Finite element analysis of the three and four cannulated screws for Pauwels III femoral neck fractures

doi:10.3969/j.issn.2095-4344.2016.26.015

Abstract

Abstract:

BACKGROUND: Femoral neck fracture is mainly fixed by three inverted triangle cannulated screws. Scholars have proposed to add a cannulated screw to enhance the fixation strength of femoral neck fracture of Pauwels III type based on three cannulated screw fixation, but the stability is not verified.

OBJECTIVE: To analyze the biomechanical stability and stress of the three and four cannulated screws for the treatment of the Pauwels III femoral neck fractures.

METHODS: The CT imaging results of the fourth generation of artificial bone sawbones were imported into the Mimics software wherein a three-dimensional finite element model of the proximal femur was prepared and introduced in the 3-matic software. Models of middle segment of femoral neck with Pauwels III fractures were established. Cannulated screw models were established with UG 8.0 software and introduced in the fractures models. Finally, finite element models of Pauwels III femoral neck fractures fixed with three and four screws were established. In the same condition, an axial load of 411 N was applied on the femoral head with Abaqus software. The displacement of two markers of the broken ends and internal fixation system Von Mises stress distribution were compared between the two models.

RESULTS AND CONCLUSION: (1) The displacement was 0.42 mm in three screws model, and 0.17 mm in the four screws model. (2) Von Mises stress peak was 547 MPa and 27.8 MPa in both models. The peak value was lower in models of four screws than that of three screws. Stress concentration position was at the fracture site in both models. The stress range of models of four screws was more extensive and scattered. (3) Finite element analysis results demonstrated that four-screw implantation for Pauwels III femoral neck fractures had strong anti-shearing force and biomechanical stability. Clinical advantages need further clinical comparative study.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Femoral Neck Fractures, Fracture Fixation, Internal, Finite Element Analysis, Tissue Engineering

CLC Number:

R318

Zhang Hao, Shi Xue-feng, Yang Chun-bao, Lv Ji-hong, Xiang Yi, Sun Zhen-jun, Guan Jing-tao, Tang Yong, Xu Li-min. Finite element analysis of the three and four cannulated screws for Pauwels III femoral neck fractures[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(26): 3897-3902.

