Bone cement augmented proximal femoral nail antirotation for type A3.3 intertrochanteric femoral fractures in elderly: a finite element analysis

doi:10.3969/j.issn.2095-4344.2795

Abstract

Abstract:

BACKGROUND: Osteoporosis and fracture type are two important reasons for the failure of internal fixation of proximal femoral nail antirotation. Type AO31-A3.3 intertrochanteric fracture, because of its involvement in the lateral wall, greatly increased the instability of the fracture. In addition, the elderly are mostly osteoporosis patients, so failure and postoperative complications of internal fixation of proximal femoral nail antirotation in the elderly with type AO31-A3.3 intertrochanteric fracture are higher.

OBJECTIVE: To explore the difference of biomechanics between bone cement augmented and common proximal femoral nail antirotation in the treatment of type AO31-A3.3 intertrochanteric fracture.

METHODS: CT data of one 75-year-old volunteer with intertrochanteric fracture were selected to import into Mimics 19.0 and Geomagic studio 2017 software to extract and optimize the three-dimensional model of the right femur. SolidWorks 2017 software was used to draw the internal fixation model and assemble it with the femur model according to the standard operation technology. The model was imported into Hypermesh 14.0 software to cut the bone to obtain the type AO31-A3.3 model with common proximal femoral nail antirotation. The cancellous bone around the proximal end of the screw blade was redefined as bone cement, which is the model of bone cement augmented proximal femoral nail antirotation. The material property parameters, boundary conditions and applied loads were set up and stored as K files respectively and imported into LS-DYNA software for solution.

RESULTS AND CONCLUSION: (1) Compared with the common proximal femoral nail antirotation, the treatment of the elderly type AO31-A3.3 intertrochanteric fracture with the bone cement augmented proximal femoral nail antirotation has the advantages of lighter cutting degree of the screw blade, smaller varus, rotation angle and displacement of the femoral head and neck bone block, and better biomechanical effect. (2) The complete lateral wall can effectively support the femoral head and neck bone block and resist the skull and neck bone block as the lateral action point of three-point support. The pronation and rotation tendency can effectively prevent the head and neck screws from withdrawing. (3) The strong anchoring force of bone cement can stabilize the screw blade, enhance the internal action point of three-point support, and conduct and disperse the pressure.

Key words: bone cement augmented, proximal femoral nail antirotation, osteoporosis, type AO31-A3.3 intertrochanteric femoral fracture, internal fixation, finite element analysis

CLC Number:

Chen Xinmin, Luo Sijia, Xia Zhuowei, Lin Ziling, Zheng Liqin, Li Musheng.

Bone cement augmented proximal femoral nail antirotation for type A3.3 intertrochanteric femoral fractures in elderly: a finite element analysis [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(27): 4265-4271.

Figures/Tables 8

References

[1] WANG J, WANG Y, LIU WD, et al. Hip fractures in Hefei, China: the Hefei osteoporosis project. J Bone Miner Metab. 2014; 32(2): 206-214.

[2] XIA WB, HE SL, XU L, et al. Rapidly increasing rates of hip fracture in Beijing, China. J Bone Miner Res. 2012;27(1): 125-129.

[3] HERNLUND E, SVEDBOM A, IVERGÅRD M, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013; 8: 136.

[4] ADIB HAJBAGHERY M, ABBASINIA M. Quality of life of the elderly after hip fracture surgery: a case-control study. J Caring Sci. 2013;2(1): 53-59.

[5] CLOSE JD, SWARTZ K, DEU R. Hip fracture in older patients: tips and tools to speed recovery. J Fam Pract. 2013; 62(9): 484-492.

[6] WANG J, MA JX, LU B, et al. Comparative finite element analysis of three implants fixing stable and unstable subtrochanteric femoral fractures: proximal femoral nail antirotation (pfna), proximal femoral locking plate (pflp), and reverse less invasive stabilization system (liss). Orthop Traumatol Surg Res. 2019.

[7] GUO Y, YANG HP, DOU QJ, et al. Efficacy of femoral nail anti-rotation of helical blade in unstable intertrochanteric fracture. Eur Rev Med Pharmacol Sci. 2017;21(3 Suppl): 6-11.

[8] VÉLEZ M, PALACIOS-BARAHONA U, ARANGO-POSADA MM, et al. Functional results and complications of the use of the proximal femoral nail in the treatment of intertrochanteric hip fractures. Acta Ortop Mex. 2018;32(3): 126-130.

