Finite element analysis of osteoporosis in proximal femur after cannulated screw fixation for femoral neck fracture

doi:10.12307/2023.909

Abstract

Abstract: BACKGROUND: After the internal fixation of cannulated screws in femoral neck fractures, because the affected limb is often unable to bear weight in the short term and the implants with high stiffness have a stress shielding effect on the fracture end, it is easy to cause osteoporosis of the affected limb and changes in the biomechanical distribution of the proximal femur, the incidence of osteonecrosis of the femoral head is high after surgery. At present, few studies have been conducted on the biomechanical effects of osteoporosis at the proximal end of the femur occurring after femoral neck fracture surgery on femoral neck fracture treated with cannulated screws.
OBJECTIVE: Using finite element analysis, to investigate the biomechanical effects of osteoporosis occurring after femoral neck fracture surgery on femoral neck fracture treated with cannulated screws and explore the role of biomechanical factors in osteonecrosis of the femoral head.
METHODS: Based on the obtained CT scan data of the femur in a patient with a femoral neck fracture, a proximal femoral model for internal fixation for femoral neck fracture was established by Mimics 19.0, 3-Matic, UG 11.0, Hypermesh 14.0, and Abaqus software. One finite element model of the proximal femur without osteoporosis and three finite element models of the proximal femur with osteoporosis were analyzed using Abaqus software. The stress, contact pressure, displacement peak and cloud map under different components of the four models were measured and analyzed, and the internal stress changes and distribution of the femoral head were compared and analyzed.

RESULTS AND CONCLUSION: The stresses and contact pressures of the femoral head and lower anterior cannulated screws varied more with the degree of osteoporosis. The peak displacement of the four models increased slowly with the degree of osteoporosis. By one-way analysis of variance, there was no significant effect of the degree of osteoporosis on the peak stress, contact pressure, and displacement of the different components. The internal stress distribution of the femoral head changed with the degree of osteoporosis. Changes in the biomechanical environment of the proximal femur have an important impact on osteonecrosis of the femoral head.

Key words: femur, femoral neck fracture, cannulated screw, internal fixation, osteoporosis, femoral head necrosis, biomechanics, finite element

CLC Number:

Xue Xiaofeng, Wei Yongkang, Qiao Xiaohong, Du Yuyong, Niu Jianjun, Ren Lixin, Yang Huifeng, Zhang Zhimin, Guo Yuan, Chen Weiyi. Finite element analysis of osteoporosis in proximal femur after cannulated screw fixation for femoral neck fracture[J]. Chinese Journal of Tissue Engineering Research, 2024, 28(6): 862-867.

