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The Influence of Static Load and Sideways Impact Fall on Extramedullary Bone Plates Used to Treat Intertrochanteric Femoral Fracture: A Preclinical Strength Assessment

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Abstract

Hip fracture accounts for a large number of hospitalizations, thereby causing substantial economic burden. Majority (> 90%) of all hip fractures are associated to sideways fall. Studies on sideways fall usually involve loading at quasi-static or at constant displacement rate, which neglects the physics of actual fall. Understanding femur resonance frequency and associated mode shapes excited by dynamic loads is also critical. Two commercial extramedullary implants, proximal femoral locking plate (PFLP) and variable angle dynamic hip screw (VA-DHS), were chosen to carry out the preclinical assessments on a simulated Evans-I type intertrochanteric fracture. In this study, we hypothesized that the behavior of the implant depends on the loading types—axial static and transverse impact—and a rigid implanted construct will absorb less impact energy for sideways fall. The in silico models were validated using experimental measurements of full-field strain data obtained from a 2D digital image correlation (DIC) study. Under peak axial load of 3 kN, PFLP construct predicted greater axial stiffness (1.07 kN/mm) as opposed to VA-DHS (0.85 kN/mm), although the former predicted slightly higher proximal stress shielding. Further, with greater mode 2 frequency, PFLP predicted improved performance in resisting bending due to sideways fall as compared to the other implant. Overall, the PFLP implanted femur predicted the least propensity to adverse stress intensities, suggesting better structural rigidity and higher capacity in protecting the fractured femur against fall.

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Acknowledgments

The authors would like to acknowledge the computational facilities available at the Biomechanics Laboratory, Biosciences and Bioengineering, Indian Institute of Technology Guwahati, India, which has helped carry out this study. The authors would also like to acknowledge Dr. Sourabh Boruah, Harris Orthopaedics Laboratory, Harvard Medical School, Boston, USA for pertinent inputs for the experimental work. The study has been partially supported by SERB, India (Grant no. SRG/2019/000235). The travel related to the study was partially supported by Fulbright Trust, USA.

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Authors and Affiliations

  1. Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781 039, India

    Pratik Nag, Neeraj Kumar & Souptick Chanda

  2. Department of Orthopaedics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, 793 018, India

    Bhaskar Borgohain & Kashif Akhtar Ahmed

  3. Department of Radiology & Imaging, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, 793 018, India

    Pranjal Phukan

  4. Department of Orthopaedic Surgery, Harris Orthopaedics Laboratory, Massachusetts General Hospital, Boston, MA, USA

    Alireza Borjali & Kartik Mangudi Varadarajan

  5. Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA

    Alireza Borjali & Kartik Mangudi Varadarajan

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  1. Pratik Nag
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Nag, P., Borgohain, B., Ahmed, K.A. et al. The Influence of Static Load and Sideways Impact Fall on Extramedullary Bone Plates Used to Treat Intertrochanteric Femoral Fracture: A Preclinical Strength Assessment. Ann Biomed Eng 50, 1923–1940 (2022). https://doi.org/10.1007/s10439-022-03013-z

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