Biomechanical evaluation of internal fixation implants for femoral neck fractures: A comparative finite element analysis.
Type
ArticleKAUST Department
Physical Science and Engineering (PSE) DivisionDate
2020-08-20Online Publication Date
2020-08-20Print Publication Date
2020-11Embargo End Date
2021-08-25Submitted Date
2020-06-17Permanent link to this record
http://hdl.handle.net/10754/664980
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BACKGROUND AND OBJECTIVE:It remains controversial regarding the optimal type of fixation implant for the treatment of femoral neck fractures (FNFs). Biomechanical rational for implant choices can benefit from the integration of finite element analysis (FEA) in device evaluation and design improvement. In this study, we aim to evaluate biomechanical performance of several internal fixation implants for Pauwels type III FNFs under physiological loading conditions using FEA, as well as to assess the biomechanical contribution of medial buttress plate (MBP) augmentation. METHODS:Several fixation styles for FNFs have been analyzed numerically by the finite element method. Five groups of models were developed with different FNFs fixation implants, including dynamic hip screw (DHS), cannulated screws (CSs), proximal femoral nail antirotation (PFNA), DHS with MBP augmentation (DHS+MBP), and CSs with MBP (CSs+MBP). For each group, four FE models were established to evaluate strain in bone and stress in devices during walking and stair climbing conditions, which simulated the hip contact force using static and dynamic loadings respectively. RESULTS:No notable differences were observed in peak strain within implanted bone and maximum stress values of the device between DHS and CSs. The implanted femur with PFNA was in a lower state of bone strain and implant stress. Although the buttress plate did not decrease peak bone strain, it alleviated stress concentration on device, especially for CSs under dynamic loadings. CONCLUSIONS:Compared to the other fixation styles, the PFNA showed biomechanical advantages of decreasing risk of implant failure and bone yielding. The MBP augmentation provided an additional load path to bridge fracture fragments, which reduced failure risk of DHS and CSs, especially during dynamic loading scenarios. Although further studies are needed for patients with other types of FNFs, our findings may provide valuable references for device design optimization in terms of complex physiological loadings, as well as for clinical decision making in surgical treatment of FNFs.Citation
Zeng, W., Liu, Y., & Hou, X. (2020). Biomechanical evaluation of internal fixation implants for femoral neck fractures: A comparative finite element analysis. Computer Methods and Programs in Biomedicine, 196, 105714. doi:10.1016/j.cmpb.2020.105714Sponsors
We thank Drs. Frank Avilucea, Yong Zeng, and Ming Ni for their valuable discussions.Publisher
Elsevier BVPubMed ID
32858283Additional Links
https://linkinghub.elsevier.com/retrieve/pii/S0169260720315479ae974a485f413a2113503eed53cd6c53
10.1016/j.cmpb.2020.105714
Scopus Count
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