Finite element analysis of proximal femoral nail anti-rotation for treating unstable femoral intertrochanteric fracture under different bones with bone cement augmentation

doi:10.12307/2023.465

Abstract

Abstract: BACKGROUND: For type A3.3 intertrochanteric fractures, proximal femoral nail anti-rotation is the most commonly used treatment. The stability of the fracture end after common proximal femoral nail anti-rotation surgery is not well, and bone cement can play a good stabilizing role.
OBJECTIVE: To simulate the biomechanical effects of bone cement on the treatment of unstable intertrochanteric fractures with different degrees of osteoporosis after proximal femoral nail anti-rotation using the finite element method.
METHODS: A finite element model of a normal right femur was created from CT images using related finite element analysis software. The femur was divided into the proximal femoral bone, lesser trochanter, and femoral body in SolidWorks 2017 software according to the AO31-A3.3 classification. Totally 12 types of fracture models with different degrees of osteoporosis fixed using proximal femoral nail anti-rotation were established in the experimental group. In the control group, 12 types of osteoporotic fracture models were fixed using bone cement augmented proximal femoral nail anti-rotation. The differences in the maximum displacement of the femur, proximal femoral nail anti-rotation, femoral stress, and varus angle between the two groups were observed in ANSYS software.
RESULTS AND CONCLUSION: (1) Under the same bone condition, the displacement of the femoral head, the displacement of the proximal femoral nail anti-rotation and the varus angle of the femoral neck in the control group were lower than those in the experimental group, and the maximum femoral stress value was higher in the control group than that in the experimental group. (2) The change rate of femoral head displacement, proximal femoral nail anti-rotation displacement, and varus angle decreased from 2.94% to 5.89%, 3.23% to 4.79%, and 0.41% to 8.51% with increase in the degree of femur osteoporosis. The maximum stress change rate of the femur increased from 12.2% to 5.74%. (3) These results suggest that in dealing with A3.3 femoral intertrochanteric fractures with different degrees of osteoporosis, cement augmented proximal femoral nail anti-rotation had better mechanical stability than ordinary proximal femoral nail anti-rotation, and the effect was most significant in severe osteoporosis. Moreover, the experimental analysis of bone cement augmented proximal femoral nail anti-rotation is not suitable for normal bone and mild bone loss.

Key words: osteoporosis, bone cement, proximal femoral nail anti-rotation, unstable intertrochanteric fracture, finite element

CLC Number:

Guo Hao, Chen Guangxin, Chen Xiaoqin, Lian Hongyu, Liu Xinwei, Li Zitao. Finite element analysis of proximal femoral nail anti-rotation for treating unstable femoral intertrochanteric fracture under different bones with bone cement augmentation[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(21): 3281-3286.

Figures/Tables 7

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