Micro‐Computed Tomography Analysis of Femoral Head Necrosis After Long‐Term Internal Fixation for Femoral Neck Fracture

Liu, Yang; Liang, Haoran; Zhou, Xin; Song, Wenjie; Shao, Huifeng; He, Yong; Yang, Yaning; Guo, Li; Li, Pengcui; Wei, Xiaochun; Duan, Wei

doi:10.1111/os.13318

Cited by 7 publications

(9 citation statements)

References 22 publications

(47 reference statements)

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“…Our previous research noted a significant degree of sclerosis surrounding the femoral screw path, as observed on computed tomography scans after prolonged retention of the internal fixation implant post-FNF surgery 7 . This densely distributed region is referred to as sclerotic cancellous bone (SCB).…”

Section: Introductionmentioning

confidence: 79%

Integrated proteomics and metabolomics analysis of sclerosis-related proteins and femoral head necrosis following internal fixation of femoral neck fractures

Liu,

Ma,

Yang

et al. 2024

Sci Rep

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Femoral head necrosis (FHN) is a serious complication after femoral neck fractures (FNF), often linked to sclerosis around screw paths. Our study aimed to uncover the proteomic and metabolomic underpinnings of FHN and sclerosis using integrated proteomics and metabolomics analyses. We identified differentially expressed proteins (DEPs) and metabolites (DEMs) among three groups: patients with FNF (Group A), sclerosis (Group B), and FHN (Group C). Using the Kyoto Encyclopedia of Genes and Genomes and Gene Ontology enrichment analyses, we examined the roles of these proteins and metabolites. Our findings highlight the significant differences across the groups, with 218 DEPs and 44 DEMs identified between the sclerosis and FNF groups, 247 DEPs and 31 DEMs between the FHN and sclerosis groups, and a stark 682 DEPs and 94 DEMs between the FHN and FNF groups. Activities related to carbonate dehydratase and hydrolase were similar in the FHN and sclerosis groups, whereas extracellular region and lysosome were prevalent in the FHN and FNF groups. Our study also emphasized the involvement of the PI3K-Akt pathway in sclerosis and FHN. Moreover, the key metabolic pathways were implicated in glycerophospholipid metabolism and retrograde endocannabinoid signaling. Using western blotting, we confirmed the pivotal role of specific genes/proteins such as ITGB5, TNXB, CA II, and CA III in sclerosis and acid phosphatase 5 and cathepsin K in FHN. This comprehensive analyses elucidates the molecular mechanisms behind sclerosis and FHN and suggests potential biomarkers and therapeutic targets, paving the way for improved treatment strategies. Further validation of the findings is necessary to strengthen the robustness and reliability of the results.

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Section: Introductionmentioning

confidence: 79%

Integrated proteomics and metabolomics analysis of sclerosis-related proteins and femoral head necrosis following internal fixation of femoral neck fractures

Liu,

Ma,

Yang

et al. 2024

Sci Rep

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“…While the advantages of screw path implants in mechanics have been mentioned above, a study demonstrated that the presentation of a sclerotic region around the screw path increases the risk of femoral head collapse due to stress concentration and prevents sclerosis formation from becoming critical [ 13 ]. We believe that the clinical outcomes of the patients can be improved by selecting appropriate implant materials and optimizing surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Previously our team has determined that regardless of whether implants are removed, there is risk of collapse of the femoral head, for as long as sclerotic bone around the screw paths persist following healing of FNFs. In addition, as we concluded in a clinical work, years after removal of the internal fixation material, no effective tissue filling develops in the screw paths [ 13 ]. Preventing the formation of osteosclerotic areas is critical.…”

Section: Introductionmentioning

confidence: 99%

Prevention of sclerosis around cannulated screw after treatment of femoral neck fractures with bioceramic nails: a finite element analysis

