Biomechanical Analysis of Two Medial Buttress Plate Fixation Methods to Treat Pauwels Type III Femoral Neck Fractures

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2022 Jan 15

PMID 35031036

Authors

Jichao Liu

Zhengwei Li

Jie Ding

Bingzhe Huang

Chengdong Piao

Affiliations

Soon will be listed here.

Abstract

Background: Femoral neck fractures in young people are usually Pauwels Type III fractures. The common treatment method are multiple parallel cannulated screws or dynamic hip screw sliding compression fixation. Due to the huge shear stress, the rate of complications such as femoral head necrosis and nonunion is still high after treatment. The aim of our study was to compare the stabilities of two fixation methods in fixating pauwels type III femoral neck fractures.

Methods: All biomimetic fracture samples are fixed with three cannulated screws combined with a medial buttress plate. There were two fixation groups for the buttress plate and proximal fracture fragment: Group A, long screw (40 mm); Group B, short screw (6 mm). Samples were subjected to electrical strain measurement under a load of 500 N, axial stiffness was measured, and then the samples were axially loaded until failure. More than 5 mm of displacement or synthetic bone fracture was considered as construct failure.

Results: There were no significant differences in failure load (P = 0.669), stiffness (P = 0.842), or strain distribution (P > 0.05) between the two groups.

Conclusions: Unicortical short screws can provide the same stability as long screws for Pauwels Type III Femoral Neck Fractures.

Citing Articles

A recent update on the fixation techniques for femoral neck fractures: A narrative review.

Kim C, Kim J J Clin Orthop Trauma. 2024; 54:102497.

PMID: 39157173 PMC: 11326900. DOI: 10.1016/j.jcot.2024.102497.

Evaluating three internal fixation techniques for Pauwels III femoral neck fractures via finite element analysis.

Li N, Cheng K, Fan J, Li Y, Yang M, Zhu S Sci Rep. 2024; 14(1):15519.

PMID: 38969693 PMC: 11226618. DOI: 10.1038/s41598-024-66638-1.

[Comparison of effectiveness of three surgical methods in treatment of Pauwels type femoral neck fracture in young and middle-aged patients].

Liu Y, Ma W, Tian K, Fan K, Kuang X, Yan J Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024; 38(4):412-421.

PMID: 38632059 PMC: 11024523. DOI: 10.7507/1002-1892.202401110.

References

Giordano V, Paes R, Alves D, Amaral A, Belangero W, Giordano M . Stability of L-shaped and inverted triangle fixation assemblies in treating Pauwels type II femoral neck fracture: a comparative mechanical study. Eur J Orthop Surg Traumatol. 2018; 28(7):1359-1367. DOI: 10.1007/s00590-018-2207-x. View

Pauyo T, Drager J, Albers A, Harvey E . Management of femoral neck fractures in the young patient: A critical analysis review. World J Orthop. 2014; 5(3):204-17. PMC: 4095012. DOI: 10.5312/wjo.v5.i3.204. View

Kuzyk P, Zdero R, Shah S, Olsen M, Waddell J, Schemitsch E . Femoral head lag screw position for cephalomedullary nails: a biomechanical analysis. J Orthop Trauma. 2012; 26(7):414-21. DOI: 10.1097/BOT.0b013e318229acca. View

Aminian A, Gao F, Fedoriw W, Zhang L, Kalainov D, Merk B . Vertically oriented femoral neck fractures: mechanical analysis of four fixation techniques. J Orthop Trauma. 2007; 21(8):544-8. DOI: 10.1097/BOT.0b013e31814b822e. View

Ben S, Zhao J, Rabczuk T . Does Hooke's law work in helical nanosprings?. Phys Chem Chem Phys. 2015; 17(32):20990-7. DOI: 10.1039/c5cp02802g. View

Stacey S, Renninger C, Hak D, Mauffrey C . Tips and tricks for ORIF of displaced femoral neck fractures in the young adult patient. Eur J Orthop Surg Traumatol. 2016; 26(4):355-63. DOI: 10.1007/s00590-016-1745-3. View

Burke N, Kennedy J, Cousins G, Fitzpatrick D, Mullett H . Locking plate fixation with and without inferomedial screws for proximal humeral fractures: a biomechanical study. J Orthop Surg (Hong Kong). 2014; 22(2):190-4. DOI: 10.1177/230949901402200215. View

Panteli M, Rodham P, Giannoudis P . Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly. Injury. 2015; 46(3):445-52. DOI: 10.1016/j.injury.2014.12.031. View

Filipov O, Stoffel K, Gueorguiev B, Sommer C . Femoral neck fracture osteosynthesis by the biplane double-supported screw fixation method (BDSF) reduces the risk of fixation failure: clinical outcomes in 207 patients. Arch Orthop Trauma Surg. 2017; 137(6):779-788. PMC: 5432592. DOI: 10.1007/s00402-017-2689-8. View

10.

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. DOI: 10.1016/j.cmpb.2020.105714. View

11.

Bhandari M, Devereaux P, Swiontkowski M, Tornetta 3rd P, Obremskey W, Koval K . Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg Am. 2003; 85(9):1673-81. DOI: 10.2106/00004623-200309000-00004. View

12.

Asnis S . Intracapsular fractures of the femoral neck. Results of cannulated screw fixation. J Bone Joint Surg Am. 1994; 76(12):1793-803. DOI: 10.2106/00004623-199412000-00005. View

13.

Grassi L, Isaksson H . Extracting accurate strain measurements in bone mechanics: A critical review of current methods. J Mech Behav Biomed Mater. 2015; 50:43-54. DOI: 10.1016/j.jmbbm.2015.06.006. View

14.

Hedlund R, Lindgren U, Ahlbom A . Age- and sex-specific incidence of femoral neck and trochanteric fractures. An analysis based on 20,538 fractures in Stockholm County, Sweden, 1972-1981. Clin Orthop Relat Res. 1987; (222):132-9. View

15.

Li J, Zhao Z, Yin P, Zhang L, Tang P . 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. PMC: 6419341. DOI: 10.1186/s13018-019-1097-x. View

16.

Augat P, Schorlemmer S . The role of cortical bone and its microstructure in bone strength. Age Ageing. 2006; 35 Suppl 2:ii27-ii31. DOI: 10.1093/ageing/afl081. View

17.

Luttrell K, Beltran M, Collinge C . Preoperative decision making in the treatment of high-angle "vertical" femoral neck fractures in young adult patients. An expert opinion survey of the Orthopaedic Trauma Association's (OTA) membership. J Orthop Trauma. 2014; 28(9):e221-5. DOI: 10.1097/BOT.0000000000000080. View

18.

Li J, Yin P, Zhang L, Chen H, Tang P . Medial anatomical buttress plate in treating displaced femoral neck fracture a finite element analysis. Injury. 2019; 50(11):1895-1900. DOI: 10.1016/j.injury.2019.08.024. View

19.

Ye Y, Chen K, Tian K, Li W, Mauffrey C, Hak D . Medial buttress plate augmentation of cannulated screw fixation in vertically unstable femoral neck fractures: Surgical technique and preliminary results. Injury. 2017; 48(10):2189-2193. DOI: 10.1016/j.injury.2017.08.017. View

20.

Giordano V, Alves D, Paes R, Amaral A, Giordano M, Belangero W . The role of the medial plate for Pauwels type III femoral neck fracture: a comparative mechanical study using two fixations with cannulated screws. J Exp Orthop. 2019; 6(1):18. PMC: 6497711. DOI: 10.1186/s40634-019-0187-3. View