 33082031 DOI: 10.1016/j.injury.2020.10.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/25/2020] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The lesser trochanter (LT) fragment in the multifragmentary intertrochanteric femur fracture (AO 31A2.2) may extend distally. If the fragment extends too distally, fixation with a short proximal femoral nail antirotation (PFNA-II) device may not be sufficient. The exact length of distal extension that can be tolerated by the short PFNA-II is not known, therefore it is our objective to determine it. MATERIALS AND METHODS A finite element analysis was performed on AO 31A2.2 fracture fixed with a 200mm length size 10 PFNA-II. The construct was loaded vertically to clinical failure of 10mm displacement. This was repeated with the size of the LT fragment increasing distally at intervals, up to 120mm from the base of the LT. The process was also repeated with the bone properties substituted with osteoporotic properties. The stiffness, maximum vertical reaction force, and the plastic deformation area were investigated. RESULTS In both non-osteoporotic and osteoporotic model, the stiffness and the maximum vertical reaction force of the construct dropped significantly when the LT fragment is larger than 40mm. Beyond 40mm of LT fragment size, there was a rapid increase in the area of plastic deformation of the cortical bone distal to the intertrochanteric fracture, signifying structural failure of the construct. CONCLUSION A long PFNA-II should be considered when fixing a multifragmentary intertrochanteric fracture if the LT fragment extends 40mm distal to the distal base of the LT as the construct fails rapidly upon uniaxial load to failure. Clinically, this threshold may be smaller to account for the multi-axial and dynamic stresses.
Collapse
Affiliation(s)
- Wu Chean Lee
- Department of Orthopaedic Surgery, Annex 1 Level 2, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
| | - Siaw Meng Chou
- School of Mechanical & Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798, Singapore
| | - Chee Wei Tan
- Advanced Analysis, Advisian, Alexandra Technopark, 438B Alexandra Road #04-09, Singapore 119968, Singapore
| | - Li Sing Chng
- School of Mechanical & Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798, Singapore
| | - Gui Jie Michael Yam
- Department of Orthopaedic Surgery, Annex 1 Level 2, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Tjun Huat Ivan Chua
- Department of Orthopaedic Surgery, Annex 1 Level 2, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| |
Collapse
|
33
|
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.
Collapse
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.
| |
Collapse
|
34
|
Medial support nail and proximal femoral nail antirotation in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association 31-A3.1): a finite-element analysis. Chin Med J (Engl) 2020; 133:2682-2687. [PMID: 32889910 PMCID: PMC7647506 DOI: 10.1097/cm9.0000000000001031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The reverse obliquity inter-trochanteric fracture is a distinct fracture pattern that is mechanically different from most inter-trochanteric fractures and the optional treatment of it is still controversial. The purpose of this study was to compare differences in the efficacy of a novel nail (medial support nail [MSN-II]) and proximal femoral nail anti-rotation (PFNA-II) in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association [AO/OTA] 31-A3.1) using finite-element analysis. METHODS Modeling software was used to establish a three-dimensional model of MSN-II and PFNA-II and an A3.1 inter-trochanteric fracture model. Abaqus software was used to implement different force loads to compare finite-element biomechanical parameters such as the maximum stress in implant and the displacement of fracture site. RESULTS The femoral stress, implant stress and fracture site displacement of MSN-II was less than that of PFNA-II. The results indicated that the maximal femoral stress was 581 MPa for PFNA-II and 443 MPa for the MSN-II. The maximum stress values in the PFNA-II and MSN-II models were 291 and 241 MPa, respectively. The maximal displacements of the fracture site were 1.47 and 1.16 mm in the PFNA-II and MSN-II models, respectively. CONCLUSION Compared with PFNA-II for inter-trochanteric fracture (AO/OTA 31-A3.1), MSN-II which was designed with a triangular stability structure can provide better biomechanical stability. The MSN-II may be a feasible option for the treatment of reverse obliquity inter-trochanteric fracture.
