Finite element analysis of adding one transverse screw for Pauwels type <b>Ⅲ</b> femoral neck fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 MA Luyao ¹ , SUN Xueao ² , TAN Qingjun ³ , LAN Yanping ¹ , WANG Xiaohu ¹ , YIN Yunsheng ¹ , MA Jinhui ⁴

1. Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan Shanxi, 030001, P. R. China;
2. Department of Orthopaedics, Daning County People’s Hospital, Daning Shanxi, 042300, P. R. China;
3. The Second Clinical Medical College, Shanxi Medical University, Taiyuan Shanxi, 030001, P. R. China;
4. The First Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, 100029, P. R. China;

Corresponding author：

MA Luyao, Email: mly_doctor@163.com

Keywords：

Femoral neck fracture; unstable fracture; transverse screw; internal fixation; finite element analysis

DOI：

10.7507/1002-1892.202501061

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Objective To investigate whether adding 1 transverse screw (TS) to the triangular parallel cannulated screw (TPCS) fixation has a mechanical stability advantage for Pauwels type Ⅲ femoral neck fractures by conducting finite element analysis on four internal fixation methods. Methods Based on CT data of a healthy adult male volunteer’s femur, three Pauwels type Ⅲ femoral neck fracture models (Pauwels angle 70°, Pauwels angle 80°, and Pauwels angle 70° combined with bone defect) were constructed using Mimics 21.0 software and SolidWorks 2017 software. Four different internal fixation models were built at the same time, including TPCS, TPCS+TS, three cross screws (TCS), and TPCS+medial buttress plate (MBP). The mechanical stability of different models under the same load was compared by finite element analysis. Results The femoral model established in this study exhibited a maximum stress of 28.62 MPa, with relatively higher stress concentrated in the femoral neck. These findings were comparable to previous studies, indicating that the constructed femoral finite element model was correct. The maximum stress of internal fixation in finite element analysis showed that TCS was the lowest and TPCS+MBP was the highest in Pauwels angle 70° and 80° models, while TPCS+TS was the lowest and TCS was the highest in Pauwels angle 70° combined with bone defect model. The maximum displacement of internal fixation in each fracture model was located at the top of the femoral head, with TCS having the highest maximum displacement of the femur. The maximum stress of fracture surface in finite element analysis showed that TCS was the lowest and TPCS was the highest in the Pauwels angle 70° model, while TPCS+MBP was the lowest and TPCS/TCS were the highest in the Pauwels angle 80° model and the Pauwels angle 70° combined with bone defect model, respectively. The maximum displacement of fracture surfece analysis showed that TPCS+MBP was the lowest and TCS was the highest in Pauwels angle 70° and 80° models, while TPCS+TS was the lowest and TCS was the highest in Pauwels angle 70° combined with bone defect model. Conclusion For Pauwels type Ⅲ femoral neck fractures, the biomechanical stability of TPCS+TS was superior to that of TPCS alone and TCS, but it has not yet reached the level of TPCS+MBP.

