Biomechanical analysis of the computer-assisted internal fixation of a femoral neck fracture

Lu, Hui Hui; Shen, Hongquan; Zhou, Shuqing; Ni, Weidong; Jiang, Dianming

doi:10.1016/j.gendis.2019.04.006

Cited by 12 publications

(5 citation statements)

References 19 publications

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“…This study showed that the fracture end displacement of the positive buttress group was smaller than that of the negative buttress group under the same load, that is, the stability was better. In addition, the object will produce a certain deformation under the action of external force, and the degree of deformation is called strain [ 31 ]. The mean stress of the calcar was greater in the negative group than in the positive group, showed that positive reduction or anatomical reduction can well restore normal stress conduction in the hip joint.…”

Section: Discussionmentioning

confidence: 99%

Clinical observation and finite element analysis of cannulated screw internal fixation in the treatment of femoral neck fracture based on different reduction quality

Zhao

Liu

et al. 2021

J Orthop Surg Res

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Objective Femoral neck fracture is one of the most common bone types. The effect of reduction quality on hip joint function and complications after screw internal fixation is not fully understood. To investigate the clinical efficacy and mechanical mechanism of positive buttress, anatomical reduction, and negative buttress in the treatment of femoral neck fracture after cannulated screw fixation. Methods Retrospective analysis of patients with femoral neck fracture treated with three cannulated screws internal fixation in our hospital from January 2013 to December 2018. According to the quality of fracture reduction, the patients were divided into positive buttress group, anatomical reduction group, and negative buttress group. Basic information such as injury mechanism, time from injury to surgery, Garden classification and Pauwels classification was collected, Harris scores were performed at 3 months, 6 months, and 12 months after surgery, and postoperative complications (femoral head necrosis, femoral neck shortening, and femoral neck nonunion) were collected. At the same time, three groups of finite element models with different reduction quality were established for stress analysis, their stress clouds were observed and the average displacement and stress of the three groups of models were compared. P < 0.05 was used to represent a statistically significant difference. Results A total of 225 cases of unilateral femoral neck fractures were included and followed up for an average of 4.12 ± 0.69 years. There was no significant difference in age, gender, side, injury mechanism, time from injury to surgery, BMI, Garden classification, Pauwels classification, and follow-up time among the three groups (P > 0.05). However, there was significant difference in Harris score at 6 and 12 months after operation among the three groups (P < 0.05), which was higher in the positive buttress group and anatomical reduction group than in the negative buttress group. In addition, the incidence of osteonecrosis of the femoral head in the negative buttress group (32.2%) was greater than that in the anatomical reduction group (13.4%) and the positive buttress group (5.4%) (P < 0.05). In addition, the incidence of femoral neck nonunion and femoral neck shortening in the negative buttress group was also higher than that in the anatomical reduction positive buttress group (P < 0.05). The finite element results showed that the stress and fracture end displacement in the negative buttress group were greater than those in the positive buttress group (P < 0.05). Conclusion Both positive buttress and anatomical reduction in the treatment of femoral neck fracture with cannulated screw internal fixation can obtain better clinical effect and lower postoperative complications. Positive brace support and anatomic reduction can limit the restoration of femoral stress conduction. Therefore, it is not necessary to pursue anatomical reduction too deliberately during surgery, while negative buttress reduction should be avoided.

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Section: Discussionmentioning

confidence: 99%

Clinical observation and finite element analysis of cannulated screw internal fixation in the treatment of femoral neck fracture based on different reduction quality

Zhao

Liu

et al. 2021

J Orthop Surg Res

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“…The stress in the horizontal group is more distributed in the screws than in the vertical group. DhCCS has reliable stability for the detection of femoral neck fractures [22]. In a study by Zhang et al [23], 24 artificial femur bones were analyzed as 3 groups.…”

Section: Resultsmentioning

confidence: 99%

“…DhCCS is recommended to treat femoral neck fractures. If the femoral neck is small, two horizontal fixations may be preferred [22]. In the study by Zhang et al showed that using one OCCS + two HCCS for the treatment of vertical femoral neck fractures outperformed using OCCS alone [23].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of cannulated screw fixation configurations in femoral neck fractures by biomechanical studies: A systematic review