Collapse
|
35
|
Anwar A, Hu Z, Adnan A, Gao Y, Li B, Nazir MU, Tian C, Wang Y, Lv D, Zhao Z, Zhang Z, Zhang H, Tong C, Lv G. Comprehensive biomechanical analysis of three clinically used fixation constructs for posterior malleolar fractures using cadaveric and finite element analysis. Sci Rep 2020; 10:18639. [PMID: 33122787 PMCID: PMC7596231 DOI: 10.1038/s41598-020-75819-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/21/2020] [Indexed: 11/11/2022] Open
Abstract
Different fixation modalities are available for fixation of posterior malleolar fractures (PMFs), but the best method is still unclear. The purpose of this study was to carry out a comparative biomechanical analysis of three commonly used fixation constructs for PMFs using experimental and finite element analysis (FEA). 15 human cadaveric ankle specimens were randomly divided into three groups. Specimens in group-A were fixed with two anteroposterior (AP) lag screws, group-B with two posteroanterior (PA) lag screws, and for group-C, a posterior plate was used. Each model was subjected to axial load. Outcomes included loads for 0.5 mm, 1 mm, 1.5 mm, and 2 mm vertical displacements of posterior fragments were noted. 3D FE models were reconstructed from computed tomography (CT) images and subjected to vertical loads. The model’s stress, fracture step-off, and resultant strains in implants were also studied in 3D FE models. Significantly higher amounts of mean compressive loads were observed to cause the same amount of vertical displacements in plate group (265 ± 60.21 N, 796 ± 57.27 N, 901.18 ± 8.88 N, 977.26 ± 13.04 N) than AP (102.7 ± 16.78 N, 169.5 ± 19.91 N, 225.32 ± 15.92 N, 269.32 ± 17.29 N) and PA (199.88 ± 31.43 N, 362.80 ± 28.46 N, 431.3 ± 28.12 N, 541.86 ± 36.05 N) lag screws respectively (P < 0.05). Simulated micro-motion analysis demonstrated that fracture step-off values in plate group (0.03 ± 0.001 mm, 0.06 ± 0.003 mm and 0.13 ± 0.010 mm) were the lowest among the three groups (P < 0.001). The cancellous bone showed the highest amount of stress in AP and PA lag groups respectively, whereas the lowest stress was noted in the plate-group. This biomechanical study concluded that posterior plating is biomechanically the most stable fixation construct for PMFs fixation. AP and PA lag screws with higher bone stress and fracture step-off values have a high tendency of bone cut-through and loss of fixation respectively.
Collapse
Affiliation(s)
- Adeel Anwar
- Institute of Translational Medicine, China Medical University, No. 77 Puhe Road, North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Zhenwei Hu
- Department of Orthopaedic Surgery, The Second Hospital of Chaoyang City, No 26, Secttion 4 Chaoyang street, Chaoyang, Liaoning, People's Republic of China
| | - Atif Adnan
- Department of Human Anatomy, School of Basic Medical Science, China Medical University, No. 77 Puhe Road, 110122 North New Area, Shenyang, Liaoning, People's Republic of China
| | - Yanming Gao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Dalian Medical University, 456 Zhong Shan Road, Dalian, 116027, Liaoning, People's Republic of China
| | - Bing Li
- Engineering Research Center of Continuous Extrusion, Ministry of Education, Dalian Jiaotong University, 794 Yellow River Road, Dalian, 116028, Liaoning, People's Republic of China
| | - Muhammad Umar Nazir
- Department of Anesthesia, The Second Affiliated Hospital of Dalian Medical University, 456 Zhong Shan Road, Dalian, 116027, Liaoning, People's Republic of China
| | - Cong Tian
- Department of Railway Vehicle, Ji Lin Railway Technology College, 1 Ji Hua East road, 132200, Ji Lin, People's Republic of China
| | - Yanfeng Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of China Medical University, 155 Nanjing street, Shenyang, 110001, Liaoning, People's Republic of China
| | - Decheng Lv
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhong shan road, Dalian, Liaoning, 116011, People's Republic of China
| | - Zhi Zhao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Dalian Medical University, 456 Zhong Shan Road, Dalian, 116027, Liaoning, People's Republic of China
| | - Zhen Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Dalian Medical University, 222 Zhong shan road, Dalian, Liaoning, 116011, People's Republic of China
| | - Hu Zhang
- Department of Orthopaedic Surgery, The 920Th Hospital of Joint Logistics Support Force, Kunming, 650032, Yunnan, People's Republic of China
| | - Changgui Tong
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Dalian Medical University, 456 Zhong Shan Road, Dalian, 116027, Liaoning, People's Republic of China
| | - Gang Lv
- Institute of Translational Medicine, China Medical University, No. 77 Puhe Road, North New Area, Shenyang, 110122, Liaoning, People's Republic of China.
