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Clinical observation and finite element analysis of femoral stable interlocking intramedullary nail in intertrochanteric fractures

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Abstract   

Purpose

This study was designed to compare clinical outcomes of the femoral stable interlocking intramedullary nail (FSIIN) with proximal femoral nail anti-rotation (PFNA) for the treatment of intertrochanteric fractures (OTA 31A1 + A2).

Methods

This study retrospectively analyzed a registered sample of 74 intertrochanteric fractures (OTA 31A1 + A2) surgically treated using FSIIN (n = 36) or PFNA (n = 38) from January 2015 to December 2021. The intra-operative variables (operation time, fluoroscopy time, intra-operative blood loss, length of incision) and fracture healing time were compared between the two groups in this study. Harris hip score (HHS) and visual analog scale (VAS) were used to evaluate the functional states. At the last follow-up, the incidence of related complications in patients was calculated. Eventually, the 3D finite element model was established to analyze the stress of FSIIN and PFNA.

Results

The distribution of all basic characteristics was similar between the two groups (p > 0.05). The operation time, fluoroscopy time, intra-operative blood loss, and length of incision were significantly decreased in the FSIIN group (p < 0.001). The FSIIN group had a shorter fracture healing time than the PFNA group (p < 0.001). There is no significant difference between the two groups in the Harris and VAS (p > 0.05). The incidences of post-operative anaemia, electrolyte imbalance, varus malalignment, and thigh pain were significantly lower in FSIIN than in PFNA groups (all p < 0.05). The finite element results show that the stress shielding effect of FSIIN is smaller.

Conclusions

Our study revealed that FSIIN seemed to be superior to PFNA in the treatment of intertrochanteric fractures (OTA 31A1 + A2) due to less surgical damage and shorter fracture healing time.

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Data availability

Data and materials during the current study are available from the corresponding author on reasonable request.

Code availability

Mimics 21.0 Software (Materialise Corporation, Leuven, Belgium); Geomagic-Studio 11 software (Raindrop Corporation, NC, USA); Abaqus 6.14 Software (Dassault Corporation, Paris, France); SPSS 26.0 Software (IBM Corporation, Armonk, NY, USA).

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Funding

This work was supported by the Tianjin Natural Science Foundation (Grant numbers [No. 21JCYBJC00280]).

Author information

Authors and Affiliations

  1. Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China

    Weiyong Wu & Bing Peng

  2. Orthopedic Department, Tianjin Fourth Central Hospital, Tianjin, 300140, China

    Weiyong Wu, Zhihui Zhao, Yongqing Wang & Meiyue Liu

  3. Institute of Robotics and Automatic Information System Tianjin Key Laboratory of Intelligent Robotics, College Of Artificial Intelligence, Nankai University, Tianjin, 300350, China

    Bin Yao

  4. Norinco Group Test and Measuring Academy, Huayin, 714200, Shanxi, China

    Pishun Shi

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Contributions

Yongqing Wang was a major contributor to the study design and critically reviewed for important intellectual content and provided the clinical data included in the manuscript. Weiyong Wu was involved in collecting data, writing, and revising the draft of the manuscript. Zhihui Zhao participated in the treatment decisions. Meiyue Liu and Bing Peng assisted with data acquisition and analysis. Bin Yao and Pishun Shi were responsible for constructing and analyzing 3D finite elements. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yongqing Wang.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the Ethics Committee of the Tianjin No.4 Central Hospital (SZXLL-2015–024). In this retrospective study, all participants gave their written informed consent to participate in the study.

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All participants gave their written informed consent to publish the obtained data of the current study.

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The authors declare no competing interests.

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Wu, W., Zhao, Z., Wang, Y. et al. Clinical observation and finite element analysis of femoral stable interlocking intramedullary nail in intertrochanteric fractures. International Orthopaedics (SICOT) 47, 2319–2326 (2023). https://doi.org/10.1007/s00264-023-05865-z

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