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Biomechanical evaluation of different internal fixation methods based on finite element analysis for Pauwels type III femoral neck fracture

      Highlights

      • Taking DHS as the core, our study explored the internal fixation method of DHS + BS for the first time, added FNS and CSS, and compared the biomechanical properties of six internal fixation methods for the treatment of Pauwels type III femoral neck fracture: CSS, DHS, DHS + SS, DHS + BS, DHS + MBP and FNS.
      • DHS combined with anti rotation screw or medial buttress plate can effectively enhance the fixation stability, and the fixation enhancement effect of medial buttress plate on DHS is better than that of single anti rotation screw.
      • The biomechanical properties of FNS and DHS + SS are very close, indicating that FNS can be used as a new choice for the treatment of femoral neck fracture.
      • Comprehensive analysis shows that DHS + BS has better biomechanical properties than the other five methods.

      Abstract

      Background and objective

      The best internal fixation method for the treatment of Pauwels type III femoral neck fractures (FNFs) remains to be demonstrated. Through finite element analysis, this study explored whether dynamic hip screw (DHS) combined with anti rotation screw or medial buttress plate can improve the stability of internal fixation, and the femoral neck system (FNS) with similar structure to DHS and the traditional cannulated screw (CSs) were added for comparison. To evaluate their respective biomechanical advantages and disadvantages in the treatment of Pauwels type III FNFs.

      Methods

      Six groups of internal fixation models for the treatment of FNFs were established, including CSs, DHS, DHS combined with single anti-rotation screw (DHS + SS), and DHS combined with both anti-rotation screw (DHS + BS), DHS combined with medial buttress plate (DHS + MBP), new femoral neck internal fixation system (Femoral Neck System, FNS). Four finite element analysis models were established for each group, evaluation of femoral displacement and internal fixation stress during stair climbing and walking conditions, and the contact force of the hip joint was used in two cases, dynamic and static.

      Results

      The fracture plane motion and peak stress of internal fixators were the lowest with DHS + BS and CSs fixation, and the two results are very close, The peak value of DHS combined with anti rotation screw or medial buttress plate is much lower than that of DHS, indicating that the fixation effect of the combined model is enhanced, and there is no significant difference between FNS and DHS + SS.

      Conclusion

      Both the anti rotation screw and medial buttress plate can effectively reduce the movement of fracture section and share the shear force of DHS, FNS has the similar fixation stability to DHS + SS, DHS + BS has the biomechanical advantages of significantly reducing the risk of internal fixation failure and femoral yield. Therefore, the use of DHS + BS may be a more favorable choice in the case of Pauwels type III FNFs with higher fixation requirements.