| |
Collapse
|
36
|
Finite element analysis of Bi-condylar Tibial Plateau fractures to assess the effect of coronal splits. Med Eng Phys 2020; 84:84-95. [DOI: 10.1016/j.medengphy.2020.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/08/2020] [Accepted: 07/26/2020] [Indexed: 11/21/2022]
|
37
|
Lu J, Wang QY, Sheng JG, Guo SC, Tao SC. A 3D-printed, personalized, biomechanics-specific beta-tricalcium phosphate bioceramic rod system: personalized treatment strategy for patients with femoral shaft non-union based on finite element analysis. BMC Musculoskelet Disord 2020; 21:421. [PMID: 32611412 PMCID: PMC7331224 DOI: 10.1186/s12891-020-03465-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/25/2020] [Indexed: 11/22/2022] Open
Abstract
Background Although double-plate fixation (DP), i.e., fixation with a combination of a main lateral plate (LP) and a support medial plate (MP), is a relatively mature method for treating femoral shaft non-union with bone defect causes complications. The purpose of this study was to evaluate LP fixation with a 3D-printed, personalized, biomechanics-specific β-TCP bioceramic rod system (LP + 3DpbsBRS) as an alternative with less collateral damage. Methods Structure-specific finite element modelling was used to simulate femoral shaft non-union with bone defects and treatment with an LP only as the blank control. Then, the peak von Mises stress (VMS), the VMS distribution, and the plate displacement were determined to compare the effectiveness of LP + CBG (cancellous bone grafting), DP + CBG, and LP + 3DpbsBRS under 850 N of axial force. Results Our results indicated that the peak VMS was 260.2 MPa (LP + 3DpbsBRS), 249.6 MPa (MP in DP + CBG), 249.3 MPa (LP in DP + CBG), and 502.4 MPa (LP + CBG). The bending angle of the plate was 1.2° versus 1.0° versus 1.1° versus 2.3° (LP + 3DpbsBRS versus MP in DP + CBG versus LP in DP + CBG versus LP + CBG). Conclusion The 3DpbsBRS in the LP + 3DpbsBRS group could replace the MP in the DP + CBG group by providing similar medial mechanical support. Furthermore, avoiding the use of an MP provides better protection of the soft tissue and vasculature.
Collapse
Affiliation(s)
- Jian Lu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.,Department of Orthopedic Surgery, Shanghai Fengxian Central Hospital, Branch of The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 201400, China.,Department of Medicine, Soochou University, Suzhou, 215123, Jiangsu, China
| | - Qi-Yang Wang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Jia-Gen Sheng
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Shang-Chun Guo
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China. .,Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Shi-Cong Tao
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| |
Collapse
|
38
|
Zhang W, Hao M, Chang Z, Wu Y, Tang P, Chen H. Comparison of a multidimensional cross locking plate versus a locking compression plate for the treatment of femoral shaft nonunion: Finite element analysis. Med Eng Phys 2020; 83:106-111. [PMID: 32507679 DOI: 10.1016/j.medengphy.2020.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 05/05/2020] [Accepted: 05/13/2020] [Indexed: 01/23/2023]
Abstract
The purpose of this study was to explore the advantages and disadvantages of a multi-dimensional cross locking plate (MDC-LP) compared with a locking compression plate (LCP) as the augmentation plate (AP) over an intramedullary nail (IMN) for the treatment of femoral shaft nonunion by using finite element analysis. A finite element model of the femur was developed to analyze the maximum stress, stress distribution, displacement of fixation and nonunion site under increasing axial and torsional loads. Some differences in the stress distribution and stress values on the fixations were observed in the five fixation models. The MDC-LP with eight screw fixation showed the lowest variety of nonunion site displacement under the increasing axial and torsional loads. Models of the MDC-LP were more stable with regard to the bending and torsional forces. The short MDC-LP with eight screw insertion as an augmentation plate over intramedullary nail shows biomechanical advantages compared to the LCP. The MDC-LP may be an appropriate and effective treatment option for femoral shaft nonunion.
Collapse
Affiliation(s)
- Wei Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, PR China
| | - Ming Hao
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, PR China
| | - Zuhao Chang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, PR China
| | - Yan Wu
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, PR China.
| | - Peifu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, PR China
| | - Hua Chen
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, PR China.
