Finite element analysis of femoral neck fracture with different fixation ways

doi:10.3969/j.issn.2095-4344.2016.31.010

Abstract

Abstract:

BACKGROUND: Finite element method is widely used in the femoral neck fracture, but the study concerning different fixation methods of femoral neck fracture is not much.

OBJECTIVE: To analyze biomechanical properties of different fixation methods for femoral neck fracture using finite element analysis.
METHODS: The femur of voluntters was scanned with CT, at thickness 0.6 mm, from the site above the greater trochanter of the femur. Scanning data were saved in .DICOM format. Data of right proximal femur were imported into Mimics software. Osteotomy was performed according to Pauwels I type fracture. Models of two tensile force screws, fully threaded hollow screw and proximal femoral locking plate were established. Three-dimensional finite element method was used to analyze stress distribution, stress concentration position, displacement distribution and maximum displacement in different models of femoral neck fracture with different internal fixation methods.
RESULTS AND CONCLUSION: (1) The maximum stress value of two lag screws model was biggest. The maximum stress value of fully threaded hollow screw model was minimized. The maximum stresses of two lag screws model, fully threaded hollow screw model and proximal femoral locking plate model all were concentrated in the fixed end of fractures. (2) The femoral maximum stress of two lag screws model was biggest. The femoral maximum stress value of proximal femoral locking plate model was minimized. The femoral maximum stresses of two lag screws model, fully threaded hollow screw model and proximal femoral locking plate model all were concentrated in the medial femoral small rotor near and medial femoral and fixation contact points. (3) The maximum displacement of two lag screws model was biggest. The maximum displacement of fully threaded hollow screw model was minimized. The maximum displacement of two lag screws model, fully threaded hollow screw model and proximal femoral locking plate model all was in the femoral head. (4) The maximum displacement value of two lag screws model fixed place was biggest. The maximum displacement value of fully threaded hollow screw model fixed place was minimized. The maximum displacement value of two lag screws model was biggest at femoral head. The maximum displacement value of fully threaded hollow screw model was minimized at femoral head. (5) Results showed that the treatment effect of fully threaded hollow screw on Pauwels I fractures was better than other two fixation methods.

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 Fractures, Finite Element Analysis, Internal Fixators, Biomechanics, Tissue Engineering

CLC Number:

R318

Xia Zhi-feng, Liang Ming, Li Ya-feng, Zeng Guan-nan. Finite element analysis of femoral neck fracture with different fixation ways[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(31): 4630-4636.

