Comparison of Three Fixation Methods for Femoral Neck Fracture in Young Adults: Experimental and Numerical Investigations

Abstract

Femoral neck fractures in young patients are usually caused by a high-energy trauma, which results in a perpendicular fracture. Although efforts are focused on preserving the femoral head in young patients, vertical femoral neck fracture is a problematic orthopedic injury due to the domination of shear forces. Due to controversy regarding which fixation method is the best choice, the purpose of this study was to find the most stable fixation method for this kind of fracture. This study includes experimental testing on cadaveric bone samples and finite element analysis (FEA) for three fracture fixation techniques, namely cannulated screws (CSs), dynamic hip screw with derotational screw (DHS + DS), and proximal femoral locking plate (PFLP). Experimental results of bone-implant stiffness, average femoral head displacement, failure load, failure energy, and relative position of the fractured fragments indicate that DHS + DS offers the strongest structure for stabilizing a vertical femoral neck fracture. Experimental data and FEA results both indicate that under static loading, the DHS + DS method of fixation produces the lowest femoral head displacement and interfragmentary movement, followed by PFLP and then CSs. The results of this research suggest that, based on the clinical assumption that a restricted weight-bearing regimen is recommended in the postoperative rehabilitation protocol, the DHS + DS method of fixation is a better choice compared to CSs and PFLP for a vertical femoral neck fracture fixation in young adults.

Complications after surgical treatment of femoral neck fractures in men with alcohol dependence syndrome: retrospective register analysis of 154 cases

“…We found that there was a substantial difference in implant survival between the treatment groups, with the SHS superior to cannulated screws when internal fixation is used. According to the current literature, the stability of SHS fixation is superior to cannulated screws, particularly in vertical and basal fractures, which are more unstable [11][12][13][14]. Our results suggest that stable fixation may be more important in ADS patients, as many trauma patients continue to drink after sustaining an injury and thus may be less likely to follow mobility restrictions during postoperative rehabilitation [15,16].…”

Biomechanical efficacy of four different dual screws fixations in treatment of talus neck fracture: a three-dimensional finite element analysis

“…According to the contact method described in references [15,16], in an ankle model containing bones, cartilage, ligaments, and screws, the boundary condition of the contact between the bone surface and the cartilage surface was set to bind, and the start and stop points of ligaments which connect with the bone were set to bind. The transmission of force between bone and bone was realized by contact between cartilages.…”

Finite element analysis of a new internal fixation implant for Pauwels type III femoral neck fractures

“…In addition, when the Pauwels angle and loads increased, the stresses and displacements of the femoral head and 26 . Several biomechanical studies 21,27,28 have revealed that the cannulated screw method of xation is not the best choice for vertical femoral neck fractures in young adults. Because single DHS xation has been shown to have a lower capacity to resist rotational forces compared with multiple cannulated screw xation, many scholars suggest inserting a derotational screw in parallel to the main DHS to overcome this limitation at the cost of a larger skin incision and the dissection of more soft tissue.…”