| |
Collapse
|
39
|
Lu J, Guo SC, Wang QY, Sheng JG, Tao SC. J-bone graft with double locking plate: a symphony of mechanics and biology for atrophic distal femoral non-union with bone defect. J Orthop Surg Res 2020; 15:144. [PMID: 32293488 PMCID: PMC7161247 DOI: 10.1186/s13018-020-01636-3] [Citation(s) in RCA: 9] [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: 01/23/2020] [Accepted: 03/13/2020] [Indexed: 12/13/2022] Open
Abstract
Objective Atrophic distal femur non-union with bone defect (ADFNBD) has been a worldwide challenge to treat due to the associated biological and mechanical problems. The purpose of this study was to introduce a new solution involving the use of a J-shaped iliac crest bone graft (J-bone) combined with double-plate (DP) in the treatment of femoral non-union. Methods Clinically, 18 patients with ADFNBD were included in this retrospective study and were treated with a combination of J-bone graft and DP. The average follow-up time was 22.1 ± 5.5 months (range, 14 to 34 months). The imaging information and knee joint activity tests and scores were used to evaluate the time to weight-bearing, the time to non-union healing, and the knee joint mobility. A finite element analysis was used to evaluate the differences between the following: (1) the use of a lateral locking plate (LLP) only group (LLP-only), (2) a DP only group (DP-only), (3) a DP with a J-bone group (DP+J-bone), and (4) an LLP with a J-bone group (LLP+J-bone) in the treatment of ADFNBD. A finite element analysis ABAQUS 6.14 (Dassault systems, USA) was used to simulate the von Mises stress distribution and model displacement of the plate during standing and normal walking. Result All patients with non-union and bone defect in the distal femur achieved bone healing at an average of 22.1 ± 5.5 months (range, 14 to 34 months) postoperatively. The average healing time was 6.72 ± 2.80 months. The knee Lysholm score was significantly improved compared with that before surgery. Under both 750 N and 1800 N axial stress, the maximum stress with the DP+J-bone structure was less than that of the LLP+J-bone and DP-only structures, and the maximum stress of J-bone in the DP+J-bone was significantly less than that of the LLP+J-bone+on structure. The fracture displacement of the DP+J-bone structure was also smaller than that of the LLP+J-bone and DP-only structures. Conclusion J-bone combined with DP resulted in less maximum stress and less displacement than did a J-bone combined with an LLP or a DP-only graft for the treatment of ADFNBD. This procedure was associated with less surgical trauma, early rehabilitation exercise after surgery, a high bone healing rate, and a satisfactory rate of functional recovery. Therefore, a combination of J-bone and DP is an effective and important choice for the treatment of ADFNBD.
Collapse
Affiliation(s)
- Jian Lu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.,The Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China
| | - Shang-Chun Guo
- Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Qi-Yang Wang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Jia-Gen Sheng
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Shi-Cong Tao
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| |
Collapse
|
40
|
Li J, Wang M, Zhou J, Zhang H, Li L. Finite element analysis of different screw constructs in the treatment of unstable femoral neck fractures. Injury 2020; 51:995-1003. [PMID: 32151421 DOI: 10.1016/j.injury.2020.02.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES In the present study, we evaluated the mechanical outcome of different configurations formed by partially threaded screws (PTS) alone or combined screws consisting of PTS and fully threaded screws (FTS) in the treatment of unstable femoral neck fracture. METHODS The Pauwels type III unstable femoral fracture and screw models of PTS and FTS were created in 3-matic software and UG-NX software respectively. We assembled the different screw fixation types to the fracture model separately to form the fixation models. We used Abaqus software to perform the finite element analysis. RESULTS Our results indicated that the peak von Mises stresses of screws increased when some PTSs changed into FTSs in all groups except for the inferior triangle group. FTS in each group underwent the most stress while PTS underwent a little bit of stress. The combined screws fixation types were less likely to be cut-out and was more stable than PTPs alone fixation strategy. Less yielding regions around the screw tunnels for the superior and inferior triangle configuration fixed by combined screws was indicated. Superior triangle fixation model underwent the largest area of stress concentration around the screw holes after screws removal. CONCLUSIONS For unstable femoral neck fractures, superior results were obtained by stabilizing the fracture with superior or inferior triangle configuration consisting of one PTS and two FTSs. If screws removal was taken into account after fracture union, fixation type of inferior triangle configuration should be the recommended choice.
Collapse
Affiliation(s)
- Jiantao Li
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, PR China
| | - Menglin Wang
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, 100191, PR China
| | - Jianfeng Zhou
- Department of Emergency, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, PR China
| | - Hao Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, PR China.
| | - Lianting Li
- Department of Orthopaedics, The Third People's Hospital of Qingdao, No. 29 Yongping Road, Qingdao 266041, PR China.