Liu

Xing

Shao

et al. 2023

BMC Musculoskelet Disord

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Purpose Conventional cannulated screws (CS) are the main treatment method for femoral neck fractures (FNF). However, the rate of femoral head necrosis remains high after FNF treatment. The study aimed to compare the biomechanical features of different internal fixation materials for the treatment of Pauwel type III FNF to explore new strategies for clinical management. Methods A new material was prepared by applying casting, freeze drying and sintering process. The independently developed calcium magnesium silicate ceramic powder and hydrogel solution were evenly mixed to obtain a high-viscosity bio-ink, and a bioceramic nail (BN) with high mechanical strength and high fracture toughness was successfully prepared. Four internal fixations were developed to establish the Pauwel type III FNF and healed fracture finite element models: A, three CSs; B, three BNs; C, two BNs and one CS; D, one BN and two CSs. Von Mises stress and displacement of the implants and femur were observed. Results The measured Mg content in ceramic powder was 2.08 wt%. The spectral data confirmed that the ceramic powder has high crystallinity, which coincides with the wollastonite-2 M (PDF# 27–0088). The maximum von Mises stresses for the four models were concentrated in the lower part of the fracture surface, at 318.42 Mpa, 103.52 MPa, 121.16 MPa, and 144.06 MPa in models A, B, C, and D, respectively. Moreover, the maximum Von-mises stresses of the implants of the four models were concentrated near the fracture end at 243.65 MPa (A) and 58.02 MPa (B), 102.18 MPa (C), and 144.06 MPa (D). The maximum displacements of the four models were 5.36 mm (A), 3.41 mm (B), 3.60 mm (C), and 3.71 mm (D). The displacements of the three models with BNs were similar and smaller than that of the triple CS fracture model. In the fracture healing models with and without three CSs, the greatest stress concentration was scattered among the lowest screw tail, femoral calcar region, and lateral femur shaft. The displacement and stress distributions in both models are generally consistent. The stress distribution and displacement of the three healed femoral models with BNs were essentially identical to the healing models with three CSs. The maximum von Mises stresses were 65.94 MPa (B), 64.61 MPa (C), and 66.99 MPa (D) while the maximum displacements of the three healed femoral models were 2.49 mm (B), 2.56 mm (C), and 2.49 mm (D), respectively. Conclusions Bioceramic nails offer greater advantages than conventional canulated screws after femoral neck fractures. However, the combination of bioceramic nails and CSs is more clinically realistic; replacing all internal fixations with bioceramic nails after the healing of femoral neck fractures can solve the problem of sclerosis formation around CSs and improve bone reconstruction by their bioactivity.

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“…In addition, trabecular plates were more involved in bone remodeling and played a leading role in sustaining the external load. Therefore, trabeculae around the screw may be partially converted from rods into plates, concentrating and thickening to form plate sclerotic bone, to withstand a larger external load [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Since little information was available on the sclerotic region around the screws, we used micro-CT to assess the changes in bone microstructure in the different regions of femoral head specimens that had undergone osteonecrosis [ 12 ]. Samples were divided into necrotic collapse, sclerotic, and relatively healthy regions (as shown in Fig.…”

Section: Methodsmentioning

confidence: 99%

Comparison of femoral mechanics before and after internal fixation removal and the effect of sclerosis on femoral stress: a finite element analysis

Liu

Song

Liang

et al. 2022

BMC Musculoskelet Disord

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Background Femoral neck fractures are a common traumatic injury. The removal of the internal fixation remains controversial, especially in terms of mechanical stability. Moreover, collapsed necrosis of the femoral head continues to occur after fracture healing. We believe that sclerotic cancellous bone (SCB) formation around the screw is associated with femoral head necrosis. We aimed to compare mechanical features before and after implant removal and determine the effect of SCB formation on stress distribution. Methods Cylindrical cancellous bone sections were collected from a relatively normal region and an SCB region of a necrotic femoral head, and their elastic moduli were measured. Four femoral finite element models were developed: a) femoral neck fracture healing with implants, b) fracture healing without implants, c) sclerosis around the screw with implants, and d) sclerosis around the screw without implants. Results The maximum von Mises peak stresses of models a and b were 66.643 MPa and 63.76 MPa, respectively, and were concentrated in the upper lateral femur. The main stress was scattered at the lowest screw tail, femoral calcar region, and lateral femur shaft. Moreover, coronal plane strain throughout the screw paths near the femoral head in models a and b was mostly in the range of 1000–3000 με. The maximum stress concentrations in models c and d were located at the lower femoral head and reached 91.199 MPa and 78.019 MPa, respectively. Conclusions The stresses in the sclerotic model around the cannulated screws are more concentrated on the femoral head than in the healing model without sclerotic bone. The overall stresses in the healing femoral neck fracture model were essentially unchanged before and after removal of the internal fixation.

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Micro‐Computed Tomography Analysis of Femoral Head Necrosis After Long‐Term Internal Fixation for Femoral Neck Fracture

Cited by 7 publications

References 22 publications

Integrated proteomics and metabolomics analysis of sclerosis-related proteins and femoral head necrosis following internal fixation of femoral neck fractures

Integrated proteomics and metabolomics analysis of sclerosis-related proteins and femoral head necrosis following internal fixation of femoral neck fractures

Prevention of sclerosis around cannulated screw after treatment of femoral neck fractures with bioceramic nails: a finite element analysis

Comparison of femoral mechanics before and after internal fixation removal and the effect of sclerosis on femoral stress: a finite element analysis

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