Highlights
- •A novel fixation strategy, compression buttress screw (CBS) fixation, was proposed for femoral neck fractures. Two differently-designed screws (PTCS and FTHCS) combined to construct a regular triangle configuration play distinct roles in biomechanics. One PTCS in the proximal neck functions as a sliding implant to provide dynamic compression during surgery, while two FTHCSs in the distal neck play the role of asymptotical sliding and as an “interosseous buttress” in the medial quadrant of the femoral neck postoperatively.
- •Biomechanical testing revealed that the CBS fixation was comparable to the anteromedial plate fixation (AMP) and medial buttress plate fixation (MBP), and demonstrated superior biomechanical performance than medial buttress plate fixation without proximal screw (MBPw) to some extent.
- •Compared with the plate fixations, the CBS fixation could not only achieve similar biomechanical strength but also possesses the surgical advantages of pure screw fixation. Thus, it is advisable to promote the application of CBS fixation for vertical femoral neck fracture.
Abstract
Objective
To compare the biomechanical properties of compression buttress screw (CBS) fixation
with three plate fixation methods for the treatment of vertical femoral neck fractures
(FNFs).
Methods
A total of forty synthetic femoral models with simulated Pauwels type III fractures
(angle of 70°) were equally assigned to one of four fixation groups: CBS fixation,
anteromedial plate fixation (AMP), medial buttress plate fixation (MBP) and medial
buttress plate fixation without proximal screw (MBPw). Within each group, half of
the specimens were randomly assigned to two loading settings, an axial compression
loading test and a hip-flexion torsion test.
Results
There were no significant differences in axial load to failure, axial stiffness, torsional
strength, or torsional stiffness when comparing CBS with MBP (p>0.05). In the axial
compression loading test, both CBS and MBP showed higher load to failure and axial
stiffness than MBPw (p<0.05). In torsional testing, AMP exhibited superior torsional
strength and torsional stiffness than both MBPw and MBP (all p<0.05) and a higher
torsional strength than CBS fixation (p<0.05). There were no significant differences
in torsional stiffness between the CBS and AMP fixation groups (p>0.05).
Conclusion
The biomechanical parameters of CBS fixation are comparable to that of AMP and MBP,
and demonstrate superior axial stiffness than MBPw fixation. Although the CBS method
for surgical fixation of vertical FNF holds promise as a less invasive surgical technique
than plate fixation with similar biomechanical assessments, further clinical evaluation
is warranted.
Keywords
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References
- The societal costs of femoral neck fracture patients treated with internal fixation.Osteoporos Int. 2014; 25: 875-885
- Femoral neck fractures in young patients: state of the art.J Orthop Trauma. 2019; 33: S7-s11
- Novel treatment options for the surgical management of young femoral neck fractures.J Orthop Trauma. 2019; 33: S33-Ss7
- Treatment of young femoral neck fractures.J Orthop Trauma. 2019; 33: S1-S6
- Treatment of femoral neck fractures in young adults.J Bone Joint Surg Am. 2008; 90: 2254-2266
- Complications following young femoral neck fractures.Injury. 2015; 46: 484-491
- Management of acute hip fracture.N Engl J Med. 2017; 377: 2053-2062
- Preoperative decision making in the treatment of high-angle "vertical" femoral neck fractures in young adult patients. An expert opinion survey of the orthopaedic trauma association's (OTA) membership.J Orthop Trauma. 2014; 28: e221-e225
- Vertical femoral neck fractures in young adults: a closed fixation strategy using a transverse cancellous lag screw.Injury. 2017; 48: S10-Ss6
- Biplane double-supported screw fixation of femoral neck fractures: surgical technique and surgical notes.J Am Acad Orthop Surg. 2019; 27: e507-ee15
- Decreased complications but a distinctive fixation loosening mechanism of fully threaded headless cannulated screw fixation for femoral neck fractures in young adults.J Orthopaedic Surg Res. 2021; 16: 234
- Biomechanics of Femoral Neck Fractures and Implications for Fixation.J Orthop Trauma. 2019; 33: S27-s32
- Application of a medial buttress plate may prevent many treatment failures seen after fixation of vertical femoral neck fractures in young adults.Med Hypotheses. 2015; 84: 429-433
- Biomechanical analysis of augmented plate fixation for the treatment of vertical shear femoral neck fractures.J Orthop Trauma. 2015; 29: 144-150