| |
Collapse
|
41
|
Wang J, Ma JX, Lu B, Bai HH, Wang Y, Ma XL. Comparative finite element analysis of three implants fixing stable and unstable subtrochanteric femoral fractures: Proximal Femoral Nail Antirotation (PFNA), Proximal Femoral Locking Plate (PFLP), and Reverse Less Invasive Stabilization System (LISS). Orthop Traumatol Surg Res 2020; 106:95-101. [PMID: 31345739 DOI: 10.1016/j.otsr.2019.04.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 04/20/2019] [Accepted: 04/30/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The optimal type of fixation implant for managing subtrochanteric fractures (STFs) is debated, as uncertainty continues to surround the comparative biomechanical performance of the proximal femoral nail antirotation (PFNA), proximal femoral locking plate (PFLP), and reverse less invasive stabilisation system (LISS). No studies have used finite element analysis (FEA) to compare these three devices. The objective of this study was to use FEA to compare the PFNA, PFLP, and LISS used to treat STFs based on the following criteria: (1) stress distribution on the femur and implant, (2) peak stress and stress on the medial side of the femur near the fracture site, and (3) smallest axial displacement of the femoral head. HYPOTHESIS Of the three implants, the PFNA has the best biomechanical performance when used for STF fixation. METHODS FEA was used to assess synthetic bone responses to the three implants used to fix three STF types, namely, Seinsheimer I, III, and IV, characterised by increasing bone loss and/or comminution with subsequent instability. Loading was with 1400N axial compression force. RESULTS The LISS and PFLP exhibited similar biomechanical properties in all three fracture types. However, with the Seinsheimer IV fracture, the triangular configuration of the PFLP resulted in stress concentration at the medial and lateral sides of the implant junction. With the Seinsheimer I and III fractures, the PFNA resulted in higher peak stress (183.85MPa and 364.58MPa, respectively) compared to the PFLP (102.90MPa and 177.52MPa) and LISS (116.55MPa and 227.97MPa). With the Seinsheimer IV fracture, peak stress was highest with LISS (2310.40MPa) and was higher with PFLP (2054.90MPa) than with PFNA (1313.30MPa). With the Seinsheimer I and III fractures, the axial femoral head displacement was greater with the PFNA (0.74mm and 1.13mm, respectively) than with the PFLP (0.48mm and 1.02mm) and LISS (0.52mm and 0.92mm). With the Seinsheimer IV fracture, in contrast, the PFNA produced less axial femoral head displacement (4.1mm) compared to the PFLP (12.03mm) and LISS (16.56mm). DISCUSSION With unstable (Seinsheimer IV) STFs, fixation stability was better with the PFNA compared to the PFLP and LISS. In contrast, with stable STFs (Seinsheimer I and III), the PFLP and LISS offered greater stability, with similar biomechanical effects. However, with Seinsheimer III fractures, the stress on the implant-femur interface was greater with the LISS. LEVEL OF EVIDENCE IV, basic science study.
Collapse
Affiliation(s)
- Jie Wang
- Department of Orthopaedics, Tianjin Medical University General Hospital, No. 154, Anshan Street, Heping District, 300052, Tianjin China; Institute of Orthopaedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, 300211 Tianjin, China
| | - Jian-Xiong Ma
- Institute of Orthopaedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, 300211 Tianjin, China
| | - Bin Lu
- Institute of Orthopaedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, 300211 Tianjin, China
| | - Hao-Hao Bai
- Institute of Orthopaedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, 300211 Tianjin, China
| | - Ying Wang
- Institute of Orthopaedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, 300211 Tianjin, China
| | - Xin-Long Ma
- Department of Orthopaedics, Tianjin Medical University General Hospital, No. 154, Anshan Street, Heping District, 300052, Tianjin China.
| |
Collapse
|
42
|
Jiang D, Zhan S, Wang Q, Ling M, Hu H, Jia W. Biomechanical Comparison of Locking Plate and Cancellous Screw Techniques in Medial Malleolar Fractures: A Finite Element Analysis. J Foot Ankle Surg 2019; 58:1138-1144. [PMID: 31562067 DOI: 10.1053/j.jfas.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/27/2018] [Accepted: 10/16/2018] [Indexed: 02/03/2023]
Abstract
As the commonly used fixation strategy of medial malleolar fractures, cancellous screws (CS) have been challenged for instability, bone destruction, and metal prominence. It is still unclear whether a locking compression plate (LCP) is a better choice in such fractures. Our purpose is to compare the mechanical efficacy of LCP with traditional 4.0-mm CS for transverse, oblique, and vertical medial malleolar fractures by using finite element analysis. In this study, 3-dimensional models of the distal tibia were reconstructed from a computed tomography scan of a young healthy male adult. Conditions included 3 fracture lines at 30°, 60°, and 90°; 2 groups of fixation (LCP and CS); and 3 adduction loads of 300, 500, and 700 N applied to the medial malleolar joint surface. The proximal part of the tibia was fixed for all degrees of freedom. The fracture displacements of the LCP were smaller than those of CS (p < .05). The stiffness of the LCP constructs was much higher than that of the CS constructs, especially in the 90° fractures (490.3 versus 163.6 N/mm). The mean stress around the CS was higher than that in LCP for 60° and 90° fractures, but there was no difference for 30°. Maximal bone stress increased (19.84 to 50.86 MPa) and concentrated on cortical bone in LCP, whereas it concentrated on cancellous bone in CS. The results showed that LCP could improve stability, preventing bone destruction in oblique and vertical medial malleolar fractures. However, in transverse fractures, CS provides sufficient stability, with no need to use LCP.