[9] XU R, RU J, JI F, et al. Comparison of efficacy, complications and TGF-β2 expression between DHS and PFNA in elderly patients with osteoporotic femoral intertrochanteric fracture. Exp Ther Med. 2018; 16(1): 394-399.

[10] FOGAGNOLO F, KFURI M JR, PACCOLA CA. Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail. Arch Orthop Trauma Surg. 2004; 124(1): 31-37.

[11] 武政,刘向栋,常宝生. PFNA治疗高龄不稳定性股骨转子间骨折内固定失败的危险因素分析[J]. 局解手术学杂志,2017,26(8): 616-619.

[12] 段志斌. 股骨近端防旋髓内钉术后螺旋刀片穿出股骨头的影响因素分析[D]. 南昌:南昌大学,2018.

[13] 王茂林,易志坚,卢明刚,等.防旋股骨近端髓内钉治疗股骨粗隆间骨折术后失效原因分析[J]. 中国骨与关节杂志,2019,8(7): 504-507.

[14] KIM Y, BAHK WJ, YOON YC, et al. Radiologic healing of lateral femoral wall fragments after intramedullary nail fixation for A3.3 intertrochanteric fractures. Arch Orthop Trauma Surg. 2015;135(10): 1349-1356.

[15] GUPTA RK, SANGWAN K, KAMBOJ P, et al. Unstable trochanteric fractures: the role of lateral wall reconstruction. Int Orthop. 2010;34(1): 125-129.

[16] 曾秋涛,赵洪斌,林勇,等.带孔螺旋刀片骨水泥增强型PFNA治疗转子间骨折的疗效分析[J]. 江西医药, 2017,52(12): 1330-1331.

[17] 王兆稳,袁治国,白登彦,等. PFNA联合骨水泥注入治疗老年骨质疏松性股骨粗隆间骨折[J].甘肃医药,2017,36(12):1048-1050.

[18] 何祥鑫,林梓凌,李鹏飞,等. 基于Hypermesh 14.0和LS-DYNA的老年转子间骨折有限元建模分析[J].中国组织工程研究,2018, 22(11):1725-1730.

[19] 郑利钦,林梓凌,何祥鑫,等.动态载荷下股骨转子间区域皮质骨厚度对骨折类型影响的有限元分析[J].医学研究生学报,2018, 31(10):1043-1046.

[20] MORGAN EF, KEAVENY TM. Dependence of yield strain of human trabecular bone on anatomic site. J Biomech, 2001, 34(5): 569-577.

[21] KAWABATA Y, MATSUO K, NEZU Y, et al. The risk assessment of pathological fracture in the proximal femur using a CT-based finite element method. J Orthop Sci, 2017, 22(5): 931-937.

[22] MA Z, CHEN J, LAN F. Biomechanical response and injury of occupant's pelvis in side impacts: effects of the femoral head and loading conditions. J Mech Med Biol. 2014;14(6): 1440001.

[23] YENI YN, BROWN CU, NORMAN TL. Influence of bone composition and apparent density on fracture toughness of the human femur and tibia. Bone, 1998, 22(1): 79-84.

[24] MCCALDEN RW, MCGEOUGH JA, BARKER MB, et al. Age-related changes in the tensile properties of cortical bone. The relative importance of changes in porosity, mineralization, and microstructure. J Bone Joint Surg Am.1993;75(8): 1193-1205.

[25] DONG XN, GUO XE. The dependence of transversely isotropic elasticity of human femoral cortical bone on porosity. J Biomech.2004;37(8):1281-1287.

[26] BAYRAKTAR HH, MORGAN EF, NIEBUR GL, et al. Comparison of the elastic and yield properties of human femoral trabecular and cortical bone tissue. J Biomech. 2004; 37(1): 27-35.

[27] SHIBO G, XUANHUI Q, XINBO H, et al. Powder injection molding of Ti-6Al-4V alloy. J Mater Proc Technol. 2006;173(3): 310-314.

[28] HINÜBER C, KLEEMANN C, FRIEDERICHS RJ, et al. Biocompatibility and mechanical properties of diamond-like coatings on cobalt-chromium-molybdenum steel and titanium-aluminum-vanadium biomedical alloys. J Biomed Mater Res A. 2010;95(2): 388-400.

