Relative instability ratios of bone wall defects in trochanteric hip fractures: A finite element analysis

Abstract

Background: For decades, medial and lateral wall fragments of trochanteric hip fractures were considered two pivotal factors that could influence the stability of postoperative femur-implant complex. However, most studies seemed to misunderstand the concept of the posteromedial fragment and equated it with the medial wall, which overlooked vital roles of the anteromedial wall. Roles of the posterior coronal bone fragment were also highlighted in some research. However, influences of the bone walls above the trochanteric fracture instability are yet to be investigated and quantified by means of finite element analysis.Methods: Eight trochanteric fracture fixation models with different wall defects were constructed. Outcome indicators were the von Mises stress of the implant models, the maximum/minimum principal strain, the risky tensile/compressive volume and the volume ratios of the bone models, the femoral head vertex displacement, and the fracture surface gap. Based on these indicator values, the relative instability ratios were computed.Results: Outcome indicators, absolute values, and nephograms of all models showed the same upward and concentrating trends with exerted hip contact loads shifting from static walking to dynamic climbing. Similarly, these indicators also exhibited the same trends when the eight models were solved in sequence. Moreover, the relative instability ratio of the medial wall (100%), particularly the anteromedial part (78.7%), was higher than the figure for the lateral wall (36.6%).Conclusion: The anteromedial wall played relatively pivotal stabilizing roles in trochanteric hip fractures compared with the posteromedial wall and the lateral wall, which indicated that orthopedic surgeons should attach more importance to the anteromedial cortex support in an operating theatre.

Anteromedial Cortical Support in Reduction of Trochanteric Hip Fractures

“…Experimental studies have underscored the greater importance of the anteromedial wall compared with the posteromedial wall. Yang et al 43 revealed that the anteromedial wall accounted for 78.7% of the medial wall stability, whereas the posteromedial wall contributed only 21.3%. Moreover, 3D-mapping studies of fracture lines by Li et al 47 and Zhang et al 48 discovered that the posteromedial wall frequently exhibited comminution, whereas the anteromedial wall was typically more intact, often displaying just 1 simple fracture line.…”

“…Experimental studies have demonstrated that the medial wall plays a more important role in maintaining stability compared with the lateral wall. In a finite element analysis study involving 8 trochanteric fracture models, Yang et al 43 observed that the influence of a lateral wall defect on stability was only 36.6% of that caused by a medial wall defect. Through biomechanical investigations of 6 pairs of cadaveric models, Nie et al 44 determined that the femora with a lateral wall defect had a mean failure load (and standard deviation) of 1,596.78 ± 273.17 N, whereas the femora with a medial wall defect exhibited a significantly lower failure load at 476.05 ± 138.85 N (p < 0.001).…”