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


      • 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.


      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.


      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.


      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.


      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.


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