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Biomechanical evaluation of compression buttress screw and medial plate fixation for the treatment of vertical femoral neck fractures

  • Author Footnotes
    # These authors contributed equally to this work.
    Zhi-Yuan Fan
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
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  • Author Footnotes
    # These authors contributed equally to this work.
    Lin-Yuan Shu
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Department of Emergency Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
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  • Author Footnotes
    # These authors contributed equally to this work.
    Ying-Zhe Jin
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
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  • Matthew C. Sherrier
    Affiliations
    Department of Orthopaedic and Physical Medicine, Medical University of South Carolina, Charleston, SC, 29425, United States of America
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  • Bo-Hao Yin
    Affiliations
    Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
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  • Chen-Jun Liu
    Affiliations
    Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
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  • Shi Zhan
    Affiliations
    Orthopaedic Biomechanical Laboratory, Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
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  • Hui Sun
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
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  • Wei Zhang
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai 200233, China
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  • Author Footnotes
    # These authors contributed equally to this work.
Published:September 28, 2022DOI:https://doi.org/10.1016/j.injury.2022.09.056

      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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