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Z Orthop Unfall 2025; 163(01): 17-26
DOI: 10.1055/a-2255-7438
Original Article

Biomechanical Stability of Femoral Neck System for Pauwels Type III Femoral Neck Fractures Based on Different Reduction Quality

Biomechanische Stabilität des Femurhalssystems für Pauwels-Typ-III-Femurhalsfrakturen basierend auf unterschiedlicher Repositionsqualität
Daoqiang Huang
1   First Department of Orthopedics, Xiaolan People's Hospital of Zhongshan, Zhongshan, China
,
Xiaoping Wang
1   First Department of Orthopedics, Xiaolan People's Hospital of Zhongshan, Zhongshan, China
,
Bingze Chen
1   First Department of Orthopedics, Xiaolan People's Hospital of Zhongshan, Zhongshan, China
,
Zhiqiang Hu
1   First Department of Orthopedics, Xiaolan People's Hospital of Zhongshan, Zhongshan, China
2   The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China (Ringgold ID: RIN70570)
,
Weili Feng
1   First Department of Orthopedics, Xiaolan People's Hospital of Zhongshan, Zhongshan, China
› Author AffiliationsSupported by: Zhongshan Social Public Welfare and Fundamental Research Projects General medical and Health Projects, 2022B1045
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Abstract

Purpose

To further investigate the biomechanics of a femoral neck system (FNS) for Pauwels type III femoral fractures based on three different reductions.

Methods

We constructed three different reduction (anatomical reduction, negative buttress reduction, and positive buttress reduction) models of Pauwels type III femoral neck fractures. Then, three cannulated screws (3CS), dynamic hip screws (DHS), dynamic hip screws combined with an anti-rotation screw (DHS + ARS), one-hole femoral neck system (1HFNS), and two-hole femoral neck system (2HFNS) were assembled with the reduction models, respectively, to simulate the internal fixation surgical procedure. All models had a load of 2100 N in line with the femoral mechanical axis applied. The implant stress, the head and implant displacements, and the rotational angles of all models were recorded and analyzed.

Results

Compared to 3CS and 2HFNS, 1HFNS had higher implant stress (higher than 92.5 MPa and 46.3 MPa, respectively) and displacement (higher than 0.9 mm and 0.8 mm, respectively) in the anatomical reduction. 2HFNS exhibited the highest stress values (225.5 MPa) in the anatomical reduction but the lowest values (159.8 MPa) in the positive buttress reduction when compared to the other implants. 2HFNS showed the best rotational stability in the negative and positive buttress reduction (rotational angels of 0.8° and 0.6°, respectively).

Conclusions

Based on the outcome of this computational study, it might be concluded that 2HFNS was an alternative fixation for the treatment of Pauwels type III femoral neck fracture, especially when anatomical reduction cannot be perfectly attained. More relevant clinical and biomechanical studies are needed in the future.

Zusammenfassung

Zielsetzung

Ziel dieser Studie war es, die Biomechanik des Femurhalssystems (FNS) für Pauwels-Typ-III-Femurhalsfrakturen anhand von 3 verschiedenen Repositionen weiter zu untersuchen.

Methoden

Die Studie umfasste 3 verschiedene Repositionsmodelle (anatomische Reposition, negative Strebepfeilerreposition und positive Strebepfeilerreposition) von Pauwels-Typ-III-Schenkelhalsfrakturen. Die Repositionsmodelle wurden jeweils mit 3 kanülierten Schrauben (3CS), dynamischen Hüftschrauben (DHS), dynamischen Hüftschrauben in Kombination mit einer Antirotationsschraube (DHS+ARS), einem 1-Loch-Femurhalssystem (1HFNS) und einem 2-Loch-Femurhalssystem (2HFNS) zusammengesetzt. Anschließend wurde das chirurgische Verfahren der internen Fixierung simuliert. Auf alle Modelle wurde eine Belastung von 2100 N in Einklang mit der mechanischen Femurachse ausgeübt. Der Implantatstress, die Kopf- und Implantatverschiebungen sowie die Rotationswinkel aller Modelle wurden erfasst und ausgewertet.

Ergebnisse

Im Vergleich zu 3CS und 2HFNS wies 1HFNS bei der anatomischen Reposition einen höheren Implantatstress (mehr als 92,5 MPa bzw. 46,3 MPa) und eine größere Verschiebung (mehr als 0,9 mm bzw. 0,8 mm) auf. Im Vergleich zu den anderen Implantaten wies das 2HFNS bei der anatomischen Reposition die höchsten Stresswerte (225,5 MPa) und bei der positiven Strebepfeilerreposition die niedrigsten Werte (159,8 MPa) auf. Das 2HFNS zeigte die beste Rotationsstabilität (Rotationswinkel von 0,8° bzw. 0,6°) in der negativen und positiven Strebepfeilerreposition.

Schlussfolgerungen

Auf der Grundlage der Ergebnisse dieser Simulationsstudie kann der Schluss gezogen werden, dass 2HFNS ein alternatives chirurgisches Verfahren zur internen Fixierung bei der Behandlung von Pauwels-Typ-III-Femurhalsfrakturen darstellt. Dies gilt insbesondere für Fälle, in denen eine anatomische Reposition nicht perfekt erreicht werden kann. In Zukunft sind jedoch weitere relevante klinische und biomechanische Studien erforderlich, um dieses Ergebnis zu untermauern.

Keywords

femoral neck fractures - femoral neck system - finite element analysis - reduction quality - biomechanics

Schlüsselwörter

Schenkelhalsfrakturen - Schenkelhalssystem - Finite-Elemente-Analyse - Reduktionsqualität - Biomechanik


Publication History

Received: 12 December 2022

Accepted after revision: 27 January 2024

Article published online:
19 March 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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