Biomechanical evaluation of internal fixation implants for femoral neck fractures: A comparative finite element analysis.
KAUST DepartmentPhysical Science and Engineering (PSE) Division
Online Publication Date2020-08-20
Print Publication Date2020-11
Embargo End Date2021-08-25
Permanent link to this recordhttp://hdl.handle.net/10754/664980
MetadataShow full item record
AbstractBACKGROUND 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.
CitationZeng, 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.2020.105714
SponsorsWe thank Drs. Frank Avilucea, Yong Zeng, and Ming Ni for their valuable discussions.
- Comparative finite element analysis of three implants fixing stable and unstable subtrochanteric femoral fractures: Proximal Femoral Nail Antirotation (PFNA), Proximal Femoral Locking Plate (PFLP), and Reverse Less Invasive Stabilization System (LISS).
- Authors: Wang J, Ma JX, Lu B, Bai HH, Wang Y, Ma XL
- Issue date: 2020 Feb
- Influence of the proximal screws of buttress plates on the stability of vertical femoral neck fractures: a finite element analysis.
- Authors: Zhan S, Jiang D, Xu J, Ling M, Yang K, Li Y, Jia W, Hu H, Zhang C
- Issue date: 2020 Dec 12
- Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: A meta-analysis.
- Authors: Ma KL, Wang X, Luan FJ, Xu HT, Fang Y, Min J, Luan HX, Yang F, Zheng H, He SJ
- Issue date: 2014 Dec
- Biomechanical Evaluation of the Femoral Neck System in Unstable Pauwels III Femoral Neck Fractures: A Comparison with the Dynamic Hip Screw and Cannulated Screws.
- Authors: Stoffel K, Zderic I, Gras F, Sommer C, Eberli U, Mueller D, Oswald M, Gueorguiev B
- Issue date: 2017 Mar
- Biomechanical Evaluation of Internal Fixation of Pauwels Type III Femoral Neck Fractures: A Systematic Review of Various Fixation Methods.
- Authors: Cha YH, Yoo JI, Hwang SY, Kim KJ, Kim HY, Choy WS, Hwang SC
- Issue date: 2019 Mar