Hybrid solution combining osteosynthesis and endoprosthesis for double column acetabular fractures in the elderly provide more stability with finite element model

Kocsis, András; Váradi, Károly; Szalai, Gábor; Kovács, Tamás; Bodzay, Tamás

doi:10.5606/ehc.2019.66592

Cited by 3 publications

(6 citation statements)

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“…The most frequently investigated fracture types in biomechanical tests as well as in FEA were an ACPHT fracture (biomechanical tests: 11; FEA: 3) [ 36 – 44 , 60 , 63 , 66 , 71 ], a posterior column/wall fracture (biomechanical tests: 9; FEA: 2) [ 52 – 59 , 62 , 67 ], and a transverse acetabular fracture (biomechanical tests: 7; FEA: 2) [ 28 – 34 , 70 ]. Other fracture types (associated both column fracture, T-shape fracture and isolated anterior column fracture) were less frequently studied in biomechanical analyses [ 35 , 45 – 51 , 61 , 64 , 65 , 68 – 70 ]. The numbers of investigated fracture types within the reported studies are demonstrated in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Most of the investigated plate systems had non-locking plate-screw connections, and only a minority of the studies evaluated a locking plate system. Furthermore, seven biomechanical analyses assessed the biomechanical properties of a THA either alone or in combination with other fixation methods [ 29 , 42 , 53 , 60 , 63 , 68 ]. THAs were mostly analyzed in studies dealing with posterior wall fractures, transverse fractures and ACPHT fractures.…”

Section: Resultsmentioning

confidence: 99%

“…Studies reporting a FEA of fixation methods for acetabular fractures mainly used a loading protocol with a double-limb stance (6 FEA) [ 64 – 69 ]. Some of the studies also evaluated additional loading forms, such as a loading in a sitting position [ 64 ], sit-to-stand loading with different angles of hip flexion [ 67 , 68 ], or loading that simulated stair climbing [ 68 ]. Aziz et al combined a biomechanical testing approach with a subsequent FEA.…”

Section: Resultsmentioning

confidence: 99%

“…Liu et al simulated various loading directions based on the loading directions observed by Bergman et al during different gait phases in vivo [ 71 , 76 ]. In an FEA, Kocsis et al applied a double-limb stance loading as well as a sit-to-stand and a climbing stairs loading in a FEA [ 68 ]. Furthermore, the hip joint forces differ during the various phases of the sit-to-stand movement, depending on the flexion angle of the hip [ 107 , 108 ].…”

Section: Discussionmentioning

confidence: 99%

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Biomechanical analysis of fixation methods in acetabular fractures: a systematic review of test setups

Hinz

Dehoust

Münch

et al. 2022

Eur J Trauma Emerg Surg

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Purpose Optimal anatomical reduction and stable fixation of acetabular fractures are important in avoiding secondary dislocation and osteoarthritis. Biomechanical studies of treatment options of acetabular fractures aim to evaluate the biomechanical properties of different fixation methods. As the setup of the biomechanical test can influence the experimental results, this review aimed to analyze the characteristics, comparability and clinical implications of studies on biomechanical test setups and finite element analyses in the fixation of acetabular fractures. Methods A systematic literature research was conducted according to the PRISMA guidelines, using the PubMed/MEDLINE and Web of Science databases. 44 studies conducting biomechanical analyses of fixation of acetabular fractures were identified, which met the predefined inclusion and exclusion criteria and which were published in English between 2000 and April 16, 2021. The studies were analyzed with respect to distinct parameters, including fracture type, material of pelvis model, investigated fixation construct, loading direction, loading protocol, maximum loading force, outcome parameter and measurement method. Results In summary, there was no standardized test setup within the studies on fixation constructs for acetabular fractures. It is therefore difficult to compare the studies directly, as they employ a variety of different test parameters. Furthermore, the clinical implications of the biomechanical studies should be scrutinized, since several test parameters were not based on observations of the human physiology. Conclusion The limited comparability and restricted clinical implications should be kept in mind when interpreting the results of biomechanical studies and when designing test setups to evaluate fixation methods for acetabular fractures.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Biomechanical analysis of fixation methods in acetabular fractures: a systematic review of test setups