Collapse
Affiliation(s)
- Dajun Jiang
- Surgeon, Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, P.R. China; Surgeon, Orthopedic Biomechanical Laboratory, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, P.R. China
| | - Shi Zhan
- Associate Registrar, Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, P.R. China; Associate Registrar, Orthopedic Biomechanical Laboratory, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, P.R. China
| | - Qing Wang
- Surgeon, Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, P.R. China
| | - Ming Ling
- Surgeon, Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, P.R. China; Surgeon, Orthopedic Biomechanical Laboratory, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, P.R. China
| | - Hai Hu
- Surgeon, Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, P.R. China; Surgeon, Orthopedic Biomechanical Laboratory, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, P.R. China.
| | - Weitao Jia
- Surgeon, Department of Orthopedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, P.R. China.
| |
Collapse
|
43
|
Tucker SM, Wee H, Fox E, Reid JS, Lewis GS. Parametric Finite Element Analysis of Intramedullary Nail Fixation of Proximal Femur Fractures. J Orthop Res 2019; 37:2358-2366. [PMID: 31254411 DOI: 10.1002/jor.24401] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/06/2019] [Indexed: 02/04/2023]
Abstract
Proximal femur fracture fixation with intramedullary nailing relies on stability at the fracture site and integrity of the fixation construct to achieve union. The biomechanics that dictate fracture site stability and implant stress depend on fracture type as well as implant features such as nail length, nail diameter, presence of distal fixation screws, and material composition of the implant. When deciding how to fix a fracture, surgeons have choices in these implant-related design variables. This study models all combinations of a range of implant variables for nine standard AO/OTA proximal femur fractures using finite element analysis. Under simulated maximum load during gait, the maximum stress in the implant and screws as well as interfragmentary motions at the fracture site in the axial and shear directions were computed. The results were separated by fracture type to show the influence of each design variable on measured biomechanical outcomes. Filling the reamed canal with the largest fitting nail diameter reduced axial and shear interfragmentary motion for all fracture types. Nail length was less predictive of shear interfragmentary motion for most simulated fracture types than other construct variables. Furthermore, gapping at the fracture site predisposed the construct to higher implant stresses and larger interfragmentary motions. Clinical significance: Biomechanical outcomes from this computational study can aid in surgical decision-making for optimizing hip fracture fixation with IM nailing. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2358-2366, 2019.
Collapse
Affiliation(s)
- Scott M Tucker
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Hwabok Wee
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Edward Fox
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - J Spence Reid
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Gregory S Lewis
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| |
Collapse
|
44
|
In Silico Optimization of Femoral Fixator Position and Configuration by Parametric CAD Model. MATERIALS 2019; 12:ma12142326. [PMID: 31336577 PMCID: PMC6679040 DOI: 10.3390/ma12142326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/11/2019] [Accepted: 07/19/2019] [Indexed: 11/17/2022]
Abstract
Structural analysis, based on the finite element method, and structural optimization, can help surgery planning or decrease the probability of fixator failure during bone healing. Structural optimization implies the creation of many finite element model instances, usually built using a computer-aided design (CAD) model of the bone-fixator assembly. The three most important features of such CAD models are: parameterization, robustness and bidirectional associativity with finite elements (FE) models. Their significance increases with the increase in the complexity of the modeled fixator. The aim of this study was to define an automated procedure for the configuration and placement of fixators used in the treatment of long bone fractures. Automated and robust positioning of the selfdynamisable internal fixator on the femur was achieved and sensitivity analysis of fixator stress on the change of major design parameters was performed. The application of the proposed methodology is considered to be beneficial in the preparation of CAD models for automated structural optimization procedures used in long bone fixation.
Collapse
|
45
|
Samsami S, Augat P, Rouhi G. Stability of femoral neck fracture fixation: A finite element analysis. Proc Inst Mech Eng H 2019; 233:892-900. [PMID: 31203740 DOI: 10.1177/0954411919856138] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Femoral neck fractures represent a relatively uncommon injury in the non-elderly population often resulting from high-energy trauma. Clinical outcome in these patients can be improved by optimizing surgical procedures and selecting appropriate fixation methods. The aim of this study was to develop a numerical fracture model to investigate the influence of critical mechanical factors on the stability of fixation methods for femoral neck fractures. The mechanical stability of fracture fixation was assessed through employing finite element models and simulating progressive consolidation of the fracture for a vertical femoral neck fracture (i.e. Pauwels type III in which the angle between the fracture line and the horizontal plane is greater than 70°). Mechanical performance was compared among three different fixation methods (cannulated screws, dynamic hip screw with de-rotational screw, and proximal femoral locking plate). Axial femoral head displacement varied from 2.3 mm for cannulated screws to 1.12 mm for proximal femoral locking plate, although dynamic hip screw with de-rotational screw indicated a value of 0.94 mm. Considering a consolidated fracture and full weight-bearing load case, average displacements of fracture fragments were obtained of about 1.5, 3 and 70 µm for dynamic hip screw with de-rotational screw, proximal femoral locking plate and cannulated screws methods, respectively. In terms of interfragmentary movements at the fracture site, outcomes of this study demonstrated that, in agreement with our previous experimental research, the dynamic hip screw with de-rotational screw implant is a more effective choice than cannulated screws and proximal femoral locking plate techniques for vertical femoral neck fractures in young patients. Thus, one may conclude that the use of dynamic hip screw with de-rotational screw, particularly during the early stages of bone healing, could provide suitable mechanical environments that facilitate direct bone formation and shorter healing times.
