Vertically Oriented Femoral Neck Fractures: A Biomechanical Comparison of 3 Fixation Constructs

Johnson, Joey P.; Borenstein, Todd; Waryasz, Gregory R.; Klinge, Stephen A.; McClure, Philip K.; Chambers, Alison; Hayda, Roman A.; Born, Christopher T.

doi:10.1097/bot.0000000000000836

Cited by 37 publications

(17 citation statements)

References 28 publications

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“…Johnson et al10) reported that the group utilizing one calcar transverse 6.5-mm partially threaded screw with two parallel 6.5-mm screws showed an average maximum failure load of 3,870 N. In comparison, the group using the three inverted triangular 6.5-mm screws had an average maximum failure load of 3,756 N ( p = 0.7669). In the 130° DHS and two-hole side plate with one 6.5-mm cannulated screw group, the average maximum failure load was significantly higher than that in the other groups.…”

Section: Resultsmentioning

confidence: 99%

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Biomechanical Evaluation of Internal Fixation of Pauwels Type III Femoral Neck Fractures: A Systematic Review of Various Fixation Methods

et al. 2019

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Background The purpose of this systematic review was to investigate various fixation methods or implants used in the treatment of Pauwels type III femoral neck fractures. Methods PubMed Central, OVID Medline, Cochrane Collaboration Library, Web of Science, Embase, and AHRQ databases were searched to identify relevant studies published until August 2017 with English language restriction. Studies were selected on the basis of the following inclusion criteria: biomechanical study of Pauwels type III femoral neck fractures and the use of dynamic hip screw (DHS) or multiple screw fixation or other devices for fixation of the fracture. Results A total of 15 studies were included in the systematic review. Eight studies were conducted using cadavers, six studies using sawbones, and one using a finite element model. During the mechanical testing, each study measured mechanical stiffness, failure to cyclic loading, failure to vertical loading of each fixation device. DHS was included in 11 studies, multiple screw fixation in 10 studies, and other devices in six studies. Baitner et al. and Samsami et al. reported that the mechanical stiffness of DHS was superior to three inverted triangular screw fixation. Hawks et al. and Gumustas et al. reported that using a transverse calcar screw can withstand vertical loading better than three inverted triangular screw fixation. In addition, there were some studies where instruments such as Intertan nail, locking plate or other devices showed excellent biomechanical properties. Conclusions There are a variety of methods and instruments for fixation of the Pauwels type III fractures. However, it is difficult to conclude that any method is more desirable because there are advantages and disadvantages to each method. Therefore, we should pay attention to the implant choice and consider adequate weight bearing affecting the stiffness of the implant.

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Section: Resultsmentioning

confidence: 99%

“…Therefore, stable fixation of a Pauwels type III femoral neck fracture with an angle greater than 70° is often difficult to achieve 13). To overcome this difficulty, various implants including the dynamic hip screw (DHS) and blade type DHS (DHS-blade) have been used for fixation of this type of fracture 45678910111213)…”

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confidence: 99%

Biomechanical Evaluation of Internal Fixation of Pauwels Type III Femoral Neck Fractures: A Systematic Review of Various Fixation Methods

et al. 2019

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“…Although multiple cannulated screws may effectively manage most of displaced FNFs, DHS was recommended for vertical and highly comminuted unstable fractures [ 27 , 34 ]. The addition of a derotational screw has been shown to improve the mechanical stability of FNFs [ 35 , 36 ]. In a biomechanical study, Samsami et al [ 37 ] demonstrated that there was a significant difference between DHS+DS and CSS in axial femoral head displacement (0.94 mm vs. 2.3 mm) and average displacement of fracture fragments (1.5 μ m vs. 70 μ m), which indicated that DHS+DS had a more stable fixation than CCS for FNFs.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome and Biomechanical Analysis of Dynamic Hip Screw Combined with Derotation Screw in Treating Displaced Femoral Neck Fractures Based on Different Reduction Qualities in Young Patients (≤65 Years of Age)

