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Duan W, Liang H, Fan X, Zhou D, Wang Y, Zhang H. Research Progress on the Treatment of Geriatric Intertrochanteric Femur Fractures with Proximal Femur Bionic Nails (PFBNs). Orthop Surg 2024. [PMID: 38982572 DOI: 10.1111/os.14134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 07/11/2024] Open
Abstract
Intertrochanteric femur fracture is the most common hip fracture in elderly people, and the academic community has reached a consensus that early surgery is imperative. Proximal femoral nail anti-rotation (PFNA) and InterTan are the preferred internal fixation devices for intertrochanteric femur fractures in elderly individuals due to their advantages, such as a short lever arm, minimal stress shielding, and resistance to rotation. However, PFNA is associated with complications such as nail back-out and helical blade cut-out due to stress concentration. As a new internal fixation device for intertrochanteric femur fractures, the proximal femoral biodegradable nail (PFBN) addresses the issue of nail back-out and offers more stable fracture fixation, a shorter lever arm, and stress distribution compared to PFNA and InterTan. Clinical studies have shown that compared to PFNA, PFBNs lead to faster recovery of hip joint function, shorter non-weight-bearing time, and faster fracture healing. This article provides a literature review of the structural characteristics, biomechanical analysis, and clinical studies of PFBNs, aiming to provide a theoretical basis for the selection of internal fixation devices for the treatment of intertrochanteric femur fractures in elderly patients and to improve the quality of life of patients during the postoperative period.
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Affiliation(s)
- Wenyu Duan
- Baotou Medical College, Baotou, China
- Department of Traumatic, Surgery, The First Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Hao Liang
- Baotou Medical College, Baotou, China
- Department of Traumatic, Surgery, The First Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Xiaolong Fan
- Department of Traumatic, Surgery, The First Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Dongming Zhou
- Department of Traumatic, Surgery, The First Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Yulu Wang
- Department of Traumatic, Surgery, The First Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Haidong Zhang
- Department of Traumatic, Surgery, The First Affiliated Hospital of Baotou Medical College, Baotou, China
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Ding K, Zhu Y, Zhang Y, Li Y, Wang H, Li J, Chen W, Zhang Q, Zhang Y. Proximal femoral bionic nail-a novel internal fixation system for the treatment of femoral neck fractures: a finite element analysis. Front Bioeng Biotechnol 2023; 11:1297507. [PMID: 38116197 PMCID: PMC10728673 DOI: 10.3389/fbioe.2023.1297507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction: Currently, cannulated screws (CSs) and dynamic hip screws (DHSs) are widely used for the treatment of femoral neck fractures, but the postoperative complications associated with these internal fixations remain high. In response to this challenge, our team proposes a new approach involving triangular-supported fixation and the development of the proximal femoral bionic nail (PFBN). The primary objective of this study is to investigate the biomechanical differences among CSs, DHSs, and the PFBN in their capacity to stabilize femoral neck fractures. Methods: A normal proximal femur model was constructed according to the CT data of a normal healthy adult. A femoral neck fracture model was constructed and fixed with CSs, DHSs, and the PFBN to simulate the fracture fixation model. Abaqus 6.14 software was used to compare the biomechanical characters of the three fracture fixation models. Results: The maximum stresses and displacements of the normal proximal femur were 45.35 MPa and 2.83 mm, respectively. Under axial loading, the PFBN was more effective than DHSs and CSs in improving the stress concentration of the internal fixation and reducing the peak values of von Mises stress, maximum principal stress, and minimum principal stress. The PFBN fixation model exhibits superior overall and fracture section stability in comparison to both the DHS fixation model and the CS fixation model under axial loading. Notably, the maximum stress and peak displacement of the PFBN and bone were lower than those of the DHS and CS fixation models under bending and torsional loading. Conclusion: The PFBN shows considerable improvement in reducing stress concentration, propagating stress, and enhancing the overall stability in the femoral neck fracture fixation model compared to DHSs and CSs. These enhancements more closely correspond to the tissue structure and biomechanical characteristics of the proximal femur, demonstrating that the PFBN has great potential for therapeutic purposes in treating femoral neck fractures.
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Affiliation(s)
- Kai Ding
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
| | - Yanbin Zhu
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
| | - Yifan Zhang
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
| | - Yonglong Li
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
| | - Haicheng Wang
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
| | - Jiaxing Li
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
| | - Wei Chen
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
| | - Qi Zhang
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
| | - Yingze Zhang
- Hebei Orthopaedic Clinical Research Center, Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
- NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei Medical University Third Hospital, Shijiazhuang, China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, China
- Chinese Academy of Engineering, Bejing, China
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Ding K, Zhu Y, Li J, Yuwen P, Yang W, Zhang Y, Wang H, Ren C, Chen W, Zhang Q, Zhang Y. Age-related Changes with the Trabecular Bone of Ward's Triangle and Neck-shaft Angle in the Proximal Femur: A Radiographic Study. Orthop Surg 2023; 15:3279-3287. [PMID: 37853985 PMCID: PMC10694024 DOI: 10.1111/os.13923] [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: 03/10/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE The Ward triangle is an important area used clinically to diagnose and assess osteoporosis and its fracture risk in the proximal femur. The main objective of this study was to investigate the rules of development and maturation of the trabeculae of Ward's triangle to provide a basis for the prevention and treatment proximal femur fracture. METHODS From January 2018 to December 2019, individuals from 4 months to 19 years old who underwent hip growth and development assessments at the Third Hospital of Hebei Medical University were selected retrospectively. The outpatient electronic medical record system was used to collect information such as age, gender, imaging images, and clinical diagnosis. The development score and maturity characteristics of the trabecular bone were analyzed using hip radiograph data. Correlation analysis was performed to identify the relationship among age, neck-shaft angle and development and maturity score of the trabecular bone. RESULTS A total of 941 patients were enrolled in this study, including 539 males and 402 females. Primary compression trabeculae were all present at 1 year of age and matured at 7 years of age and older; primary tension trabeculae were all present at 4 years of age and matured at 18 years of age. Secondary compression trabeculae were present at 4 years of age and matured at 18 years of age. In addition, the neck-shaft angle progressively decreases from 4 months to 14 years of age but barely changes between 15 and 19 years of age. CONCLUSION In short, the development and maturation of the trabeculae in the ward' triangle followed a specific temporal pattern that was related to the neck-shaft angle. Therefore, these findings can help us understand structure and mechanical characteristics of proximal femoral trabeculae, and improve our understanding of the mechanism and treatment of proximal femoral fractures.
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Affiliation(s)
- Kai Ding
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Jiaxing Li
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Peizhi Yuwen
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Weijie Yang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Yifan Zhang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Haicheng Wang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Chuan Ren
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Wei Chen
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Qi Zhang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
- Chinese Academy of EngineeringBingjiaokou HutongBejingChina
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