1.	Johnson JP, Borenstein TR, Waryasz GR, et al. Vertically oriented femoral neck fractures: a biomechanical comparison of 3 fixation constructs. J Orthop Trauma, 2017, 31(7): 363-368.
2.	Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury, 2018, 49(8): 1458-1460.
3.	Parker MJ, Raghavan R, Gurusamy K. Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res, 2007, 458: 175-179.
4.	Loizou CL, Parker MJ. Avascular necrosis after internal fixation of intracapsular hip fractures; a study of the outcome for 1 023 patients. Injury, 2009, 40(11): 1143-1146.
5.	Damany DS, Parker MJ, Chojnowski A. Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures. Injury, 2005, 36(1): 131-141.
6.	Cai L, Zheng W, Chen C, et al. Comparison of young femoral neck fractures treated by femoral neck system, multiple cancellous screws and dynamic hip screws: a retrospectively comparison study. BMC Musculoskelet Disord, 2024, 25(1): 188. doi: 10.1186/s12891-024-07319-y.
7.	Guimarães JAM, Rocha LR, Noronha Rocha TH, et al. Vertical femoral neck fractures in young adults: a closed fixation strategy using a transverse cancellous lag screw. Injury, 2017, 48 Suppl 4: S10-S16.
8.	Nauth A, Creek AT, Zellar A, et al. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. The Lancet, 2017, 389(10078): 1519-1527.
9.	Tianye L, Peng Y, Jingli X, et al. Finite element analysis of different internal fixation methods for the treatment of Pauwels type Ⅲ femoral neck fracture. Biomed Pharmacother, 2019, 112: 108658. doi: 10.1016/j.biopha.2019.108658.
10.	Gümüştaş SA, Tosun HB, Ağır İ, et al. Influence of number and orientation of screws on stability in the internal fixation of unstable femoral neck fractures. Acta Orthop Traumatol Turc, 2014, 48(6): 673-678.
11.	Jiang D, Zhan S, Cai Q, et al. Long-term differences in clinical prognosis between crossed- and parallel-cannulated screw fixation in vertical femoral neck fractures of non-geriatric patients. Injury, 2021, 52(11): 3408-3414.
12.	崔增桢, 许翔宇, 曹源, 等. 4枚不平行空心螺钉与3枚平行空心螺钉治疗股骨颈骨折的疗效对比. 中国微创外科杂志, 2023, 23(6): 449-455.
13.	Stoffel K, Zderic I, Gras F, et al. Biomechanical evaluation of the femoral neck system in unstable Pauwels Ⅲ femoral neck fractures: a comparison with the dynamic hip screw and cannulated screws. J Orthop Trauma, 2017, 31(3): 131-137.
14.	Stockton DJ, Lefaivre KA, Deakin DE, et al. Incidence, magnitude, and predictors of shortening in young femoral neck fractures. J Orthop Trauma, 2015, 29(9): e293-e298.
15.	李英周, 叶锋, 万蕾, 等. 改良经皮加压钢板治疗Pauwels Ⅲ型股骨颈骨折的疗效分析. 中国骨伤, 2018, 31(2): 120-123.
16.	Li J, Yin P, Zhang L, et al. Medial anatomical buttress plate in treating displaced femoral neck fracture a finite element analysis. Injury, 2019, 50(11): 1895-1900.
17.	Van Houcke J, Schouten A, Steenackers G, et al. Computer-based estimation of the hip joint reaction force and hip flexion angle in three different sitting configurations. Appl Ergon, 2017, 63: 99-105.
18.	Painkra R, Sanyal S, Bit A. An anisotropic analysis of human femur bone with walking posture: experimental and numerical analysis. BioNanoScience, 2018, 8(4): 1054-1064.
19.	Collinge CA, Mir H, Reddix R. Fracture morphology of high shear angle “vertical” femoral neck fractures in young adult patients. J Orthop Trauma, 2014, 28(5): 270-275.
20.	梅炯. 重视对股骨颈骨折的骨缺损评估以优化手术方案决策. 中国骨伤, 2023, 36(3): 199-203.
21.	顾叶, 王秋霏, 方涛彭, 等. 动力交叉螺钉应用于不稳定型股骨颈骨折的生物力学分析. 中国组织工程研究, 2023, 27(22): 3481-3485.
22.	Xiong WF, Chang SM, Zhang YQ, et al. Inferior calcar buttress reduction pattern for displaced femoral neck fractures in young adults: a preliminary report and an effective alternative. J Orthop Surg Res, 2019, 14(1): 70. doi: 10.1186/s13018-019-1109-x.
23.	Liu JF, Zhang SD, Huang L, et al. Dynamic limited axial compression yields favorable functional outcomes in the fixation of Pauwels type-3 femoral neck fractures: A retrospective cohort study. Injury, 2020, 51(8): 1851-1857.
24.	苏志豪, 谭宏莉, 徐子环, 等. PauwelsⅢ型股骨颈骨折骨缺损不同内固定方案的生物力学分析. 中国骨伤, 2023, 36(3): 255-261.