Hinz

Dehoust

Münch

et al. 2022

Eur J Trauma Emerg Surg

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“…[14] Finite element modeling is a well-established method to the joint contact stresses. [15,16] In the present study, we aimed to investigate the relationship between the Böhler's angle and the stresses on the calcaneus and the subtalar joint compared to the healthy model. In our FEA, we examined any correlation between the Böhler's angle, calcaneal strength, and subtalar joint stress.…”

mentioning

confidence: 99%

The importance of Böhler’s angle in calcaneus geometry: A finite element model study

et al. 2021

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Objectives: Calcaneal fractures are the most common tarsal fractures following a foot-ankle trauma. The Böhler’s angle is an important measurable angle before, during, and after surgery. In this study, we aimed to investigate correlation between Böhler’s angle, calcaneal strength, and subtalar joint stress using a finite element analysis (FEA). Patients and methods: Between January 2016 and December 2016, computed tomography (CT) scans were used with MIMICS® software for FEA. The ankle and foot of a 23-year-old male person with a height of 180 cm and weighing 80 kg was modeled as reference. Raw coronal CT images were obtained in Digital Imaging and Communications in Medicine format with the resolution of 512X512 pixels and 0.3-mm slice intervals in 135 kV. The structures including tibia, fibula and 26 other bones (talus, calcaneus, cuboid, navicular, three cuneiforms, five metatarsals, and 14 components of phalanges), cartilage and ligamentous tissues were modeled to form ankle joint. After determining Böhler’s angle as 35 degrees for the reference model, a fracture line was created on calcaneus. Calcaneus was remodeled with the Böhler’s angle of 45, 40, 30, 25, 20, 10, and 0 degrees respectively. All models were transferred to ANSYS software for FEA and the loads on the lower extremities with normal posture were applied on models. Results: Analysis of all models based in the reference model revealed that maximum tension values on calcaneus increased, while the Böhler’s angle decreased, indicating a statistically significant difference. The decreased Böhler’s angle indicated statistically significantly higher maximum tension values (p=0.04). Action force in subtalar joint was evaluated by comparing with the forces in reference model. The increased Böhler’s angle was found to be associated with statistically significantly decreased amount of load on subtalar joint. The decreased Böhler’s angle was related to the statistically significantly increased amount of load on subtalar joint. Conclusion: Our study results suggest that decreased Böhler’s angle increases the possibility of subtalar arthrosis, although overcorrection of the Böhler’s angle seems not to increase the risk of subtalar arthrosis.

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Biomechanical evaluation of a healed acetabulum with internal fixators: finite element analysis

et al. 2023

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Background Treatment of complicated acetabular fracture with internal fixation usually has high risk of failure because of unbefitting fixation. However, evaluation of the biomechanical effect of internal fixation under physiological loading for fracture healing is still generally rarely performed. The purpose of this study is to analyze the biomechanical characteristics of a healed acetabulum with designed internal fixators under gait and to explore the biomechanical relationship between the healed bone and the internal fixator. Methods A patient-specific finite element model of whole pelvis with designed internal fixators was constructed based on the tomographic digital images, in which the spring element was used to simulate the main ligaments of the pelvis. And the finite element analysis under both the combination loading of different phases and the individual loading of each phase during the gait cycle was carried out. The displacement, von Mises stress, and strain energy of both the healed bone and the fixation were calculated to evaluate the biomechanical characteristics of the healed pelvis. Results Under the combination loading of gait, the maximum difference of displacement between the left hip bone with serious injury and the right hip bone with minor injury is 0.122 mm, and the maximum stress of the left and right hemi-pelvis is 115.5 MPa and 124.28 MPa, respectively. Moreover, the differences of average stress between the bone and internal fixators are in the range of 2.3–13.7 MPa. During the eight phases of gait, the stress distribution of the left and right hip bone is similar. Meanwhile, based on the acetabular three-column theory, the strain energy ratio of the central column is relatively large in stance phases, while the anterior column and posterior column of the acetabular three-column increase in swing phases. Conclusions The acetabular internal fixators designed by according to the anatomical feature of the acetabulum are integrated into the normal physiological stress conduction of the pelvis. The design and placement of the acetabular internal fixation conforming to the biomechanical characteristics of the bone is beneficial to the anatomical reduction and effective fixation of the fracture, especially for complex acetabular fracture.

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Hybrid solution combining osteosynthesis and endoprosthesis for double column acetabular fractures in the elderly provide more stability with finite element model

Cited by 3 publications

References 8 publications

Biomechanical analysis of fixation methods in acetabular fractures: a systematic review of test setups

Biomechanical analysis of fixation methods in acetabular fractures: a systematic review of test setups

The importance of Böhler’s angle in calcaneus geometry: A finite element model study

Biomechanical evaluation of a healed acetabulum with internal fixators: finite element analysis

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