Collapse
Affiliation(s)
- Shabnam Samsami
- 1 Institute for Biomechanics, Trauma Center Murnau, Murnau, Germany.,2 Faculty of Medicine, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Peter Augat
- 1 Institute for Biomechanics, Trauma Center Murnau, Murnau, Germany.,3 Institute for Biomechanics, Paracelsus Private Medical University, Salzburg, Austria
| | - Gholamreza Rouhi
- 4 Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| |
Collapse
|
46
|
Choh AC, Chong DY. Biomechanical analysis of the placement of fixation lag screw in different intertrochanteric hip fracture angles. BIOSURFACE AND BIOTRIBOLOGY 2019. [DOI: 10.1049/bsbt.2018.0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Alex C.T. Choh
- Department of Biomedical EngineeringNational University of SingaporeSingapore
| | | |
Collapse
|
47
|
Medial sustainable nail versus proximal femoral nail antirotation in treating AO/OTA 31-A2.3 fractures: Finite element analysis and biomechanical evaluation. Injury 2019; 50:648-656. [PMID: 30827705 DOI: 10.1016/j.injury.2019.02.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/12/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Using finite element analysis and biomechanical tests, the biomechanical behaviors of Medial Sustainable Nail (MSN) and Proximal Femoral Nail Antirotation (PFNA) were compared for the fixation of fracture type of AO/OTA 31-A2.3. METHODS Finite element software Abaqus 6.14 was used to conduct axial loading of 2100 N and we analyzed the von Mises stress distribution and the model displacement of two implant models. Biomechanical tests were separately conducted in the axial stiffness test and axial cyclical loading test on a mechanical testing machine. RESULTS The results indicate that von Mises stress of MSN was lower than that of PFNA, and the model displacement in the MSN group was lower than that in the PFNA group. In the axial stiffness tests, MSN group was stiffer than PFNA construct. With respect to the axial load to ultimate failure, the PFNA construct exhibited higher loads exceeding 4000 N while the MSN construct withstood 3313.8 ± 92.8 N. Specifically, F10mm was 2178.6 ± 133.2 N of the MSN group and 1822.6 ± 93.1 N of the PFNA group (P = 0.001). Additionally, X2100N was 9.8 ± 0.5 mm of the MSN group and 11.7 ± 0.7 mm of the PFNA group (P = 0.002). The MSN group exhibited superior performances in terms of the mean value of the vertical displacement, frontal rotation angle, and lateral rotation angle. CONCLUSIONS The results indicated that the MSN construct might exhibit a better biomechanical performance when compared with that of the PFNA in reducing displacement and anti-varus in fracture type of AO/OTA 31-A2.3.
Collapse
|
48
|
Biomechanical Investigation of an Integrated 2-Screw Cephalomedullary Nail Versus a Sliding Hip Screw in Unstable Intertrochanteric Fractures. J Orthop Trauma 2019; 33:82-87. [PMID: 30562248 DOI: 10.1097/bot.0000000000001351] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the efficacy of 2 intertrochanteric (IT) fracture fixation devices in conferring mechanical stability to unstable IT femur fractures. METHODS Nine pairs of cadaveric female femurs with a groupwise average bone quality indicative of osteopenia were used. An unstable IT fracture without calcar support (OTA/AO 31-A2) was created and stabilized with either a sliding hip screw and side plate (SHS) or a cephalomedullary nail using an integrated dual-screw fixation [InterTAN (ITN)]. Constructs were evaluated under stepwise and increasing cyclic loading up to 50,000 cycles (1500 N) or by failure in a test model that may best simulate hip joint contact forces at heel strike. Number of cycles to failure, failure load, and femoral head rotation about the screw axis were compared between groups. RESULTS The average number of cycles in the ITN group was greater compared with that in the SHS group (48,383 vs. 31,403 cycles, P = 0.046). Similarly, the average maximum load survived by the ITN group was greater than that of the SHS group (1456 vs. 1113 N, P = 0.046). The number of constructs that survived up to the maximum applied load of 1500 N was greater in the ITN group (8/9, 89%) when compared with that of the SHS constructs (3/9, 33%) (P = 0.049). Finally, the ITN group conferred greater rotational control of the femoral head compared with the SHS constructs (1.5 vs. 5.5 degrees, P = 0.018), and reduced the amount of varus collapse (11.1 vs. 31.1 degrees, P = 0.038). CONCLUSIONS The integrated dual-screw construct appeared to confer significantly greater fracture stability compared with a sliding hip screw and side plate using a worst-case model that simulates heel strike during gait. Study data provide biomechanical evidence that the ITN device may provide more stability and rotational resistance than a sliding hip screw in the elderly female patient population with an unstable IT fracture and compromised bone quality.
