Yukun Xiao , Kui He , Xiaoqi Tan , Daiqing Wei , Jiyuan Yan , Yunkang Yang , Feifan Xiang
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Biomechanical evaluation of implant techniques for ipsilateral femoral neck and shaft fractures: A finite element analysis
Purpose
No consensus has been reached regarding the treatment of ipsilateral femoral neck fractures and femoral shaft fractures (FNF + FSF). This study discusses the stability and differences between multiple single- and dual-implant strategies in the treatment of FNF + FSF and aims to provide a theoretical reference for clinical applications.
Methods
Based on multi-sample finite element analysis, models of basicervical FNF (bFNFs Pauwels III) combined with three different FSFs (proximal (PFSF), middle (MFSF), and distal (DFSF)) were developed. Five implant strategies were established: (A) reconstructive nail (RN), (B) proximal femoral nail antirotation II (PFNA-II), (C) three cannulated compression screws + retrograde intramedullary nail (3CCS + RIN), (D) dynamic hip screw + antirotation screw (DHS + AS) + RIN, and (E) femoral neck system (FNS) + RIN. The biomechanical characteristic of FNF + FSF treated with five strategies were statistically analyzed.
Results
In most cases, there was no significant difference between the single- and dual-implant groups in the FSF gait cycle (at 0° hip joint pressure load or with FNF + MFSF). In other cases, the dual-implant group was predominant. Maximum mean stress of neck-screw: A (235.1 MPa) > B (194.1 MPa) > D (191.5 MPa) > E (181.9 MPa) > C (153.9 MPa) at 30° hip joint loading; A (137.9 MPa) > E (126.3 MPa) > B (105.5 MPa) > D (104.1 MPa) > C (89.30 MPa) at 0°; A (306.3 MPa) > B (261.6 MPa) > D (259.5 MPa) > E (246.2 MPa) > C (217.2 MPa) at −30°. Meanwhile, group C had the lowest fracture interface stress and relative displacement of bFNFs.
Conclusion
Dual-implant strategy for combined fixation, which can effectively strengthen the integral structural stiffness of the femur, is recommended for FNF + FSF. 3CSS and DHS + AS in the dual-implant strategies have better regional stability of bFNFs.
期刊介绍：
The Journal of the Mechanical Behavior of Biomedical Materials is concerned with the mechanical deformation, damage and failure under applied forces, of biological material (at the tissue, cellular and molecular levels) and of biomaterials, i.e. those materials which are designed to mimic or replace biological materials.
The primary focus of the journal is the synthesis of materials science, biology, and medical and dental science. Reports of fundamental scientific investigations are welcome, as are articles concerned with the practical application of materials in medical devices. Both experimental and theoretical work is of interest; theoretical papers will normally include comparison of predictions with experimental data, though we recognize that this may not always be appropriate. The journal also publishes technical notes concerned with emerging experimental or theoretical techniques, letters to the editor and, by invitation, review articles and papers describing existing techniques for the benefit of an interdisciplinary readership.
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