[29] GOFFIN JM, PANKAJ P, SIMPSON AH, et al. Does bone compaction around the helical blade of a proximal femoral nail anti-rotation (PFNA) decrease the risk of cut-out?: A subject-specific computational study. Bone Joint Res. 2013; 2(5): 79-83.

[30] CARNEY KS, PEREIRA JM, REVILOCK DM, et al. Jet engine fan blade containment using an alternate geometry. Int J Impact Eng. 2009; 36(5):720-728.

[31] HELGASON B, VICECONTI M, RÚNARSSON TP, et al. On the mechanical stability of porous coated press fit titanium implants: a finite element study of a pushout test. J Biomech. 2008;41(8): 1675-1681.

[32] BOBBILI R, RAMAKRISHNA B, MADHU V. Dynamic compressive behavior and fracture modeling of Titanium alloy IMI 834. J Alloys Comp. 2017;714:225-231.

[33] DHANOPIA A, BHARGAVA M. Finite element analysis of human fractured femur bone implantation with PMMA thermoplastic prosthetic plate. Proc Eng. 2016;173: 1658-1665.

[34] 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.

[35] 武建超,师政伟,李吉鹏,等.股骨粗隆间骨折外侧壁损伤的研究进展[J].中国修复重建外科杂志, 2018,21(12):1605-1610.

[36] HAN L, LIU JJ, HU YG, et al. Controlled study on Gamma nail and proximal femoral locking plate for unstable intertrochanteric femoral fractures with broken lateral wall. Sci Rep. 2018;8(1): 11114.

[37] HU SJ, ZHANG SM, YU GR. Treatment of femoral subtrochanteric fractures with proximal lateral femur locking plates. Acta Ortop Bras.2012;20(6): 329-333.

[38] 陈鹏,傅德皓.股骨近端防旋髓内钉治疗老年股骨转子间骨折内固定失败原因分析[J]. 中国修复重建外科杂志, 2019,33(10): 1270-1274.

[39] 张世民,马卓,杜守超.股骨近端外侧壁的解剖学研究及其对转子间骨折内固定的意义[J]. 中国临床解剖学杂志, 2016, 34(1): 39-42.

[40] STOCKS GW. Treatment of reverse obliquity fractures of the intertrochanteric region of the femur. J Bone Joint Surg Am. 2002;84(5): 869-870.

[41] 王嘉嘉,徐美涛,张帅,等.经皮加压钢板治疗老年患者股骨逆粗隆间骨折17例临床观察[J]. 海军医学杂志, 2017,38(4):346-349.

[42] 王炎,汪海滨,史法见,等.PFNA和DHS固定治疗股骨粗隆间骨折的比较[J].中国矫形外科杂志,2019,27(24):2223-2227.

[43] 张景涛,雷卫军,周广伟.PFNA和LPFP在老年股骨粗隆间骨折治疗中的疗效比较[J].中国老年学杂志,2019,39(24):6001-6003.

[44] NIE B,CHEN X,LI J,et al. The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study. J Orthop Surg Res. 2017;12(1):197.

[45] 官煜超,李开南.股骨转子间骨折内侧壁损伤的研究现状[J]. 中国矫形外科杂志,2018,26(12):1116-1119.

[46] GAO Z,LV Y,ZHOU F,et al. Risk factors for implant failure after fixation of proximal femoral fractures with fracture of the lateral femoral wall. Injury. 2018;49(2):315-322.

[47] 李尧,胡传真,茅凌洲,等.股骨近端防旋髓内钉联合小钢板重建外侧壁治疗AO/OTA 31-A3型股骨转子间骨折[J].中国修复重建外科杂志, 2019,33(10):1223-1227.

[48] 姜昊,曹烈虎,潘思华,等.有限切开钛缆捆扎辅助PFNA与单纯微创辅助PFNA治疗老年骨质疏松性31-A3型股骨粗隆间骨折的疗效对比[J]. 中国骨与关节杂志,2019, 8(3):191-195.

[49] 王勇,潘骏.标准骨水泥强化型PFNA治疗老年股骨粗隆间不稳定骨折[J].中国矫形外科杂志, 2018, 26(18):1653-1658.

[50] 张磊,唐晓菊,黄有荣,等. 聚甲基丙烯酸甲酯骨水泥及磷酸钙骨水泥的材料性能及改性的研究进展[J].广西医学,2019,41(16): 2114-2118+2122.