Collapse
|
49
|
Li J, Wang M, Li L, Zhang H, Hao M, Li C, Han L, Zhou J, Wang K. Finite element analysis of different configurations of fully threaded cannulated screw in the treatment of unstable femoral neck fractures. J Orthop Surg Res 2018; 13:272. [PMID: 30373617 PMCID: PMC6206921 DOI: 10.1186/s13018-018-0970-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 10/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the present study, we evaluated the mechanical outcome of different configurations formed by fully threaded screws and partially threaded screws in the treatment of unstable femoral neck fracture. METHODS The Pauwels type III unstable femoral fracture and the models of the fully threaded screw and partially threaded screw were constructed in 3-matic software and UG-NX software respectively. We then assembled the different screw configurations to the fracture model separately to form the fixation models. After meshing the models' elements, we used Abaqus software to perform the finite element analysis. Parameters of von Mises stress distribution on the screws, peak stress, displacement between fracture fragments, and model principal strains in cancellous bone were reported. RESULTS Our results indicated that the peak von Mises stresses of screws was concentrated in the middle surface of the screw near the fracture line in each group. Peak stress value of the implants was highest in the model of triangle with posterior single screw. And the lowest stress values were observed in the triangular model. Fully threaded screw in each group underwent the most stress while partially threaded screw underwent a little bit of stress. Lowest displacement was observed in the triangular model. The volume of bone susceptible to yielding in the femoral neck region was the lowest for triangular configuration. CONCLUSIONS For unstable femoral neck fractures, superior results were obtained by stabilizing the fracture with triangular configuration formed by one superior partially threaded screw and two inferior fully threaded screws. This study will require clinical confirmation as to its practicality in the management of unstable femoral fractures.
Collapse
Affiliation(s)
- Jiantao Li
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Menglin Wang
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Lianting Li
- Department of Orthopaedics, The Third People's Hospital of Qingdao, No. 29 Yongping Road, Qingdao, 266041, People's Republic of China
| | - Hao Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Ming Hao
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Chen Li
- Department of Orthopaedics, Tianjin Hospital, NO. 406 Jiefang Road, Tianjin, 300211, People's Republic of China
| | - Lin Han
- Graduate School of the Second Military Medical University, Shanghai, 200433, China
| | - Jianfeng Zhou
- Department of Emergency, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Kun Wang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| |
Collapse
|
50
|
Berti F, La Barbera L, Piovesan A, Allegretti D, Ottardi C, Villa T, Pennati G. Residual Stresses in Titanium Spinal Rods: Effects of Two Contouring Methods and Material Plastic Properties. J Biomech Eng 2018; 140:2683662. [DOI: 10.1115/1.4040451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Indexed: 01/01/2023]
Abstract
Posterior spinal fixation based on long spinal rods is the clinical gold standard for the treatment of severe deformities. Rods need to be contoured prior to implantation to fit the natural curvature of the spine. The contouring processes is known to introduce residual stresses and strains which affect the static and fatigue mechanical response of the implant, as determined through time- and cost-consuming experimental tests. Finite element (FE) models promise to provide an immediate understanding on residual stresses and strains within a contoured spinal rods and a further insight on their complex distribution. This study aims at investigating two rod contouring strategies, French bender (FB) contouring (clinical gold standard), and uniform contouring, through validated FE models. A careful characterization of the elastoplastic material response of commercial implants is led. Compared to uniform contouring, FB induces highly localized plasticizations in compression under the contouring pin with extensive lateral sections undergoing tensile residual stresses. The sensitivity analysis highlighted that the assumed postyielding properties significantly affect the numerical predictions; therefore, an accurate material characterization is recommended.
Collapse
Affiliation(s)
- Francesca Berti
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| | - Luigi La Barbera
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy e-mail:
| | - Agnese Piovesan
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| | - Dario Allegretti
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| | - Claudia Ottardi
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| | - Tomaso Villa
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| | - Giancarlo Pennati
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| |
Collapse
|