Aims In this study, we aimed to explore surgical variations in the Femoral Neck System (FNS) used for stable fixation of Pauwels type III femoral neck fractures. Methods Finite element models were established with surgical variations in the distance between the implant tip and subchondral bone, the gap between the plate and lateral femoral cortex, and inferior implant positioning. The models were subjected to physiological load. Results Under a load of single-leg stance, Pauwels type III femoral neck fractures fixed with 10 mm shorter bolts revealed a 7% increase of the interfragmentary gap. The interfragmentary sliding, compressive, and shear stress remained similar to models with bolt tips positioned close to the subchondral bone. Inferior positioning of FNS provided a similar interfragmentary distance, but with 6% increase of the interfragmentary sliding distance compared to central positioning of bolts. Inferior positioning resulted in a one-third increase in interfragmentary compressive and shear stress. A 5 mm gap placed between the diaphysis and plate provided stability comparable to standard fixation, with a 7% decrease of interfragmentary gap and sliding distance, but similar compressive and shear stress. Conclusion Finite element analysis with FNS on Pauwels type III femoral neck fractures revealed that placement of the bolt tip close to subchondral bone provides increased stability. Inferior positioning of FNS bolt increased interfragmentary sliding distance, compressive, and shear stress. The comparable stability of the fixation model with the standard model suggests that a 5 mm gap placed between the plate and diaphysis could viably adjust the depth of the bolt. Cite this article: Bone Joint Res 2022;11(2):102–111.

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Although sandblasting is mainly used to improve bonding between dental zirconia and resin cement, the details on the in-depth damages are limited. The aim of this study was to evaluate phase transformations and subsurface changes after sandblasting in three different dental zirconia (3, 4, and 5 mol% yttria-stabilized zirconia; 3Y-TZP, 4Y-PSZ, and 5Y-PSZ). Zirconia specimens (14.0 × 14.0 × 1.0 mm3) were sandblasted using different alumina particle sizes (25, 50, 90, 110, and 125 µm) under 0.2 MPa for 10 s/cm2. Phase transformations and residual stresses were investigated using X-ray diffraction and the Williamson-Hall method. Subsurface damages were evaluated with cross-sections by a focused ion beam. Stress field during sandblasting was simulated by the finite element method. The subsurface changes after sandblasting were the emergence of a rhombohedral phase, micro/macro cracks, and compressive/tensile stresses depending on the interactions between blasting particles and zirconia substrates. 3Y-TZP blasted with 110-µm particles induced the deepest transformed layer with the largest compressive stress. The cracks propagated parallel to the surface with larger particles, being located up to 4.5 µm under the surface in 4Y- or 5Y-PSZ subgroups. The recommended sandblasting particles were 110 µm for 3Y-TZP and 50 µm for 4Y-PSZ or 5Y-PSZ for compressive stress-induced phase transformations without significant subsurface damages.

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Background Femoral neck fractures are a common injury in older adults and their management presents a significant challenge for orthopedic surgeons. The Femoral Neck System (FNS) was recently introduced for the fixation of femur neck fractures. Although neck shortening was reduced with the FNS, the complication rates were not reduced. Thus, improvements to enhance fixation stability should be made for the FNS. We hypothesized that (1) the pre-sliding technique and (2) the use of longer anti-rotation screw would increase fracture stability. This study aimed to determine the change in fracture stability using the pre-sliding technique and long anti-rotation screw in the FNS for fixation of Pauwels type III femoral neck fractures. Methods Finite element models of Pauwels type III femoral neck fracture fixed with pre-sliding FNS and 5-mm longer anti-rotation screw were established. The models were subjected to normal walking load. The material properties of the elements belonging to the bone were mapped by assigning the formulation with the computed tomography Hounsfield unit. Results Pauwels type III femoral neck fractures fixed with pre-slided FNS showed better fracture stability, decreasing fracture gap and sliding by 14% and 12%, respectively, under normal walking load. No element of cortical bone in any of the models had an absolute value of principal strain that exceeded 1%. The peak von Mises stress (VMS) of the implants ranged from 260 to 289 MPa, and the highest peak VMS value was 50% lower than the yield strength of the titanium alloy (800 MPa). The longer anti-rotation screw did not affect fracture stability. Conclusions The pre-sliding technique using the FNS showed higher fracture stability than the standard fixation technique for a Pauwels type III femoral neck fracture. The longer anti-rotation screw did not contribute significantly to fixation stability. As this finite element analysis considered the inhomogeneous mechanical property of the bone, it offered equivalent mechanical conditions to investigate the components of interest.