      Keywords

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      References

        • Johnell O.
        • Kanis J.A.
        An estimate of the worldwide prevalence and disability associated with osteoporotic fractures.
        Osteoporosis Int. 2006; 17: 1726-1733https://doi.org/10.1007/s00198-006-0172-4
        • Johnell O.
        • Kanis J.A.
        An estimate of the worldwide prevalence, mortality and disability associated with hip fracture.
        Osteoporosis Int. 2004; 15: 897-902https://doi.org/10.1007/s00198-004-1627-0
        • Abrahamsen B.
        • van Staa T.
        • Ariely R.
        • Olson M.
        • Cooper C.
        Excess mortality following hip fracture: a systematic epidemiological review.
        Osteoporosis Int. 2009; 20: 1633-1650https://doi.org/10.1007/s00198-009-0920-3
        • Gullberg B.
        • Johnell O.
        • Kanis J.A.
        World-wide projections for hip fracture.
        Osteoporosis Int. 1997; 7: 407-413https://doi.org/10.1007/PL00004148
        • Bartonicek J.
        Pauwels' classification of femoral neck fractures: correct interpretation of the original.
        J Orthop Trauma. 2001; 15: 358-360https://doi.org/10.1097/00005131-200106000-00009
        • Slobogean G.P.
        • Sprague S.A.
        • Scott T.
        • Bhandari M.
        Complications following young femoral neck fractures.
        Injury. 2015; 46: 484-491https://doi.org/10.1016/j.injury.2014.10.010
        • Marsh J.L.
        • Slongo T.F.
        • Agel J.
        • Broderick J.S.
        • Creevey W.
        • Decoster T.A.
        • Prokuski L.
        • Sirkin M.S.
        • Ziran B.
        • Henley B.
        • et al.
        Fracture and dislocation classification compendium-2007 - Orthopaedic Trauma Association classification, database and outcomes committee.
        J Orthop Trauma. 2007; 21S: S1-S133https://doi.org/10.1097/00005131-200711101-00001
        • Liporace F.
        • Gaines R.
        • Collinge C.
        • Haidukewych G.J.
        Results of internal fixation of Pauwels type-3 vertical femoral neck fractures.
        J Bone Joint Surg Am. 2008; 90A: 1654-1659https://doi.org/10.2106/JBJS.G.01353
        • Wang G.
        • Tang Y.
        • Wu X.
        • Yang H.
        Finite element analysis of a new plate for Pauwels type III femoral neck fractures.
        J Int Med Res. 2020; 481410560510https://doi.org/10.1177/0300060520903669
        • Li J.
        • Zhao Z.
        • Yin P.
        • Zhang L.
        • Tang P.
        Comparison of three different internal fixation implants in treatment of femoral neck fracture-a finite element analysis.
        J Orthop Surg Res. 2019; 14https://doi.org/10.1186/s13018-019-1148-3
        • Samsami S.
        • Saberi S.
        • Sadighi S.
        • Rouhi G.
        Comparison of three fixation methods for femoral neck fracture in young adults: experimental and numerical investigations.
        J Med Biol Eng. 2015; 35: 566-579https://doi.org/10.1007/s40846-015-0085-9
        • Li J.
        • Yin P.
        • Zhang L.
        • Chen H.
        • Tang P.
        Medial anatomical buttress plate in treating displaced femoral neck fracture a finite element analysis.
        Injury. 2019; 50: 1895-1900https://doi.org/10.1016/j.injury.2019.08.024
        • Kemker B.
        • Magone K.
        • Owen J.
        • Atkinson P.
        • Martin S.
        • Atkinson T.
        A sliding hip screw augmented with 2 screws is biomechanically similar to an inverted triad of cannulated screws in repair of a Pauwels type-III fracture.
        Injury. 2017; 48: 1743-1748https://doi.org/10.1016/j.injury.2017.05.013
        • Stoffel K.
        • Zderic I.
        • Gras F.
        • Sommer C.
        • Eberli U.
        • Mueller D.
        • Oswald M.
        • Gueorguiev B.
        Biomechanical evaluation of the femoral neck system in unstable Pauwels III femoral neck fractures: a comparison with the dynamic hip screw and cannulated screws.
        J Orthop Trauma. 2017; 31: 131-137https://doi.org/10.1097/BOT.0000000000000739
        • Bhandari M.
        • Devereaux P.J.
        • Guyatt G.
        • Thabane L.
        • Walter S.D.
        • Heetveld M.J.
        • Jeray K.J.
        • Liew S.
        • Schemitsch E.H.
        • Tornetta P.I.
        • et al.
        Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial.
        Lancet. 2017; 389: 1519-1527https://doi.org/10.1016/S0140-6736(17)30066-1
        • Taheri N.S.
        • Blicblau A.S.
        • Singh M.
        Comparative study of two materials for dynamic hip screw during fall and gait loading: titanium alloy and stainless steel.
        J Orthop Sci. 2011; 16: 805-813https://doi.org/10.1007/s00776-011-0145-0
