Finite element analysis modelling of proximal femoral fractures, including post-fixation periprosthetic fractures

Noor, Saqib; Pridham, Cerianne; Fawcett, Tim; Barclay, Michael; Feng, Y. T.; Hassan, O.; Pallister, Ian

doi:10.1016/j.injury.2012.10.023

Cited by 10 publications

(7 citation statements)

References 20 publications

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“…The interfragmentary motion is limited, but this may lead to less bone formation, higher bone resorption and consequently fixation loosening [13,56,57]. Furthermore, the direct contact between the screws and bone might lead to disruption of the blood supply [58]. No significant difference was observed between the 8 and 7-screw constructs (C1, C2 and C3, Figure 4(a)).…”

Section: Discussionmentioning

confidence: 99%

Effect of screw position on bone tissue differentiation within a fixed femoral fracture

Nasr¹,

Hunt²,

Duncan

2013

JBiSE

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Plate and screw constructs are routinely used in the treatment of long bone fractures. Despite considerable advancements in technology and techniques, there can still be complications in the healing of long bone fractures. Non-unions, delayed unions, and hardware failures are common complications observed in clinical practice following open reduction and internal fixation of fractures [1]. Potential causes of these adverse clinical effects may be disruptive to the periosteal and endosteal blood supply, stress shielding effects, and inadequate mechanical stability. The goal of the present study was to explore the effect of screw position on the fracture healing and formation of new bone tissue with mechanoregulatory algorithms in a computational model. An idealized poroelastic 3D finite element (FE) model of a femur with a 5 mm fracture gap, including a plate-screw construct was developed. Nineteen different plate-screw combinations, created by varying the number and position of screws within the plate, were created to identify a construct with the most favourable attributes for fracture healing. The first phase of the study evaluated constructs through mechanical stress analyses to identify those constructs with high loadsupport capability. The second phase of the study evaluated healing and bone formation with a biphasic mechanoregulatory algorithm to simulate tissue differentiation for fixation within selected constructs. The results of our analysis demonstrated a 4-screw symmetrical construct with the largest distance between screws to provide the most favourable balance of stability and optimized conditions to promote fracture healing.

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Section: Discussionmentioning

confidence: 99%

Effect of screw position on bone tissue differentiation within a fixed femoral fracture

Nasr¹,

Hunt²,

Duncan

2013

JBiSE

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“…Periprosthetic fractures occur around or adjacent to prosthetic joints or orthopedic implants. 1 Currently, 0.8% to 1.1% of total hip arthroplasty (THA) and 0.5% to 1.1% of total knee arthroplasty (TKA) patients will experience a periprosthetic fracture in the first 5 years from surgery, and these numbers are expected to increase. 2 – 6 The indications for THA are expanding, leading to more implants in younger patients, as well as in older adults.…”

Section: Introductionmentioning

confidence: 99%

Mortality and Financial Burden of Periprosthetic Fractures of the Femur

Shields

Behrend²,

Bair

et al. 2014

Geriatr Orthop Surg Rehabil

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Objective:This study examines patient factors to identify risks of 12-month mortality following periprosthetic femur fractures. Hospital charges were analyzed to quantify the financial burden for treatment modalities.Methods:Data were retrospectively analyzed from a prospective database at a university hospital setting. One-hundred and thirteen patients with a periprosthetic fracture of the proximal or distal femur were identified. Risk factors for 12-month mortality were analyzed, and financial data were compared between the various treatment modalities.Results:In all, 14% of patients died (16 of 113) within 3 months and the 1-year mortality was 17.7% (20 of 113). Patients who died within 1 year had higher hospital charges (US$33 880 ± 25 051 vs US$22 886 ± 16 841; P = .01) and were older (87.6 ± 8.5 vs 81.5 ± 8.6; P = .004). Logistic regression analysis revealed age was the only significant predictor of 1-year mortality (P = .029, odds ratio 1.1). Analysis of financial data revealed 4 distinct groups (P < .05 between groups). Distal femoral revision arthroplasty (RA-DF) generated the highest hospital charges of US$91 035 ± 25 579 (n = 3). The second most highly charged group included proximal femoral fractures treated with revision arthroplasty (US$34 078 ± 17 832; n = 20) and hemi/total hip arthroplasty (THA; US$41 556 ± 23 651; n = 8). The third most charged group underwent open reduction internal fixation of the proximal (US$18 706 ± 6829; n = 35) and distal (US$22 381 ± 10 835; n = 35) femur. Nonoperative treatment generated the lowest charges (US$6426 ± 2899; n = 11). On average, the hospital lost money treating patients with RA-DF (US$−19 080 ± 2022 per patient) and hemi/THA (US$−6594 ± 9305 per patient), while all other treatment groups were profitable.Conclusion:One-year mortality after periprosthetic femur fractures was 17.7%, is mostly influenced by age, and 80% of deaths occur within 3 months. Patients treated with primary/revision arthroplasty generate more hospital charges than internal fixation. The average patient treated with revision arthroplasty of the distal femur or hemi/THA for a periprosthetic femur fractures resulted in net financial losses for the hospital.

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“…A methodology for assessing the causes of a given scenario is the use of Finite Element (FE) analysis. In the biomechanical evaluation of osteosynthesis medical devices, many applications can be found in the literature (Dubov et al, 2011;Noor et al, 2013), but to the authors' knowledge this is the first investigation aimed at evaluating the causes of a real failure event after a re-intervention following PFF. Such events are currently object of forensic debate as more and more often hospitals, surgeons, and medical device manufacturers are denounced by patients to whom similar events occur.…”

Section: Introductionmentioning

confidence: 99%

Finite Element Modeling Application in Forensic Practice: A Periprosthetic Femoral Fracture Case Study

Terzini

Aldieri

Nurisso

et al. 2020

Front. Bioeng. Biotechnol.

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The incidence of periprosthetic fractures has rapidly increased in the last two decades and has been the cause of a large number of revision surgeries and permanent physical disability for many patients, as well as a significant socioeconomic burden for many nations. This research deals with a periprosthetic femur fracture real event, occurred following a total hip arthroplasty and treated with one of the most widespread internal fixation methods: the implant of a periprosthetic femur plate system. A Finite Element analysis was performed to investigate the implanted femur plate break after a short follow-up and to understand the plate break causes. Such events are currently object of forensic debate as more and more often hospitals, surgeons, and medical device manufacturers are denounced by patients to whom similar events occur. In this work, different load situations acting on the femur during daily and incidental activities were simulated, in order to validate the correct behavior of the plate, according to the intended use recommended by the manufacturer. The analysis demonstrates that the plate failure can occur in situations of unconventional loading such as that caused by stumbling and in presence of incomplete bone healing.

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Finite element analysis modelling of proximal femoral fractures, including post-fixation periprosthetic fractures

Cited by 10 publications

References 20 publications

Effect of screw position on bone tissue differentiation within a fixed femoral fracture

Effect of screw position on bone tissue differentiation within a fixed femoral fracture

Mortality and Financial Burden of Periprosthetic Fractures of the Femur

Finite Element Modeling Application in Forensic Practice: A Periprosthetic Femoral Fracture Case Study

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