Femoral neck system and cannulated compression screws in the treatment of non-anatomical reduction Pauwels type-III femoral neck fractures: A finite element analysis

Zhong, Zhang; Lan, Xi; Xiang, Zhou; Duan, Xin

doi:10.1016/j.clinbiomech.2023.106060

Cited by 5 publications

(2 citation statements)

References 39 publications

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“…Transcervical shear fractures (AO Classification 31B2.3, so-called Pauwels type III femoral neck fractures) are more debated, and a large number of studies have been published in this regard in recent years [7,8,[12][13][14][15][16][17][18][19]. However, almost all research about transcervical shear fractures concerns stability after osteosynthesis.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and Treatment Strategies for Basicervical and Transcervical Shear Fractures of the Femoral Neck

Kijima,

Yamada,

Kawano

et al. 2023

JCM

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This study aimed to define basicervical and transcervical shear fractures using area classification and to determine the optimal osteosynthesis implants for them. The clinical outcomes of 1042 proximal femur fractures were investigated. A model of the proximal femur of a healthy adult was created from computed tomography images, and basicervical and transcervical shear fractures were established in the model. Osteosynthesis models were created using a short femoral nail with a single lag screw or two lag screws and a long femoral nail with a single lag screw or two lag screws. The minimum principal strains of the fracture surfaces were compared when the maximum loads during walking were applied to these models using finite element analysis software. Basicervical fractures accounted for 0.96% of all proximal femur fractures, 67% of which were treated with osteosynthesis; the failure rate was 0%. Transcervical shear fractures accounted for 9.6% of all proximal femur fractures, 24% of which were treated with osteosynthesis; the failure rate was 13%. Finite element analysis showed that transcervical shear fracture has high instability. To perform osteosynthesis, multiple screw insertions into the femoral head and careful postoperative management are required; joint replacement should be considered to achieve early mobility.

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Section: Introductionmentioning

confidence: 99%

Characteristics and Treatment Strategies for Basicervical and Transcervical Shear Fractures of the Femoral Neck

Kijima,

Yamada,

Kawano

et al. 2023

JCM

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“…[19,20] Despite the minimal surgical trauma and its prevalent application in an inverted triangle con guration for internal xation, critical analyses of postoperative outcomes have illuminated a conspicuously elevated rate of reoperation, alongside instances of varying degrees of femoral neck shortening post-surgery, culminating in a substantive diminution of hip functionality. [21][22][23] Emerging from contemporary orthopedic clinical practice, the Femoral Neck System (FNS), with its inherent robust stability, commendable resistance to rotational and shear forces, and minimal propensity for displacement, has astutely permeated clinical orthopedics, offering a new therapeutic avenue for femoral neck fractures. The academic and clinical communities are currently exploring FNS utility in the treatment of Pauwels type III fractures, inviting rigorous study and analysis.…”

Section: Introductionmentioning

confidence: 99%

Femoral neck system interferes less with the gluteus medius muscle than cannulated compression screws in patients with Pauwels' type III femoral neck fracture: a retrospective study of 103 cases

zhao,

Wu,

Zhou

et al. 2023

Preprint

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Background The femoral neck system (FNS) shows promise as an effective alternative for treating femoral neck fractures, particularly Pauwels type III fractures. However, limited literature exists on comparative studies investigating the effects of FNS versus cannulated compression screws (CCS) on the gluteus medius (GM) muscle. This study aims to compare the impact of FNS and CCS interventions on the GM in Pauwels type III femoral neck fracture treatment. Methods This study included 103 patients diagnosed with Pauwels type III femoral neck fractures, treated between January 2019 and September 2021. Among them, 54 patients underwent FNS treatment (FNS group), while 49 patients received CCS fixation (CCS group). Changes in GM area were assessed through ultrasound at 3 and 6 months postoperatively, and hip function was assessed by Harris hip score. Results At 3-, and 6-months post-surgery, the GM area was notably reduced on the operated side in the CCS group compared to the healthy side (p < 0.0001), while no significant disparity was observed in the FNS group (p = 0.402 at 3 months, p = 0.989 at 6 months). The Harris hip score, reflecting postoperative recovery, was significantly superior in the FNS group compared to the CCS group both in March (84.5 ± 3.9 vs. 82.7 ± 4.4, P = 0.029) and June (91.4 ± 4.4 vs. 89.7 ± 4.0, P = 0.037). Conclusion FNS internal fixation for Pauwels type III femoral neck fractures minimally impacts the GM compared to compression screws, suggesting its potential to improve hip function, facilitate gait, and enhance overall hip joint rehabilitation.

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Biomechanical Evaluation of Femoral Neck Fracture Fixation Based on Finite Element Analysis

Rao,

Mittal,

Kabra

et al. 2024

Preprint

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Pauwels type III fracture, wherein the fracture plane makes an angle of 50°-70° with the transverse plane, is the most unstable femoral neck fracture. Although there are various types of internal fixation devices, including Cannulated cancellous screws (CCS), dynamic hip screw (DHS), dynamic hip screw along with anti-rotation screws (DHS+ARS), and a newly introduced femoral neck system (FNS), patients with Pauwels type III fracture often experience implant failure. There was no study investigating the performance of these internal fixators under physiological musculoskeletal loading. The objective of the present study was to compare the biomechanical performance of CCS, DHS, DHS+ARS and FNS under daily physiological activities like normal walking and stair climbing. The unstable Pauwels type III fracture was virtually induced in a composite femur bone model and was fixed with all four internal fixators. Second-order tetrahedral elements were used to develop the FE models. The stresses, strains, and deformations of intact and reconstructed femur and implant components were compared to understand the biomechanical efficacy. FNS showed the highest inferior axial displacement of the femoral head while DHS+ARS exhibited the least inferior axial displacement. Among the four fracture fixation systems, DHS+ARS offered the highest post-fixation stability in terms of fracture gap opening (normal walking: 0.82mm and stair climbing: 0.95mm) and contact sliding, while the performance of single hole locking plated FNS was the worst (normal walking: 2.65mm, stair climbing: 3.72mm). Based on this computational study, DHS+ARS seems to be a better performing system in Pauwels type III fracture fixation.

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Femoral neck system and cannulated compression screws in the treatment of non-anatomical reduction Pauwels type-III femoral neck fractures: A finite element analysis

Cited by 5 publications

References 39 publications

Characteristics and Treatment Strategies for Basicervical and Transcervical Shear Fractures of the Femoral Neck

Characteristics and Treatment Strategies for Basicervical and Transcervical Shear Fractures of the Femoral Neck

Femoral neck system interferes less with the gluteus medius muscle than cannulated compression screws in patients with Pauwels' type III femoral neck fracture: a retrospective study of 103 cases

Biomechanical Evaluation of Femoral Neck Fracture Fixation Based on Finite Element Analysis

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