Single-plane osteotomy model is inaccurate for evaluating the optimal strategy in treating vertical femoral neck fractures: A finite element analysis

Zhan, Shi; Jiang, Dajun; Hu, Qingxiang; Wang, Miao; Feng, Chenglong; Jia, Weitao; Hu, Hai; Niu, Wenxin

doi:10.1016/j.cmpb.2024.108036

Cited by 9 publications

(4 citation statements)

References 28 publications

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“…The analysis was also limited to CMNs equipped with a single lag screw, omitting the potential insights from configurations using double lag screws [ 13 ]. Additionally, the fracture simulation in this FE model is simplified by creating single-plane osteotomy on a single femur, which may not reflect the actual occurrence of bone fracture which may be multiplanar fracture configurations [ 28 ] and could fail to reflect anatomical variations across the population. Lastly, the model simplified bone composition to only cortical and cancellous types, neglecting the heterogeneity seen in pathological conditions such as osteoporosis, where bone properties are significantly altered.…”

Section: Discussionmentioning

confidence: 99%

Torsional stability of fixation methods in basicervical femoral neck fractures: a biomechanical study

Mahaisavariya,

Jitprapaikulsarn,

Mahaisavariya

et al. 2024

J Orthop Surg Res

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Background Basicervical femoral neck fracture is a rare proximal femur fracture with a high implant failure rate. Biomechanical comparisons between cephalomedullary nails (CMNs) and dynamic hip screws (DHSs) under torsion loading are lacking. This study compared the biomechanical performance of three fixations for basicervical femoral neck fractures under torsion load during early ambulation. Methods The biomechanical study models used three fixations: a DHS, a DHS with an anti-rotation screw, and a short CMN. Finite element analysis was used to simulate hip rotation with muscle forces related to leg swing applied to the femur. The equivalent von Mises stress (EQV) on fixation, fragment displacement, and strain energy density at the proximal cancellous bone were monitored for fixation stability. Results The EQV of the short CMN construct (304.63 MPa) was comparable to that of the titanium DHS construct (293.39 MPa) and greater than that of the titanium DHS with an anti-rotation screw construct (200.94 MPa). The proximal fragment displacement in the short CMN construct was approximately 0.13 mm, the greatest among the constructs. The risk of screw cutout for the lag screw in short CMNs was 3.1–5.8 times greater than that for DHSs and DHSs with anti-rotation screw constructs. Conclusions Titanium DHS combined with an anti-rotation screw provided lower fragment displacement, stress, and strain energy density in the femoral head than the other fixations under torsion load. Basicervical femoral neck fracture treated with CMNs may increase the risk of lag screw cutout. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Torsional stability of fixation methods in basicervical femoral neck fractures: a biomechanical study

Mahaisavariya,

Jitprapaikulsarn,

Mahaisavariya

et al. 2024

J Orthop Surg Res

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“…Secondly, in this finite element study, the utilization of 75% of normal bone density to simulate osteoporotic patients differed from real-world conditions. Thirdly, the single-plane osteotomy model might have limitations, thus rendering natural fracture models a potentially superior choice ( Zhan et al, 2024 ). Lastly, despite the superior biomechanical stability of PFBN compared to conventional CMNs, randomized controlled studies are still needed to validate its clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The VMS and displacement of the implant models were calculated to evaluate the biomechanical stability. The stability of the proximal fracture fragment was assessed through VMS of the proximal femur and contact pressure on the fracture surface ( Cheng et al, 2023 ; Zhan et al, 2024 ).…”

Section: Methodsmentioning

confidence: 99%

Comparative study of a novel proximal femoral bionic nail and three conventional cephalomedullary nails for reverse obliquity intertrochanteric fractures: a finite element analysis

Yang,

Tong,

Cheng

et al. 2024

Front. Bioeng. Biotechnol.