Zhu

Zhang

et al. 2022

BioMed Research International

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Objective. To examine the clinical results and biomechanical mechanism of the dynamic hip screw (DHS) and derotation screw (DS) in the treatment of displaced femoral neck fractures (FNF) based on different reduction qualities in young patients (≤65 years of age). Methods. All patients with FNF who received closed reduction and internal fixation with DHS+DS from January 2014 to August 2019 were retrospectively analyzed. Data on demographics, surgery, clinical outcomes, and postoperative complications were collected. According to the reduction quality immediately after surgery, all patients were categorized into the positive buttress reduction group (PBRG) and the anatomical reduction group (ARG). The complications and clinical outcomes were compared between the two groups. Meanwhile, the biomechanical mechanism of different reduction qualities was further analyzed with finite element analysis (FEA). The distribution of von Mises stress, the peak stress of internal fixation, and the displacement of the proximal fragment were compared between the two groups. Results. A total of 68 patients were included in our study. Among them, 31 were divided into the PBRG while 37 were in the ARG. The surgical time and fluoroscopy time were significantly shorter in the PBRG than in the ARG ( p < 0.05 ). The degree of femoral neck shortening and the varus change of the femoral-neck shaft angle were lower in the PBRG compared to the ARG ( p < 0.05 ). The excellent-good rate of the Harris hip score was higher in the PBRG compared to the ARG (83.9% vs. 64.8%). The FEA results demonstrated that the stress of DHS+CS and the downward displacement of the proximal femoral neck fragment were greater in the ARG than in the PBRG. Conclusion. For displaced FNF with difficulty to achieve reduction, DHS+CS combined with positive buttress reduction was an effective treatment in young patients due to better mechanical support, shorter surgical time, less radiation exposure, and higher excellent-good rate of Harris hip score.

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“…To compare different fixation methods using a standardized protocol, we developed a 3D printed synthetic bone model to compare static biomechanical properties regarding three different types of K-wire fixation methods [ 32 ]. Additionally, we aimed to develop a method that can be easily reproduced, and the models can be shared with other experts.…”

Section: Introductionmentioning

confidence: 99%

Development of a Novel X-ray Compatible 3D-Printed Bone Model to Characterize Different K-Wire Fixation Methods in Support of the Treatment of Pediatric Radius Fractures

et al. 2021

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Additive manufacturing technologies are essential in biomedical modeling and prototyping. Polymer-based bone models are widely used in simulating surgical interventions and procedures. Distal forearm fractures are the most common pediatric fractures, in which the Kirschner wire fixation is the most widely used operative method. However, there is still lingering controversy throughout the published literature regarding the number of wires and sites of insertion. This study aims to critically compare the biomechanical stability of different K-wire fixation techniques. Different osteosyntheses were reconstructed on 189 novel standardized bone models, which were created using 3D printing and molding techniques, using PLA and polyurethane materials, and it has been characterized in terms of mechanical behavior and structure. X-ray imaging has also been performed. The validation of the model was successful: the relative standard deviations (RSD = 100 × SD × mean−1, where RSD is relative standard deviation, SD is the standard deviation) of the mechanical parameters varied between 1.1% (10° torsion; 6.52 Nm ± 0.07 Nm) and 5.3% (5° torsion; 4.33 Nm ± 0.23 Nm). The simulated fractures were fixed using two K-wires inserted from radial and dorsal directions (crossed wire fixation) or both from the radial direction, in parallel (parallel wire fixation). Single-wire fixations with shifted exit points were also included. Additionally, three-point bending tests with dorsal and radial load and torsion tests were performed. We measured the maximum force required for a 5 mm displacement of the probe under dorsal and radial loads (means for crossed wire fixation: 249.5 N and 355.9 N; parallel wire fixation: 246.4 N and 308.3 N; single wire fixation: 115.9 N and 166.5 N). We also measured the torque required for 5° and 10° torsion (which varied between 0.15 Nm for 5° and 0.36 Nm for 10° torsion). The crossed wire fixation provided the most stability during the three-point bending tests. Against torsion, both the crossed and parallel wire fixation were superior to the single-wire fixations. The 3D printed model is found to be a reliable, cost-effective tool that can be used to characterize the different fixation methods, and it can be used in further pre-clinical investigations.

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Vertically Oriented Femoral Neck Fractures: A Biomechanical Comparison of 3 Fixation Constructs

Cited by 37 publications

References 28 publications

Biomechanical Evaluation of Internal Fixation of Pauwels Type III Femoral Neck Fractures: A Systematic Review of Various Fixation Methods

Biomechanical Evaluation of Internal Fixation of Pauwels Type III Femoral Neck Fractures: A Systematic Review of Various Fixation Methods

Clinical Outcome and Biomechanical Analysis of Dynamic Hip Screw Combined with Derotation Screw in Treating Displaced Femoral Neck Fractures Based on Different Reduction Qualities in Young Patients (≤65 Years of Age)

Development of a Novel X-ray Compatible 3D-Printed Bone Model to Characterize Different K-Wire Fixation Methods in Support of the Treatment of Pediatric Radius Fractures

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