1. Johnson JP, Borenstein TR, Waryasz GR, et al. Vertically oriented femoral neck fractures: a biomechanical comparison of 3 fixation constructs. J Orthop Trauma, 2017, 31(7): 363-368.
2. Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury, 2018, 49(8): 1458-1460.
3. Parker MJ, Raghavan R, Gurusamy K. Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res, 2007, 458: 175-179.
4. Loizou CL, Parker MJ. Avascular necrosis after internal fixation of intracapsular hip fractures; a study of the outcome for 1 023 patients. Injury, 2009, 40(11): 1143-1146.
5. Damany DS, Parker MJ, Chojnowski A. Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures. Injury, 2005, 36(1): 131-141.
6. Cai L, Zheng W, Chen C, et al. Comparison of young femoral neck fractures treated by femoral neck system, multiple cancellous screws and dynamic hip screws: a retrospectively comparison study. BMC Musculoskelet Disord, 2024, 25(1): 188. doi: 10.1186/s12891-024-07319-y.
7. Guimarães JAM, Rocha LR, Noronha Rocha TH, et al. Vertical femoral neck fractures in young adults: a closed fixation strategy using a transverse cancellous lag screw. Injury, 2017, 48 Suppl 4: S10-S16.
8. Nauth A, Creek AT, Zellar A, et al. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. The Lancet, 2017, 389(10078): 1519-1527.
9. Tianye L, Peng Y, Jingli X, et al. Finite element analysis of different internal fixation methods for the treatment of Pauwels type Ⅲ femoral neck fracture. Biomed Pharmacother, 2019, 112: 108658. doi: 10.1016/j.biopha.2019.108658.
10. Gümüştaş SA, Tosun HB, Ağır İ, et al. Influence of number and orientation of screws on stability in the internal fixation of unstable femoral neck fractures. Acta Orthop Traumatol Turc, 2014, 48(6): 673-678.
11. Jiang D, Zhan S, Cai Q, et al. Long-term differences in clinical prognosis between crossed- and parallel-cannulated screw fixation in vertical femoral neck fractures of non-geriatric patients. Injury, 2021, 52(11): 3408-3414.
12. 崔增桢, 许翔宇, 曹源, 等. 4枚不平行空心螺钉与3枚平行空心螺钉治疗股骨颈骨折的疗效对比. 中国微创外科杂志, 2023, 23(6): 449-455.
13. Stoffel K, Zderic I, Gras F, et al. Biomechanical evaluation of the femoral neck system in unstable Pauwels Ⅲ femoral neck fractures: a comparison with the dynamic hip screw and cannulated screws. J Orthop Trauma, 2017, 31(3): 131-137.
14. Stockton DJ, Lefaivre KA, Deakin DE, et al. Incidence, magnitude, and predictors of shortening in young femoral neck fractures. J Orthop Trauma, 2015, 29(9): e293-e298.
15. 李英周, 叶锋, 万蕾, 等. 改良经皮加压钢板治疗Pauwels Ⅲ型股骨颈骨折的疗效分析. 中国骨伤, 2018, 31(2): 120-123.
16. Li J, Yin P, Zhang L, et al. Medial anatomical buttress plate in treating displaced femoral neck fracture a finite element analysis. Injury, 2019, 50(11): 1895-1900.
17. Van Houcke J, Schouten A, Steenackers G, et al. Computer-based estimation of the hip joint reaction force and hip flexion angle in three different sitting configurations. Appl Ergon, 2017, 63: 99-105.
18. Painkra R, Sanyal S, Bit A. An anisotropic analysis of human femur bone with walking posture: experimental and numerical analysis. BioNanoScience, 2018, 8(4): 1054-1064.
19. Collinge CA, Mir H, Reddix R. Fracture morphology of high shear angle “vertical” femoral neck fractures in young adult patients. J Orthop Trauma, 2014, 28(5): 270-275.
20. 梅炯. 重视对股骨颈骨折的骨缺损评估以优化手术方案决策. 中国骨伤, 2023, 36(3): 199-203.
21. 顾叶, 王秋霏, 方涛彭, 等. 动力交叉螺钉应用于不稳定型股骨颈骨折的生物力学分析. 中国组织工程研究, 2023, 27(22): 3481-3485.
22. Xiong WF, Chang SM, Zhang YQ, et al. Inferior calcar buttress reduction pattern for displaced femoral neck fractures in young adults: a preliminary report and an effective alternative. J Orthop Surg Res, 2019, 14(1): 70. doi: 10.1186/s13018-019-1109-x.
23. Liu JF, Zhang SD, Huang L, et al. Dynamic limited axial compression yields favorable functional outcomes in the fixation of Pauwels type-3 femoral neck fractures: A retrospective cohort study. Injury, 2020, 51(8): 1851-1857.
24. 苏志豪, 谭宏莉, 徐子环, 等. PauwelsⅢ型股骨颈骨折骨缺损不同内固定方案的生物力学分析. 中国骨伤, 2023, 36(3): 255-261.

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