Medial sustainable nail versus proximal femoral nail antirotation in treating AO/OTA 31-A2.3 fractures: Finite element analysis and biomechanical evaluation

Li, Jiantao; Han, Lin; Zhang, Hao; Zhao, Zhe; Su, Xiuyun; Zhou, Jianfeng; Li, Chen; Yin, Peng; Hao, Ming; Wang, Kun; Xu, Gaoxiang; Zhang, Lihai; Tang, Peifu

doi:10.1016/j.injury.2019.02.008

Cited by 41 publications

(50 citation statements)

References 37 publications

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“…The signi cance of this study lay in its potential to challenge the dose-effect relationship between the femoral lateral wall thickness and the risk of PFNA implant failure in terms of the stress and displacement of the bone and implant from a biomechanical point of perspective. At T4 and T5 conditions, the prediction showed that the fracture was triggered in the PFNA nail where the location of the fracture was the same as that reported in the fatigue test [17]. This suggested that the femoral lateral wall thickness at T4-T5 (21.368 mm to 19.342mm) may be both the critical value of the PFNA breakage.…”

Section: Discussionsupporting

confidence: 56%

“…In other words, a vertical fracture line could may induce a shear force on the PFNA as large as the applied load on the femoral head. A Medical Sustainable Nail presented similar construct but featured two nails (cephalic nail and sustainable nail) on the nail shaft which may explain the stronger support in the vertical direction for the xation of unstable fractures [17].…”

Section: Discussionmentioning

confidence: 99%

“…Material fracture or failure could be resembled by the propagation of element deletion in the FE simulation. We simulated a critical loading case resembling the suggested high loading condition during walking [17]. The femoral head was loaded 2,100 N at 10° lateral to the inferior axis on the frontal plane and 9°p osterior to the inferior axis on the sagittal plane [17], as demonstrated in Figure 3.…”

Section: Materials Propertiesmentioning

confidence: 99%

“…The femoral head was loaded 2,100 N at 10° lateral to the inferior axis on the frontal plane and 9°p osterior to the inferior axis on the sagittal plane [17], as demonstrated…”

Section: Figurementioning

confidence: 99%

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Risk of Proximal Femoral Nail Antirotation Implant Failure Upon Different Lateral Femoral Wall Thickness in Intertrochanteric Fracture :A Finite Element Analysis.

Zheng

Wong

Chen

et al. 2020

Preprint

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PurposePFNA has been commonly used to treat intertrochanteric fractures, despite the risk of implant failure. The integrity of the femur could influence the risk of implant failure. This study aims to evaluate the influence of lateral femoral wall thickness on potential implant failure using a computational modeling approach. MethodsFinite element model of the hip was reconstructed from the Computed Tomography of a female patient. Five intertrochanteric fracture models at different lateral femoral wall thickness (T1 = 27.6 mm, T2 = 25.4 mm, T3 = 23.4 mm, T4 = 21.4 mm, and T5 = 19.3 mm) were created and fixed with PFNA. A critical loading condition was simulated that mimicked a high loading scenario during walking. The implant failure condition, stress and displacement of the PFNA implant and fracture femur were predicted for analysis. ResultsImplant failure of PNFA occurred at the sides of the proximal nail canal especially for the thinner wall models (T4 and T5).The maximum von Mises stress of the nail for T4 changed abruptly to 298.1 MPa. However, thinner wall decreased the displacement of the PFNA implant. There was approximately opponent trend of stress and displacement on proximal and distal fragments with decreasing thickness possibly due to the adaptation after failure.ConclusionA thinner wall increased the risk of PFNA implant failure. Our prediction showed that complete failure occurred when the thickness was 21.4 mm which was close to the value suggested to determine the stability type.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Materials Propertiesmentioning

confidence: 99%

“…The femoral head was loaded 2,100 N at 10° lateral to the inferior axis on the frontal plane and 9°p osterior to the inferior axis on the sagittal plane [17], as demonstrated…”

Section: Figurementioning

confidence: 99%

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Risk of Proximal Femoral Nail Antirotation Implant Failure Upon Different Lateral Femoral Wall Thickness in Intertrochanteric Fracture :A Finite Element Analysis.

Zheng

Wong

Chen

et al. 2020

Preprint

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“…The initial finite-element analysis and biomechanical testing have confirmed that, compared to the proximal femoral nail anti-rotation (PFNA-II), the MSN system was more effective in preventing coxa varus and displacement of proximal segment. [ 11 ] However, in further biomechanical experiments, the sliding distance of MSN was greater than that of PFNA-II, and the limit load was lower than that of PFNA-II, so we improved it and designed a new type of MSN (MSN-II), as shown in Figure 1 A. It is hoped to verify its advantages through finite-element simulation analysis.…”

Section: Introductionmentioning

confidence: 99%

Medial support nail and proximal femoral nail antirotation in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association 31-A3.1): a finite-element analysis

Nie

Zhao

et al. 2020

Chinese Medical Journal

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Background The reverse obliquity inter-trochanteric fracture is a distinct fracture pattern that is mechanically different from most inter-trochanteric fractures and the optional treatment of it is still controversial. The purpose of this study was to compare differences in the efficacy of a novel nail (medial support nail [MSN-II]) and proximal femoral nail anti-rotation (PFNA-II) in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association [AO/OTA] 31-A3.1) using finite-element analysis. Methods Modeling software was used to establish a three-dimensional model of MSN-II and PFNA-II and an A3.1 inter-trochanteric fracture model. Abaqus software was used to implement different force loads to compare finite-element biomechanical parameters such as the maximum stress in implant and the displacement of fracture site. Results The femoral stress, implant stress and fracture site displacement of MSN-II was less than that of PFNA-II. The results indicated that the maximal femoral stress was 581 MPa for PFNA-II and 443 MPa for the MSN-II. The maximum stress values in the PFNA-II and MSN-II models were 291 and 241 MPa, respectively. The maximal displacements of the fracture site were 1.47 and 1.16 mm in the PFNA-II and MSN-II models, respectively. Conclusion Compared with PFNA-II for inter-trochanteric fracture (AO/OTA 31-A3.1), MSN-II which was designed with a triangular stability structure can provide better biomechanical stability. The MSN-II may be a feasible option for the treatment of reverse obliquity inter-trochanteric fracture.

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Finite Element Analysis of Fracture Fixation

Lewis

Mischler

Wee

et al. 2021

Curr Osteoporos Rep

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Medial sustainable nail versus proximal femoral nail antirotation in treating AO/OTA 31-A2.3 fractures: Finite element analysis and biomechanical evaluation

Cited by 41 publications

References 37 publications

Risk of Proximal Femoral Nail Antirotation Implant Failure Upon Different Lateral Femoral Wall Thickness in Intertrochanteric Fracture :A Finite Element Analysis.

Risk of Proximal Femoral Nail Antirotation Implant Failure Upon Different Lateral Femoral Wall Thickness in Intertrochanteric Fracture :A Finite Element Analysis.

Medial support nail and proximal femoral nail antirotation in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association 31-A3.1): a finite-element analysis

Finite Element Analysis of Fracture Fixation

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