Figures/Tables 6

References

[1] SWART E, ROULETTE P, LEAS D, et al. ORIF or Arthroplasty for Displaced Femoral Neck Fractures in Patients Younger Than 65 Years Old: An Economic Decision Analysis. J Bone Joint Surg Am. 2017;99(1):65-75.
[2] TIAN FM, ZHANG L, ZHAO HY, et al. An increase in the incidence of hip fractures in Tangshan, China. Osteoporos Int. 2014;25(4):1321-1325.
[3] 张长青,张英泽,余斌,等.成人股骨颈骨折诊治指南[J].中华创伤骨科杂志,2018,20(11):921-928.
[4] 徐凯航,纪方.青壮年股骨颈骨折的治疗进展[J].中华创伤骨科杂志,2020,22(6):549-552.
[5] SLOBOGEAN GP, SPRAGUE SA, SCOTT T, et al. Complications following young femoral neck fractures. Injury. 2015;46(3):484-491.
[6] STOCKTON DJ, O’HARA LM, O’HARA NN, et al. High rate of reoperation and conversion to total hip arthroplasty after internal fixation of young femoral neck fractures: a population-based study of 796 patients. Acta Orthop. 2019;90(1):21-25.
[7] PATTERSON JT, ISHII K, TORNETTA P 3RD, et al. Open Reduction Is Associated With Greater Hazard of Early Reoperation After Internal Fixation of Displaced Femoral Neck Fractures in Adults 18-65 Years. J Orthop Trauma. 2020;34(6):294-301.
[8] SLOBOGEAN GP, STOCKTON DJ, ZENG B, et al. Femoral Neck Fractures in Adults Treated With Internal Fixation: A Prospective Multicenter Chinese Cohort. J Am Acad Orthop Surg. 2017;25(4):297-303.
[9] LI M, COLE PA. Anatomical considerations in adult femoral neck fractures: how anatomy influences the treatment issues? Injury. 2015; 46(3):453-458.
[10] UEO T, TSUTSUMI S, YAMAMURO T, et al. Biomechanical aspects of the development of aseptic necrosis of the femoral head. Arch Orthop Trauma Surg (1978). 1985;104(3):145-149.
[11] 张永飞,张义修.股骨颈骨折术后股骨头坏死的力学因素[J].骨与关节损伤杂志,2001,16(4):270-272.
[12] KIM YM, LEE SH, LEE FY, et al. Morphologic and biomechanical study of avascular necrosis of the femoral head. Orthopedics. 1991;14(10): 1111-1116.
[13] WANG Y, MA JX, YIN T, et al. Correlation Between Reduction Quality of Femoral Neck Fracture and Femoral Head Necrosis Based on Biomechanics. Orthop Surg. 2019;11(2):318-324.
[14] SUN W, WANG BL, LI ZR, et al. Chinese specialist consensus on diagnosis and treatment of osteonecrosis of the femoral head. Orthop Surg. 2011;3(2):131-137.
[15] YUE Y, YANG H, LI Y, et al. Combining ultrasonic and computed tomography scanning to characterize mechanical properties of cancellous bone in necrotic human femoral heads. Med Eng Phys. 2019;66:12-17.
[16] MA JX, HE WW, ZHAO J, et al. Bone Microarchitecture and Biomechanics of the Necrotic Femoral Head. Sci Rep. 2017;7(1):13345.
[17] CIARELLI MJ, GOLDSTEIN SA, KUHN JL, et al. Evaluation of orthogonal mechanical properties and density of human trabecular bone from the major metaphyseal regions with materials testing and computed tomography. J Orthop Res. 1991;9(5):674-682.
[18] HARP JH, ARONSON J, HOLLIS M. Noninvasive determination of bone stiffness for distraction osteogenesis by quantitative computed tomography scans. Clin Orthop Relat Res. 1994;(301):42-48.
[19] HOBATHO MC, RHO JY, ASHMAN RB. Anatomical variation of human cancellous bone mechanical properties in vitro. Stud Health Technol Inform. 1997;40:157-173.
[20] RHO JY, HOBATHO MC, ASHMAN RB. Relations of mechanical properties to density and CT numbers in human bone. Med Eng Phys. 1995;17(5): 347-355.
[21] 张国栋,廖维靖,陶圣祥,等.股骨有限元分析赋材料属性的方法[J].中国组织工程研究与临床康复,2009,13(43):8436-8441.
[22] LENGSFELD M, SCHMITT J, ALTER P, et al. Comparison of geometry-based and CT voxel-based finite element modelling and experimental validation. Med Eng Phys. 1998;20(7):515-522.