Figures/Tables 3

References

[1] Zhang Y.Clinical epidemiology of orthopedic trauma. Thieme, Stuttgart & New York,2012.
[2] Gullberg B,Johnell O,Kanis J.World-wide projections for hip fracture.Osteop Tnt.1997;7(5):407-413.
[3] Florschutz AV,Langford JR,Haidukewych GJ,et al. Femoral Neck Fractures: Current Management.J Orthoped Trauma.2015;29(3):121-129.
[4] Pauwels F.Der Schenkelhalsbruch, ein mechanisches Problem. Grundlagen des Heilvorganges. Prognose und kausale Therapie.Z Orthop Chir.1935;6(Suppl 3):157.
[5] Papakostidis C,Panagiotopoulos A,Piccioli A,et al. Timing of internal fixation of femoral neck fractures. A systematic review and meta-analysis of the final outcome. Injury.2015;46(3):459-466.
[6] Slobogean GP,Sprague SA,Scott T,et al. Complications following young femoral neck fractures.Injury. 2015;46(3):484-491.
[7] Wang W,Wei J,Xu Z,et al.Retraction Note: Open reduction and closed reduction internal fixation in treatment of femoral neck fractures: a meta-analysis.BMC Musculoskelet Disord.2015; 16(1):70.
[8] Zhao W,Tu C,Zhang H,et al.[Comparing different treatments for femoral neck fracture of displacement type in the elderly:a meta analysis].Zhonghua Wai Ke Za Zhi.2014;52(4):294-299.
[9] Liporace F,Gaines R,Collinge C,et al.Results of internal fixation of Pauwels type-3 vertical femoral neck fractures.J Bone Joint Surg Am.2009;90(8): 1654-1659.
[10] 高悠水,陈松,周祖彬,等. Pauwels 3型股骨颈骨折的手术治疗46例分析[J].中国骨与关节杂志,2015,4(2): 96-100.
[11] Gümüstas SA,Tosun HB,Agir I,et al.Influence of number and orientation of screws on stability in the internal fixation of unstable femoral neck fractures.Acta Orthop Traumatol Turc.2014;48(6): 673-678.
[12] Althausen PL,Kurnik CG,Shields T,et al.Clinical and economic impact of using generic 7.3-mm cannulated screws at a level II trauma center.Am J Orthop(Belle Mead, NJ).2014;43(9):405-410.
[13] Khoo C,Haseeb A,Ajit Singh V.Cannulated Screw Fixation For Femoral Neck Fractures : A 5-year Experience In A Single Institution.Malays Orthop J.2014;8(2):14-21.
[14] Duckworth AD,Bennet SJ,Aderinto J,et al.Fixation of intracapsular fractures of the femoral neck in young patients: risk factors for failure.J Bone Joint Surg Br. 2011;93(6):811-816.
[15] Huang HK,Su YP,Chen CM,et al. Displaced femoral neck fractures in young adults treated with closed reduction and internal fixation.Orthopedics. 2010; 33(12):873.
[16] Carpintero P,Caeiro JR,Carpintero R,et al. Complications of hip fractures: A review. World J Orthop.2014;5(4):402.
[17] Pauyo T,Drager J,Albers A,et al.Management of femoral neck fractures in the young patient: A critical analysis review.World J Orthop.2014;5(3):204.
[18] Su E,Su S.Femoral neck fractures A Changing Paradigm.Bone Joint J.2014;96(11 Supple A):43-47.
[19] Akiyama H,Yamamoto K,Kaneuji A,et al.In-vitro characteristics of cemented titanium femoral stems with a smooth surface finish.J Orthop Sci.2013;18(1): 29-37.
[20] Chen SH,Yu TC,Chang CH,et al. Biomechanical analysis of retrograde intramedullary nail fixation in distal femoral fractures.Knee.2008;15(5):384-389.
[21] Iesaka K,Kummer FJ,Di Cesare PE.Stress risers between two ipsilateral intramedullary stems: a finite-element and biomechanical analysis.J Arthroplasty. 2005;20(3):386-391.
[22] Zhao Y,Jin ZM,Wilcox RK.Modelling cement augmentation: a comparative experimental and finite element study at the continuum level.Proc Inst Mech Eng H. 2010;224(7):903-911.
[23] Hanke M,Djonov V,Tannast M,et al.Prevention of cement leakage into the hip joint by a standard cement plug during PFN-A cement augmentation: a technical note.Arch Orthop Trauma Surg.2016.[Epub ahead of print]
[24] Basu S,Patel DR,Dhakal G,et al.Results of cement augmentation and curettage in aneurysmal bone cyst of spine.Indian J Orthop.2016;50(1):99-102.
[25] Mueller JU,Baldauf J,Marx S,et al.Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws.J Neurosurg Spine.2016:1-7. [Epub ahead of print]
[26] Fan HT,Zhang RJ,Shen CL,et al.The Biomechanical Properties of Pedicle Screw Fixation Combined With Trajectory Bone Cement Augmentation in Osteoporotic Vertebrae.Clin Spine Surg.2016;29(2):78-85.
[27] Gupta SP, Garg G.Curettage with cement augmentation of large bone defects in giant cell tumors with pathological fractures in lower-extremity long bones.J Orthop Traumatol.2016.[Epub ahead of print]
[28] Costa F,Ortolina A,Galbusera F,et al.Pedicle screw cement augmentation. A mechanical pullout study on different cement augmentation techniques.Med Eng Phys.2016;38(2):181-186.
[29] Tai CL,Tsai TT,Lai PL,et al.A Biomechanical Comparison of Expansive Pedicle Screws for Severe Osteoporosis: The Effects of Screw Design and Cement Augmentation.PLoS One. 2015;10(12): e0146294.
[30] Park CK,Park CK,Lee DC,et al.A new technique of bone cement augmentation via the disc space for percutaneous pedicle screw fixation.J Neurosurg Spine. 2016;24(1):16-19.
[31] Schliemann B, Seifert R, Rosslenbroich SB, et al. Screw augmentation reduces motion at the bone-implant interface: a biomechanical study of locking plate fixation of proximal humeral fractures.J Shoulder Elbow Surg.2015;24(12):1968-1973.
[32] Hwee Weng DH,Jun HT,Chuen ST,et al.Subsequent Vertebral Fractures Post Cement Augmentation of the Thoracolumbar Spine: Does it Correlate With Level-specific Bone Mineral Density Scores?Spine (Phila Pa 1976).2015;40(24):1903-1909.
[33] Li C,Zhang HB,Zhang H,et al.Severe pathological fractures caused by vertebral hemangiomas with posterior decompression, bone cement augmentation and internal fixation.Orthop Traumatol Surg Res.2016.pii: S1877-0568(16)00095-5.doi: 10.1016/j.otsr.2016.01.024. [Epub ahead of print]
[34] Hartung MP,Tutton SM,Hohenwalter EJ,et al.Safety and Efficacy of Minimally Invasive Acetabular Stabilization for Periacetabular Metastatic Disease with Thermal Ablation and Augmented Screw Fixation.J Vasc Interv Radiol. 2016;27(5):682-688.e1.
[35] Arab HR,Moeintaghavi A,Taheri M,et al.Lateral Ridge Augmentation with Autogenous Bone Harvested Using Trephine Drills: A Noninvasive Technique.Open Dent J. 2016 ;10:1-11.
[36] Rüger M,Sellei RM,Stoffel M,et al.The Effect of Polymethyl Methacrylate Augmentation on the Primary Stability of Cannulated Bone Screws in an Anterolateral Plate in Osteoporotic Vertebrae: A Human Cadaver Study.Global Spine J. 2016;6(1): 46-52.
[37] Roukis TS,Kang RB.Vascularized Pedicled Fibula Onlay Bone Graft Augmentation for Complicated Tibiotalocalcaneal Arthrodesis With Retrograde Intramedullary Nail Fixation: A Case Series.J Foot Ankle Surg.2016.pii: S1067-2516(15)00575-X. doi: 10.1053/j.jfas.2015.12.003. [Epub ahead of print]
[38] Sakkas A,Schramm A,Karsten W,et al. A clinical study of the outcomes and complications associated with zygomatic buttress block bone graft for limited preimplant augmentation procedures.J Craniomaxillofac Surg.2016;44(3):249-256.