Arikan¹,

Ayanoğlu²

2022

jbioni

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To investigate the cannulated screw fixation methods used in the treatment of femoral neck fractures with a systematic review. Methods: PubMed Central, Web of Science, OVID Medline, Embase, and Google Scholar databases were searched to identify relevant studies published until December 2021 with English language restriction. Studies were selected on the basis of the following inclusion criteria: biomechanical study of femoral neck fractures and the use of multiple screw fixation of the fracture. Results: A total of 10 studies were included in the systematic review. Five studies were conducted using cadavers and five studies using sawbones. Multiple cannulated screw fixation, fully threaded cannulated screw fixation, cannulated screw fixation perpendicular to the calcar, and fixation performed in a wider area have various advantages. During the mechanical tests, axial loading measuring device values, axial failure displacement, load to failure values, and axial loading values were measured for each operation. Conclusions: There are various surgical techniques and biomedical materials for the detection of femoral neck fractures. In addition, each cannulated screw treatment configuration has advantages and disadvantages. For this reason, the most appropriate treatment configuration should be selected, taking into account the experience of the surgeon and the fracture types.

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“…Femur computed tomography (CT) data were obtained from a 26-year-old male object using a Siemens 64-row CT scanner with a layer thickness of 0.7 mm were obtained. The CT image was stored in DICOM format and was outputted to the three-dimensional reconstruction medical software Mimics 21.0 (Materialise, Belgium) [ 17 ]. A three-dimensional model of the femur was built on the basis of the gray value of the tissue and segmentation of the region and then exported in stereolithography (STL) format.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical study of femoral neck system for young patients with nonanatomically reduced femoral neck fractures: a finite element

Zhirong

Chen

et al. 2023

BMC Musculoskelet Disord

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Background A consensus regarding the optimal approach for treating femoral neck fractures is lacking. We aimed to investigate the biomechanical outcomes of Femoral Neck System (FNS) internal fixation components in the treatment of nonanatomically reduced femoral neck fractures. Method We constructed two types of femoral neck fractures of the Pauwels classification with angles of 30° and 50°, and three models of anatomic reduction, positive buttress reduction and negative buttress reduction were constructed. Subgroups of 1 to 4 mm were divided according to the distance of displacement in the positive buttress reduction and negative buttress reduction models. The von Mises stress and displacements of the femur and FNS internal fixation components were measured for each fracture group under 2100-N axial loads. Results When the Pauwels angle was 30°, the positive 1-mm and 2-mm models had lower FNS stress than the negative buttress model. The positive 3- and 4-mm models showed FNS stress similar to that of the negative buttress model. But the four positive buttress models had similar stresses on the femur as the negative buttress model. When the Pauwels angle was 50°, the four positive buttress models had higher FNS stress than the negative buttress model. Three positive buttress models (2 mm, 3 and 4 mm) resulted in lower stress of the femur than the negative buttress model, though the 1-mm model did not. When the Pauwels angle was 30°, the positive buttress model had a lower displacement of the FNS than the negative buttress model and a similar displacement of the femur with the negative buttress model. When the Pauwels angle was 50°, the positive buttress model had a higher displacement of the FNS and femur than the negative buttress model. Our study also showed that the von Mises stress and displacement of the internal fixation and the femur increased as the fracture angle increased. Conclusion From the perspective of biomechanics, when the Pauwels angle was 30°, positive buttress was more stable to negative buttress. However, when the Pauwels angle was 50°, this advantage weakens. In our opinion, the clinical efficacy of FNS internal fixation with positive buttress may be related to the fracture angle, neck-shaft angle and alignment in the lateral view. This result needs verification in further clinical studies.

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Biomechanical analysis of the computer-assisted internal fixation of a femoral neck fracture

Cited by 12 publications

References 19 publications

Clinical observation and finite element analysis of cannulated screw internal fixation in the treatment of femoral neck fracture based on different reduction quality

Clinical observation and finite element analysis of cannulated screw internal fixation in the treatment of femoral neck fracture based on different reduction quality

Evaluation of cannulated screw fixation configurations in femoral neck fractures by biomechanical studies: A systematic review

Biomechanical study of femoral neck system for young patients with nonanatomically reduced femoral neck fractures: a finite element

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