Impaction Bone Grafting and Valgus Osteotomy: A Technical Trick for the Treatment of Femoral Neck Nonunions

Jayaramaraju, Dheenadhayalan; Valleri, Durga Prasad; Devendra, Agraharam; Rajasekaran, Shanmuganathan

doi:10.1097/bot.0000000000001564

Cited by 3 publications

(1 citation statement)

References 28 publications

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“…The technique of Gotfried reduction is to stabilize unstable sub-cephalic fractures [ 29 ]. In our study, Pauwels type I and type II femoral neck fractures were adopted as the fracture mode.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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Role of impaction bone grafting of allografts in the management of benign lesions of the proximal femur

Rajasekaran

Jayaramaraju

Palanisami

et al. 2022

Journal of Orthopaedics

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A quantitative biomechanical study of positive buttress techniques for femoral neck fractures

Wang

Tang

et al. 2019

Chinese Medical Journal

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Background:Refractory femoral neck fractures cannot be anatomically reduced by closed traction reduction which may affect fracture healing. We evaluated the biomechanical effects of positive, negative, and anatomic reduction of various degrees of displacement in Pauwels I femoral neck fractures by a finite element analysis.Methods:Five reduction models of Pauwels type I femoral neck fracture were established using the Mimics 17.0 (Materialize, Leuven, Belgia) and Hypermesh 12.0 (Altair Engineering, Troy, MI, USA). According to the degree of fracture displacement, there were three models of positive support, an anatomic reduction model, and a negative 2 mm reduction model. Finite element analysis was conducted using the ABAQUS 6.9 software (Simulia, Suresnes, France). The von Mises stress distribution and the stress peak of internal fixation in different models, the displacement between fracture blocks, and the principal strain of the femoral neck cancellous bone model were recorded under the axial stress of 2100 N.Results:The peak von Mises stress on screw of each model was located at the thread of the screw tip. The peak von Mises stress was the lowest at the tip of the anatomic reduction model screw (261.2 MPa). In the positive 4 mm model, the von Mises stress peak was the highest (916.1 MPa). The anatomic reduction model showed the minimum displacement (0.388 mm) between fracture blocks. The maximum displacement was noted in the positive 4 mm model (0.838 mm). The displacement in the positive 3 mm model (0.721 mm) was smaller than that in the negative 2 mm model (0.786 mm). Among the five models, the strain area of the femoral neck cancellous bone was mainly concentrated around the screw hole, and the area around the screw hole could be easily cut.Conclusions:Compared with negative buttress for femoral neck fracture, positive buttress can provide better biomechanical stability. In Pauwel type I fracture of femoral neck, the range of positive buttress should be controlled below 3 mm as far as possible.

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Impaction Bone Grafting and Valgus Osteotomy: A Technical Trick for the Treatment of Femoral Neck Nonunions

Cited by 3 publications

References 28 publications

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

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

Role of impaction bone grafting of allografts in the management of benign lesions of the proximal femur

A quantitative biomechanical study of positive buttress techniques for femoral neck fractures

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