Comparative finite element analysis of four different internal fixation implants for Pauwels type III femoral neck fractures in various fracture angles in the sagittal plane

Abstract

Objectives This study aimed to evaluate the performance of four different fixation techniques for Pauwels type III femoral neck fractures considering the fracture morphology in the sagittal plane. Materials and methods We constructed three different fracture morphologies in the sagittal plane in Pauwels type III femoral neck fractures: posteriorly angled at 20°, neutral, and anteriorly angled at 20°. We set up four fixation devices, including three cannulated screws (3CS), a dynamic hip screw with an antirotational screw (DHS+CS), a proximal femoral locking plate (PFLP), and three cannulated screws with a medial buttress plate (3CS+MBP). The twelve models were created and analyzed using the finite element analysis. Results The finite element analysis revealed that 3CS+MBP yields better results in total vertical and rotational displacements, regardless of the fracture angle in the sagittal plane. For the anterior and posterior angled fractures in the sagittal plane, the PFLP was superior to the DHS+CS. However, the DHS+CS exhibited less displacement than the PFLP in the neutral fracture line in the sagittal plane. The 3CS group demonstrated poor mechanical stability for Pauwels type III fractures. Conclusion Regardless of the fracture line in the sagittal plane, the 3CS+MBP showed better biomechanical behaviors than the 3CS, DHS+CS, and PFLP. In addition, in contrast to the DHS+CS, the PFLP displayed less vertical and rotational displacement in the anterior and posterior fracture lines in the sagittal plane.

A meta‐analysis comparing the effects of cemented and uncemented prostheses on wound infection and pain in patients with femoral neck fractures

“…The elderly population often presents with various underlying diseases, reduced bone strength, increased fragility, and declining physical function. Conventional conservative or internal fixation treatments may not achieve satisfactory results 3,4 . In recent years, clinical reports have suggested that total hip arthroplasty is an effective treatment for femoral neck fractures in the elderly, allowing for good treatment outcomes, rapid recovery of limb function, reduced occurrence of complications, and decreased risk of secondary surgery associated with the internal fixation treatment 5,6 .…”

“…Conventional conservative or internal fixation treatments may not achieve satisfactory results. 3,4 In recent years, clinical reports have suggested that total hip arthroplasty is an effective treatment for femoral neck fractures in the elderly, allowing for good treatment outcomes, rapid recovery of limb function, reduced occurrence of complications, and decreased risk of secondary surgery associated with the internal fixation treatment. 5,6 However, there is currently no consensus on the choice of artificial hip joint prosthesis in clinical practice, with the primary focus being on the selection between cemented and uncemented prostheses.…”

Preoperative computed tomography morphological characteristics of displaced femoral neck fractures

“…[2] Due to poor biomechanical stability and failure to bear weight early after surgery, patients may have refracture, internal fixation failure, and ischemic necrosis of the femoral head. [3] In particular, once the femoral head necrosis occurs, it would be an irreversible complication and, therefore, the femoral head ischemic necrosis is also known as the deathless cancer. [4] Currently, the prognosis is usually evaluated according to different types of femoral neck fractures.…”

Can a coracoclavicular screw added to the clavicular hook plate reduce subacromial stress? A finite element analysis

“…The finite element analysis (FEA) is frequently used in the biomechanical analysis of orthopedic implants. [14][15][16][17][18][19] It has previously been used to investigate the effects of different designs of CHPs on the acromion and clavicle. [14][15][16] In the present study, in addition to the model created using the standard hook plate, we constituted a new model with an additional cortical screw placed in the coracoid process through the third hole of the hook plate (CC screw) and aimed to investigate the stresses on the hook of the plate in both models with FEA.…”