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PurposeConventional cephalomedullary nails (CMNs) are commonly employed for internal fixation in the treatment of reverse obliquity intertrochanteric (ROI) fractures. However, the limited effectiveness of conventional CMNs in addressing ROI fractures results in significant implant-related complications. To address challenges associated with internal fixation, a novel Proximal Femoral Bionic Nail (PFBN) has been developed.MethodsIn this study, a finite element model was constructed using a normal femoral specimen, and biomechanical verification was conducted using the GOM non-contact optical strain measurement system. Four intramedullary fixation approaches—PFBN, Proximal Femoral Nail Antirotation InterTan nail (ITN), and Gamma nail (Gamma nail)—were employed to address three variations of ROI fractures (AO/OTA 31-A3). The biomechanical stability of the implant models was evaluated through the calculation of the von Mises stress contact pressure and displacement.ResultsCompared to conventional CMNs, the PFBN group demonstrated a 9.36%–59.32% reduction in the maximum VMS at the implant. The A3.3 ROI fracture (75% bone density) was the most unstable type of fracture. In comparison to conventional CMNs, PFBN demonstrated more stable data, including VMS values (implant: 506.33 MPa, proximal fracture fragment: 34.41 MPa), contact pressure (13.28 MPa), and displacement (17.59 mm).ConclusionCompared to the PFNA, ITN, and GN, the PFBN exhibits improvements in stress concentration, stress conduction, and overall model stability in ROI fractures. The double triangle structure aligns better with the tissue structure and biomechanical properties of the proximal femur. Consequently, the PFBN has significant potential as a new fixation strategy for the clinical treatment of ROI fractures.

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“…The use of a single subject limits the ability to capture variations in foot biomechanics across different individuals ( Wong et al, 2021 ). Follow-up studies should consider multiple human sample models for study ( Zhan et al, 2024 ). Secondly, while this study examined internal effects through intra-test differences, it did not assess external effects, which may limit the generalizability of the research conclusions ( Chen et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Effect of forefoot transverse arch stiffness on foot biomechanical response--based on finite element method

Zhang,

Zhong

et al. 2024

Front. Bioeng. Biotechnol.

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BackgroundThe plantar vault, comprising the transverse and longitudinal arches of the human foot, is essential for impact absorption, elastic energy storage, and propulsion. Recent research underscores the importance of the transverse arch, contributing over 40% to midfoot stiffness. This study aimed to quantify biomechanical responses in the ankle-foot complex by varying the stiffness of the deep metatarsal transverse ligament (DTML).MethodsUsing CT image reconstruction, we constructed a complex three-dimensional finite element model of the foot and ankle joint complex, accounting for geometric complexity and nonlinear characteristics. The focus of our study was to evaluate the effect of different forefoot transverse arch stiffness, that is, different Young’s modulus values of DTML (from 135 MPa to 405 MPa), on different biomechanical aspects of the foot and ankle complex. Notably, we analyzed their effects on plantar pressure distribution, metatarsal stress patterns, navicular subsidence, and plantar fascial strain.ResultsIncreasing the stiffness of the DTML has significant effects on foot biomechanics. Specifically, higher DTML stiffness leads to elevate von Mises stress in the 1st, 2nd, and 3rd metatarsals, while concurrently reducing plantar pressure by 14.2% when the Young’s modulus is doubled. This stiffening also impedes navicular bone subsidence and foot lengthening. Notably, a 100% increase in the Young’s modulus of DTML results in a 54.1% decrease in scaphoid subsidence and a 2.5% decrease in foot lengthening, which collectively contribute to a 33.1% enhancement in foot longitudinal stiffness. Additionally, doubling the Young’s modulus of DTML can reduce the strain stretch of the plantar fascia by 38.5%.ConclusionPreserving DTML integrity sustains the transverse arch, enhancing foot longitudinal stiffness and elastic responsiveness. These findings have implications for treating arch dysfunction and provide insights for shoe developers seeking to enhance propulsion.

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Single-plane osteotomy model is inaccurate for evaluating the optimal strategy in treating vertical femoral neck fractures: A finite element analysis

Cited by 9 publications

References 28 publications

Torsional stability of fixation methods in basicervical femoral neck fractures: a biomechanical study

Torsional stability of fixation methods in basicervical femoral neck fractures: a biomechanical study

Comparative study of a novel proximal femoral bionic nail and three conventional cephalomedullary nails for reverse obliquity intertrochanteric fractures: a finite element analysis

Effect of forefoot transverse arch stiffness on foot biomechanical response--based on finite element method

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