Figures/Tables 3

References

[1] 冼敬锋.全髋关节置换术与骨折内固定术治疗中老年股骨颈骨折的疗效分析[J].重庆医学,2013,42(13): 1528-1529.
[2] 陈涛,尚希福,贺瑞,等.先天性短股骨颈人工全髋关节置换时避免下肢延长的临床研究[J].中国修复重建外科杂志, 2012,26(3):289-291.
[3] 蒲晓斌,李裕标,马波,等.内固定术后股骨颈短缩的多因素分析及其对骨折的影响[J].现代生物医学进展,2012, 12(17):3263-3266.
[4] 韦积华.计算机辅助骨科手术系统在股骨颈骨折经皮空心拉力螺钉技术中的实验研究[D].广西医科大学,2012.
[5] 骆东.三种内固定方式治疗股骨颈骨折的生物力学研究[D].吉林大学,2012.
[6] SooHoo NF, Farng E, Chambers L, et al.Comparison of complication rates between hemiarthroplasty and total hip arthroplasty for intracapsular hip fractures. Orthopedics. 2013;36(4): e384-e389.
[7] Napoli N, Schwartz AV, Palermo L, et al.Risk factors for subtrochanteric and diaphyseal fractures: the study of osteoporotic fractures. J Clin Endocrinol Metab. 2013; 98(2): 659-667.
[8] van Embden D, Rhemrev SJ, Genelin F, et al. The reliability of a simplified Garden classification for intracapsular hip fractures. Orthop Traumatol Surg Res.2012;98(4):405-408.
[9] van Embden D, Roukema GR, Rhemrev SJ, et al. The Pauwels classification for intracapsular hip fractures: is it reliable? Injury. 2011;42 (11): 1238-1240.
[10] Gaspard, Crnkovic T, Durovic D, et al. AO group, AO subgroup, Garden and Pauwels classification systems of femoral neck fractures: are they reliable and reproducible? Med Glas (Zenica). 2012;9(2): 243-247.
[11] Taha ME, Audigé L, Siegel G, et al.Factors predicting secondary displacement after non-operative treatment of undisplaced femoral neck fractures. Arch Orthop Trauma Surg. 2015;135(2): 243-249.
[12] Voskuijl T, Neuhaus V, Kinaci A, et al. In-hospital outcomes after hemiarthroplasty versus total hip arthroplasty for isolated femoral neck fractures. Arch Bone Jt Surg. 2014;2(3): 151-156.
[13] Li SG, Sun TS, Liu Z, et al. Factors influencing postoperative mortality one year after surgery for hip fracture in Chinese elderly population. Chin Med J (Engl). 2013;126(14): 2715-2719.
[14] Neuman MD, Donegan DJ, Mehta S. Comparative effectiveness of joint reconstruction and fixation for femoral neck fracture: inpatient and 30-day mortality. Am J Orthop (Belle Mead NJ). 2013;42(7): E42-E47.
[15] van den Bekerom MP, Siereveld IN, Bonke H, et al.The natural history of the hemiarthroplasty for displaced intracapsular femoral neck fractures.Acta Orthop. 2013; 84(6): 555-560.
[16] Liem IS, Kammerlander C, Raas C, et al. Is there a difference in timing and cause of death after fractures in the elderly? Clin Orthop Relat Res. 2013;471(9): 2846-2851.
[17] Araujo TP, Guimaraes TM, Andrade-Silva FB, et al.Influence of time to surgery on the incidence of complications in femoral neck fracture treated with cannulated screws. Injury. 2014;45(Suppl 5): S36-S39.
[18] Papanastassiou ID, Mavrogenis AF, Kokkalis ZT, et al.Fixation of femoral neck fractures using divergent versus parallel cannulated screws. J Long Term Eff Med Implants. 2011;1(1): 63-69.
[19] Viberg B, Overgaard S, Lauritsen J, et al. Lower reoperation rate for cemented hemiarthroplasty than four uncemented hemiarthroplasty and internal fixation following femoral neck fracture: 12-to 19-year follow-up of patients aged 75 years or more. Acta Orthop. 2013;84(3): 254-259.
[20] Kain MS, Marcantonio AJ, Iorio R.Revision surgery occurs frequently after percutaneous fixation of stable femoral neck fractures in elderly patients. Clin Orthop Relat Res. 2014;472(12): 4010-4014.
[21] Wang T, Sun JY, Zha GC, et al.Analysis of risk factors for femoral head necrosis after internal fixation in femoral neck fractures. Orthopedics. 2014;37(12): e1117-e1123.
[22] Tsai CH, Hsu HC, Fong YC, et al. Treatment for ipsilateral fractures of femoral neck and shaft. Injury. 2009;40 (7): 778-782.
[23] Saglam N, Kucuk Durmaz F, Kivilcim H, et al. Biomechanical comparison of anti rotator compression hip screw and cannulated screw fixations in the femoral neck fractures. Acta Orthop Traumatol Turc. 2014;48(2): 196-201.
[24] 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.
[25] Zdero R, Keast-Butler O, Schemitsch EH. A biomechanical comparison of two triple-screw methods for femoral neck fracture fixation in a synthetic bone model. J Trauma. 2010;69 (6):1537-1544.
[26] Gao H, Liu Z, Xing D, et al.Which is the best alternative for displaced femoral neck fractures in the elderly? A meta-analysis.Clin Orthop Relat Res. 2012;470(6): 1782-1791.
[27] Hailer NP, Weiss RJ, Stark A, et al. The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. An analysis of 78,098 operations in the Swedish Hip Arthroplasty Register. Acta Orthop. 2012;83(5):442-448.
[28] Burgers PT, van Geene AR, van den Bekerom MP, et al.Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials. Int Orthop. 2012;36(8):1549-1560.
[29] Taylor F, Wright M, Zhu M. Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. J Bone Joint Surg Am. 2012;94(7): 577-583.
[30] Langslet E, Frihagen F, Opland V, et al. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial. Clin Orthop Relat Res. 2014;472(4): 1291-1299.
[31] Middleton RG, Uzoigwe CE, Young PS, et al. Peri-operative mortality after hemiarthroplasty for fracture of the hip: does cement make a difference? Bone Joint J. 2014;96B(9): 1185-1191.
[32] Yang B, Lin X, Yin XM, et al. Bipolar versus unipolar hemiarthroplasty for displaced femoral neck fractures in the elder patient: a systematic review and meta-analysis of randomized trials. Eur J Orthop Surg Traumatol. 2014. [Epub ahead of print].
[33] Kanto K, Sihvonen R, Eskelinen A, et al. Uni-and bipolar hemiarthroplasty with a modern cemented femoral component provides elderly patients with displaced femoral neck fractures with equal functional outcome and survivorship at medium-term Follow-up. Arch Orthop Trauma Surg. 2014;134(9): 1251-1259.
[34] Yu L, Wang Y, Chen J. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures: meta-analysis Of randomized trials. Clin Orthop Relat Res. 2012;470(8): 2235-2243.
[35] Adam P, Philippe R, Ehlinger M, et al. Dual mobility cups hip arthroplasty as a treatment for displaced fracture of the femoral neck in the elderly. A prospective, systematic,multicenter study with specific focus on postoperative dislocation. Orthop Traumatol Surg Res. 2012;98(3):296-300.
[36] Renken F, Renken SPeech A, et al.Early functional results after hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach. BMC Musculoskelet Disord. 2012;13: 141.
[37] Zi-Sheng A, You-Shui G, Zhi-Zhen J, et al. Hemiarthroplasty vs primary total hip arthroplasty for displaced fractures of the femoral neck in the elderly: a meta-analysis. J Arthroplasty. 2012;27(4): 583-590.
[38] 黄梦全.有限元法分析后内侧骨折对近端股骨的力学影响[J].中国矫形外科杂志,2010,2(1):18-24．
[39] 钟砚琳,王海鹏．不同屈曲角度下膝关节主要韧带有限元模型的建立和验证[J].中国组织工程研究与临床康复, 2010, 7(23):14-30．
[40] 袁平,王万春．膝关节三维有限元模型的建立及生物力学分析[J].中南大学学报:医学版,2010,35(1):85-89．
[41] 贾全章,张广玉,顾海栋,等. 蘑菇状股骨头表面置换体生物力学有限元分析[J].中国矫形外科杂志,2010,18(6): 479-482.
[42] 马文辉,张学敏．髋臼缺损翻修中所用移植材料的有限元分析[J].中国组织工程研究与临床康复,2010,14(26): 14-19.
[43] Seral B,Garcia JM,Cegonino J．Finite element study of intramedullary osteosynthesis in the treatment of trochanteric fractures of the hip,Gamma and PFN. Injury. 2010;35(2):130-135.
[44] 陈执平. 应用三维有限元分析探讨髓芯减压术后产生的空洞对股骨头应力的影响[J]. 中华关节外科杂志(电子版), 2009,3(5):617-623.