        • Sitthiseripratip K.
        • Van Oosterwyck H.
        • Vander Sloten J.
        • Mahaisavariya B.
        • Bohez E.
        • Suwanprateeb J.
        • Van Audekercke R.
        • Oris P.
        Finite element study of trochanteric gamma nail for trochanteric fracture.
        Med Eng Phys. 2003; 25: 99-106https://doi.org/10.1016/S1350-4533(02)00185-6
        • Chen W.P.
        • Tai C.L.
        • Shih C.H.
        • Hsieh P.H.
        • Leou M.C.
        • Lee M.S.
        Selection of fixation devices in proximal femur rotational osteotomy: clinical complications and finite element analysis.
        Clin Biomech. 2004; 19: 255-262https://doi.org/10.1016/j.clinbiomech.2003.12.003
        • Eberle S.
        • Gerber C.
        • von Oldenburg G.
        • Hungerer S.
        • Augat P.
        Type of hip fracture determines load share in intramedullary osteosynthesis.
        Clin Orthop Relat Res. 2009; 467: 1972-1980https://doi.org/10.1007/s11999-009-0800-3
        • Heller M.O.
        • Bergmann G.
        • Kassi J.P.
        • Claes L.
        • Haas N.P.
        • Duda G.N.
        Determination of muscle loading at the hip joint for use in pre-clinical testing.
        J Biomech. 2005; 38: 1155-1163https://doi.org/10.1016/j.jbiomech.2004.05.022
        • Chalernpon K.
        • Aroonjarattham P.
        • Aroonjarattham K.
        Static and dynamic load on hip contact of hip prosthesis and thai femoral bones.
        Int J Mech Mechatron Eng. 2015; 58: 251-255https://doi.org/10.5281/zenodo.1099670
        • Lu H.
        • Shen H.
        • Zhou S.
        • Ni W.
        • Jiang D.
        Biomechanical analysis of the computer-assisted internal fixation of a femoral neck fracture.
        Genes Dis. 2020; 7: 448-455https://doi.org/10.1016/j.gendis.2019.04.006
        • Panteli M.
        • Rodham P.
        • Giannoudis P.V.
        Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly.
        Injury. 2015; 46: 445-452https://doi.org/10.1016/j.injury.2014.12.031
        • Ma J.
        • Kuang M.
        • Xing F.
        • Zhao Y.
        • Chen H.
        • Zhang L.
        • Fan Z.
        • Han C.
        • Ma X.
        Sliding hip screw versus cannulated cancellous screws for fixation of femoral neck fracture in adults: a systematic review.
        Int J Surg. 2018; 52: 89-97https://doi.org/10.1016/j.ijsu.2018.01.050
        • Hoshino C.M.
        • Christian M.W.
        • O'Toole R.V.
        • Manson T.T.
        Fixation of displaced femoral neck fractures in young adults: fixed-angle devices or Pauwel screws?.
        Injury. 2016; 47: 1676-1684https://doi.org/10.1016/j.injury.2016.03.014
        • Zeng W.
        • Liu Y.
        • Hou X.
        Biomechanical evaluation of internal fixation implants for femoral neck fractures: a comparative finite element analysis.
        Comput Methods Programs Biomed. 2020; 196105714https://doi.org/10.1016/j.cmpb.2020.105714
        • Xia Y.
        • Zhang W.
        • Hu H.
        • Yan L.
        • Zhan S.
        • Wang J.
        Biomechanical study of two alternative methods for the treatment of vertical femoral neck fractures—A finite element analysis.
        Comput Methods Programs Biomed. 2021; 211106409https://doi.org/10.1016/j.cmpb.2021.106409
        • Enocson A.
        • Lapidus L.J.
        The vertical hip fracture-a treatment challenge. A cohort study with an up to 9 year follow-up of 137 consecutive hips treated with sliding hip screw and antirotation screw.
        BMC Musculoskelet Disord. 2012; 13https://doi.org/10.1186/1471-2474-13-171
        • Schopper C.
        • Zderic I.
        • Menze J.
        • Müller D.
        • Rocci M.
        • Knobe M.
        • Shoda E.
        • Richards G.
        • Gueorguiev B.
        • Stoffel K.
        Higher stability and more predictive fixation with the femoral neck system versus Hansson pins in femoral neck fractures Pauwels II.
        J Orthop Transl. 2020; 24: 88-95https://doi.org/10.1016/j.jot.2020.06.002
        • Kunapuli S.C.
        • Schramski M.J.
        • Lee A.S.
        • Popovich Jr., J.M.
        • Cholewicki J.
        • Reeves N.P.
        • Crichlow R.J.
        Biomechanical analysis of augmented plate fixation for the treatment of vertical shear femoral neck fractures.
        J Orthop Trauma. 2015; 29: 144-150https://doi.org/10.1097/BOT.0000000000000205
        • Yang J.
        • Lin L.
        • Chao K.
        • Chuang S.
        • Wu C.
        • Yeh T.
        • Lian Y.
        Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration.
        J Bone Joint Surg Am. 2013; 95A: 61-69https://doi.org/10.2106/JBJS.K.01081