Optimum Configuration of Cannulated Compression Screws for the Fixation of Unstable Femoral Neck Fractures: Finite Element Analysis Evaluation

Li, Jiantao; Wang, Menglin; Zhou, Jianfeng; Han, Lin; Zhang, Hao; Li, Chen; Li, Lianting; Hao, Ming

doi:10.1155/2018/1271762

Cited by 41 publications

(28 citation statements)

References 25 publications

(27 reference statements)

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“…Due to the unique anatomical structure of the femoral neck, the incidence of postoperative complications (fracture nonunion, femoral head necrosis, and deformity healing) can reach up to 40% 2,26 . And the optimal configuration of the screws is controversial 15,27,28 . One of the factors that greatly affect the configuration is the 3D shape of the femoral neck, especially the shape of the cross‐section of the FNI.…”

Section: Discussionmentioning

confidence: 99%

The Oval‐like Cross‐section of Femoral Neck Isthmus in Three‐dimensional Morphological Analysis

Zhang

Zhao

et al. 2021

Orthopaedic Surgery

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Objectives To investigate the cross‐section shape of the femoral neck isthmus (FNI) in three‐dimensional reconstruction model of the femoral neck. Methods From December 2009 to December 2012, computed tomography (CT) data of bilateral hip joint from 200 consecutive patients (137 males and 63 females, 69.41 ± 9.21 years old, ranged from 50–85 years old) who underwent surgical treatments for proximal femoral fracture were retrospectively reviewed. The 3D model of the proximal femur was reconstructed, and the “inertia axis” method, which was applied to measure the long and short axes of the cross‐section of the FNI, was established. The cross‐sectional area and perimeter were calculated by a formula using the length of the long and short axes and then compared with the actual measured values by the software. Correlation between the descriptive parameters of the FNI cross‐section (area, perimeter, and eccentricity) and patients' demographics (age, height, and weight) was analyzed. Stepwise linear regression analysis was used to determine the main relevant factors. Results The ICC results showed excellent data reproducibility ranged from 0.989 to 0.996. There was no significant difference in the cross‐sectional area of the FNI between the actual measured values and the predicted values using the formula (732.83 ± 126.74 mm2 vs 731.62 ± 128.15 mm2, P = 0.322). The perimeter using the two methods showed narrow while significant difference (97.86 ± 8.60 mm vs 92.84 ± 8.65 mm, P < 0.001), the actual measured values were about 5 mm greater than the predicted values. The parameters (area, perimeter, and eccentricity) were significantly larger in male than female (P < 0.001). A positive correlation between the cross‐sectional area, perimeter, height, and weight was observed. The stepwise linear regression analysis showed that the regression equation of the FNI area was as follows: Y = −1083.75 + 1033.86 × HEIGHT + 1.92 × WEIGHT, R2 = 0.489. Conclusion The cross‐section shape of the FNI appears to be oval‐like in the 3D model, which is separated according to the inertia axis, and the findings proposed an anatomical basis for the further study of the spatial configuration of cannulated screws in the treatment of femoral neck fractures.

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Section: Discussionmentioning

confidence: 99%

The Oval‐like Cross‐section of Femoral Neck Isthmus in Three‐dimensional Morphological Analysis

Zhang

Zhao

et al. 2021

Orthopaedic Surgery

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“…Closed reduction and internal xation have become the standard methods for the treatment of femoral neck fractures in patients 60 years of age or younger. Fixation with three parallel cannulated screws placed in an inverted triangle con guration, is a common method for femoral neck fracture 7 . If complication didn't occur, the patient can resume normal activities.…”

Section: Discussionmentioning

confidence: 99%

A Simple and Effective Guide Device for Femoral Neck Fracture Fixed With Cannulated Screw Fixation

Ren¹,

ma²,

Gao³

et al. 2020

Preprint

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Background: Accurate placement of cannulated screws is the key to stable fixation of the femoral neck fracture. A simple guide device was developed to improve the accuracy of screw placement.Methods: 40 synthetic femoral bones were divided into conventional technique group and the experimental group. Three Kirschner wire were inserted into the femoral neck fracture by conventional technique or by the simple guide device. The operative time, total drilling times and fluoroscopic frequency were evaluated.Results: By using the guide device, the fluoroscopy and operation time of the experimental group were shorter that of the conventional method. The total drilling times with the simple guide device were significantly lower than the conventional technique group. Conclusions: The use of this guide device can make screw fixation for femoral neck fracture easier. This is helpful for an inexperienced hand.

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“…Concerning the selection of the internal fixation model, the more stable fixation method is the inverted triangle parallel hollow compression screw fixation, which has been confirmed in many studies. [19] Previous studies on finite element analysis of femoral neck fractures were limited to the selection of internal fixators and configurations. [20]…”

Section: Discussionmentioning

confidence: 99%

A quantitative biomechanical study of positive buttress techniques for femoral neck fractures

Wang

Tang

et al. 2019

Chinese Medical Journal

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Background:Refractory femoral neck fractures cannot be anatomically reduced by closed traction reduction which may affect fracture healing. We evaluated the biomechanical effects of positive, negative, and anatomic reduction of various degrees of displacement in Pauwels I femoral neck fractures by a finite element analysis.Methods:Five reduction models of Pauwels type I femoral neck fracture were established using the Mimics 17.0 (Materialize, Leuven, Belgia) and Hypermesh 12.0 (Altair Engineering, Troy, MI, USA). According to the degree of fracture displacement, there were three models of positive support, an anatomic reduction model, and a negative 2 mm reduction model. Finite element analysis was conducted using the ABAQUS 6.9 software (Simulia, Suresnes, France). The von Mises stress distribution and the stress peak of internal fixation in different models, the displacement between fracture blocks, and the principal strain of the femoral neck cancellous bone model were recorded under the axial stress of 2100 N.Results:The peak von Mises stress on screw of each model was located at the thread of the screw tip. The peak von Mises stress was the lowest at the tip of the anatomic reduction model screw (261.2 MPa). In the positive 4 mm model, the von Mises stress peak was the highest (916.1 MPa). The anatomic reduction model showed the minimum displacement (0.388 mm) between fracture blocks. The maximum displacement was noted in the positive 4 mm model (0.838 mm). The displacement in the positive 3 mm model (0.721 mm) was smaller than that in the negative 2 mm model (0.786 mm). Among the five models, the strain area of the femoral neck cancellous bone was mainly concentrated around the screw hole, and the area around the screw hole could be easily cut.Conclusions:Compared with negative buttress for femoral neck fracture, positive buttress can provide better biomechanical stability. In Pauwel type I fracture of femoral neck, the range of positive buttress should be controlled below 3 mm as far as possible.

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Optimum Configuration of Cannulated Compression Screws for the Fixation of Unstable Femoral Neck Fractures: Finite Element Analysis Evaluation

Cited by 41 publications

References 25 publications

The Oval‐like Cross‐section of Femoral Neck Isthmus in Three‐dimensional Morphological Analysis

The Oval‐like Cross‐section of Femoral Neck Isthmus in Three‐dimensional Morphological Analysis

A Simple and Effective Guide Device for Femoral Neck Fracture Fixed With Cannulated Screw Fixation

A quantitative biomechanical study of positive buttress techniques for femoral neck fractures

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