[23] MEI J, LIU S, JIA G, et al. Finite element analysis of the effect of cannulated screw placement and drilling frequency on femoral neck fracture fixation. Injury. 2014;45(12):2045-2050.
[24] ZENG W, LIU Y, HOU X. Biomechanical evaluation of internal fixation implants for femoral neck fractures: A comparative finite element analysis. Comput Methods Programs Biomed. 2020;196:105714.
[25] EBERLE S, GERBER C, VON OLDENBURG G, et al. A biomechanical evaluation of orthopaedic implants for hip fractures by finite element analysis and in-vitro tests. Proc Inst Mech Eng H. 2010;224(10):1141-1152.
[26] TAYLOR ME, TANNER KE, FREEMAN MA, et al. Stress and strain distribution within the intact femur: compression or bending? Med Eng Phys. 1996;18(2):122-131.
[27] TIANYE L, PENG Y, JINGLI X, et al. Finite element analysis of different internal fixation methods for the treatment of Pauwels type III femoral neck fracture. Biomed Pharmacother. 2019;112:108658.
[28] LI J, ZHAO Z, YIN P, et al. Comparison of three different internal fixation implants in treatment of femoral neck fracture-a finite element analysis. J Orthop Surg Res. 2019;14(1):76.
[29] FREITAS A, TOLEDO JÚNIOR JV, FERREIRA DOS SANTOS A, et al. Biomechanical study of different internal fixations in Pauwels type III femoral neck fracture - A finite elements analysis. J Clin Orthop Trauma. 2020 ;14:145-150.
[30] 赵耀,许新忠,程文丹,等.股骨颈动力交叉钉系统内固定治疗股骨颈骨折的早期疗效分析[J].中国骨与关节损伤杂志,2022,37(4): 389-391.
[31] 孙玉生.不同数量空心螺钉内固定治疗股骨颈骨折的有限元分析及生物力学测定[D].蚌埠:蚌埠医学院,2020.
[32] JIANG D, ZHAN S, WANG L, et al. Biomechanical comparison of five cannulated screw fixation strategies for young vertical femoral neck fractures. J Orthop Res. 2021;39(8):1669-1680.
[33] 梁跃闯,李艳军,于鹤童,等.正三角构型, 倒三角构型空心螺钉内固定及股骨颈动力交叉钉系统固定治疗股骨颈骨折的有效性分析[J].创伤外科杂志,2022,24(9):659-664.
[34] 刘俊俊,付建国,柳威,等.三角稳定固定系统对股骨颈骨折生物力学特性的有限元分析[J].中国医学物理学杂志,2021,38(7):893-897.
[35] BHANDARI M, TORNETTA P 3RD, HANSON B, et al. Optimal internal fixation for femoral neck fractures: multiple screws or sliding hip screws? J Orthop Trauma. 2009;23(6):403-407.
[36] TSAO AK, ROBERSON JR, CHRISTIE MJ, et al. Biomechanical and clinical evaluations of a porous tantalum implant for the treatment of early-stage osteonecrosis. J Bone Joint Surg Am. 2005;87 Suppl 2:22-27.
[37] 邱士超,刘利,吴迪.股骨头坏死的生物力学及有限元分析相关研究[J].临床医药文献电子杂志,2019,6(28):43-44.
[38] XIAO D, YE M, LI X, et al. Biomechanics analysis for the treatment of ischemic necrosis of the femoral head by using an interior supporting system. Int J Clin Exp Med. 2015;8(3):4551-4556.
[39] ZHANG Y, TIAN L, YAN Y, et al. Biomechanical evaluation of the expansive cannulated screw for fixation of femoral neck fractures. Injury. 2011;42(11):1372-1376.
[40] 赵春伶,贾少薇,李剑,等.基于 3D 打印多孔支架和植入体的结构设计研究进展[J].医用生物力学,2019,34(4):446-452.
[41] 褚楷,张兴琳,鲁兴,等.股骨颈骨折内固定物取出后股骨头内部微骨折发生风险研究[J].中国修复重建外科杂志,2020,34(9):1091-1095.
[42] 潘显明,胡修德,谭映军,等.82 例青壮年股骨颈骨折治疗结果的评价[J].中华创伤杂志,2000,16(3):145-147.
[43] 王荣升,韩雪,王静,等.股骨颈骨折行闭合复位空心钉内固定后股骨头坏死[J].中国老年学杂志,2020,40(23):4984-4986.
[44] 马剑雄,何伟伟,赵杰,等.股骨头坏死发病机制研究的最新进展[J].中国组织工程研究,2017,21(27):4397.
[45] SEBESTYÉN A, MESTER S, VOKÓ Z, et al. Wintertime surgery increases the risk of conversion to hip arthroplasty after internal fixation of femoral neck fracture. Osteoporos Int. 2015;26(3):1109-1117.
[46] 王义生,李劲峰.股骨头坏死发病机制的研究现状与展望[J].中华实验外科杂志,2020,37(6):1001-1010.
[47] 申洪全,陆慧,张孝华,等.计算机辅助 2 枚空心钉置入内固定治疗股骨颈骨折的生物力学分析[J].中国组织工程研究,2020,24(6): 882-887.
[48] 余霄,张迪峰,宋蒙胜,等.骨质疏松性股骨颈骨折空心钉内固定术后股骨颈短缩对髋关节生物力学影响的有限元分析[J].中华医学杂志,2020,100(33):2628-2632.
[49] PEDERSEN DR, BRAND RA, DAVY DT. Pelvic muscle and acetabular contact forces during gait. J Biomech. 1997;30(9):959-965.