- The role of the medial plate for Pauwels type III femoral neck fracture: a comparative mechanical study using two fixations with cannulated screws.J Experimental Orthop. 2019; 6: 18
- Medial anatomical buttress plate in treating displaced femoral neck fracture a finite element analysis.Injury. 2019; 50: 1895-1900
- Medial plating of Pauwels Type III femoral neck fractures decreases shear and angular displacement compared to derotational screw.J Orthop Trauma. 2020;
- Influence of the proximal screws of buttress plates on the stability of vertical femoral neck fractures: a finite element analysis.BMC Musculoskeletal Disorders. 2020; 21: 842
- Medial buttress plate augmentation of cannulated screw fixation in vertically unstable femoral neck fractures: Surgical technique and preliminary results.Injury. 2017; 48: 2189-2193
- Treatment of femoral neck nonunion with a new fixation construct through the Watson-Jones approach.J Orthop Translation. 2019; 19: 126-132
- Medial femoral plate with cannulated screw for Pauwels type III femoral neck fracture: a meta-analysis.Back Musculoskeletal Rehabilitation. 2020;
- Anteromedial femoral neck plate with cannulated screws for the treatment of irreducible displaced femoral neck fracture in young patients: a preliminary study.Eur J Trauma Emergency Surg. 2019; 45: 995-1002
- A new configuration of cannulated screw fixation in the treatment of vertical femoral neck fractures.Int Orthop. 2018; 42: 1949-1955
- Ordinary cannulated compression screws or headless cannulated compression screws? A synthetic bone biomechanical research in the internal fixation of vertical femoral neck fracture.Biomed Res Int. 2018; 20184898301
- Biomechanical evaluation of the modified cannulated screws fixation of unstable femoral neck fracture with comminuted posteromedial cortex.Biomed Res Int. 2019; 20192584151
- A model to evaluate Pauwels type III femoral neck fractures. Proceedings of the institution of mechanical engineers part H.J Eng Med. 2018; 954411917752972
- Femoral neck fracture fixation with a medial buttress plate that led to impingement with hip flexion: a case report.JBJS Case Connector. 2019; 9: e21
- Fixation effects of different types of cannulated screws on vertical femoral neck fracture: a finite element analysis and experimental study.Med Eng Phys. 2021; 97: 32-39
- Biomechanical comparison of five cannulated screw fixation strategies for young vertical femoral neck fractures.J Orthop Res. 2021; 39: 1669-1680
- Isaksson H. How accurately can subject-specific finite element models predict strains and strength of human femora? Investigation using full-field measurements.J Biomech. 2016; 49: 802-806
- Full-field strain measurement during mechanical testing of the human femur at physiologically relevant strain rates.J Biomech Eng. 2014; 136
- Rotationally stable screw-anchor versus sliding hip screw plate systems in stable trochanteric femur fractures: a biomechanical evaluation.J Orthop Trauma. 2013; 27: e127-e136
- Biomechanical femoral neck fracture experiments–a narrative review.Injury. 2012; 43: 1633-1639
- Torsion and bending analysis of internal fixation techniques for femoral neck fractures: the role of implant design and bone density.J Orthop Res. 1987; 5: 433-444
- Treatment of femoral neck fractures in young adults.Instr Course Lect. 2009; 58: 69-81
- Vascular anatomy of the medial femoral neck and implications for surface plate fixation.J Orthop Trauma. 2019; 33: 111-115
- Clinical and biomechanical effects of femoral neck buttress plate used for vertical femoral neck fractures.Injury. 2021;
- Treatment of femoral neck fractures: sliding hip screw or cannulated screws? A meta-analysis.J Orthopaedic Surg Res. 2021; 16: 54
- 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: 131-137
- Osteonecrosis of the femoral head, nonunion and potential risk factors in Pauwels grade-3 femoral neck fractures: a retrospective cohort study.Medicine. 2016; 95: e3706
- Fracture morphology of high shear angle "vertical" femoral neck fractures in young adult patients.J Orthop Trauma. 2014; 28: 270-275
- Posterior inferior comminution significantly influences torque to failure in vertically oriented femoral neck fractures: a biomechanical study.J Orthop Trauma. 2020;
- Perforated H-beam implant can be used in femoral neck fracture. Proceedings of the Institution of Mechanical Engineers Part H.J Eng Med. 2019; 233: 354-361
- A biomechanical comparison of composite femurs and cadaver femurs used in experiments on operated hip fractures.J Biomech. 2014; 47: 3898-3902
Article Info
Publication History
Published online: September 28, 2022
Accepted:
September 26,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
