Skip to main content

Advertisement

SpringerLink
Log in

Proposal for a New Fixation Method for Pauwels Type III Femoral Neck Fracture-Metaphyseal Stem: A Finite-Element Analysis

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Objective

To evaluate the biomechanical behavior of a metaphyseal stem specifically designed for the fixation of Pauwels type-III femoral neck fractures using finite-element analysis.

Methods

Three different constructions were studied: the dynamic hip screw with a superior anti-rotation screw (DHS + ARS), multiple cannulated screws in an inverted triangle configuration (ASNIS), and the Metaphyseal Nailing System (MNS), a new implant developed by the authors. Vertical and total displacement, localized and total maximum and minimum principal, and the Von Mises peak stresses were evaluated.

Results

Results are shown for the DHS + ARS, ASNIS, and MNS models, respectively. Vertical displacement (mm) was 1.49, 3.63, and 1.90; total displacement (mm) was: 5.33, 6.02, and 6.30; localized maximum principal (Mpa) was: 2.77, 4.5, and 1.7; Total maximum principal (Mpa) was: 126, 223, and 531; localized minimum principal (Mpa) was: −1.8, −3.15, and −0.39; total minimum (Mpa) was: −121, −449, and −245; and Von Mises peak stress (MPA) was: 315.5, 326.1, and 286.0.

Conclusion

The present FEM study showed that the MNS device increases general stresses and reduces localized stresses, when compared to the DHS + ARS and ASNIS constructions used to fix Pauwels type-III femoral neck fracture in synthetic models. In this sense, the MNS showed a low fracture focus shift, conducive to the consolidation environment. The significant reduction in the maximum principal stress, allows to affirm that the main deforming force, the shear, in this fracture pattern, was considerably reduced and the low value of Von Mises obtained, consistent with an implant capable of making an effective load sharing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Shen, M., Wang, C., Chen, H., Rui, Y., & Zhao, S. (2016). An update on the Pauwels classification. Journal of Orthopaedic Surgery and Research, 11, 161.

    Article  Google Scholar 

  2. Parker, M. J. (2009). Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. Jounal of Bone and Joint Surgery American Volume, 2009, 490–491.

    Google Scholar 

  3. Haidukewych, G. J., Rothwell, W. S., Jacofsky, D. J., Torchia, M. E., & Berry, D. J. (2004). Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. Journal of Bone and Joint Surgery American Volume, 86(8), 1711–1716.

    Article  Google Scholar 

  4. Bartonicek, J. (2001). Pauwels’ classification of femoral neck fractures: correct interpretation of the original. Journal of Orthopaedic Trauma, 15(5), 358–360.

    Article  CAS  Google Scholar 

  5. Cha, Y. H., Yoo, J. I., Hwang, S. Y., Kim, K. J., Kim, H. Y., Choy, W. S., & Hwang, S. C. (2019). Biomechanical evaluation of internal fixation of Pauwels type III femoral neck fractures: A systematic review of various fixation methods. Clinics in Orthopedic Surgery, 11(1), 1–14.

    Article  Google Scholar 

  6. Slobogean, G. P., Sprague, S. A., Scott, T., & Bhandari, M. (2015). Complications following young femoral neck fractures. Injury, 46(3), 484–491.

    Article  CAS  Google Scholar 

  7. Panteli, M., Rodham, P., & Giannoudis, P. V. (2015). Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly. Injury, 46(3), 445–452.

    Article  Google Scholar 

  8. Giordano, V., Alves, D. D., Paes, R. P., Amaral, A. B., Giordano, M., Belangero, W., Freitas, A., Koch, H. A., & Amaral, N. P. (2019). The role of the medial plate for Pauwels type III femoral neck fracture: a comparative mechanical study using two fixations with cannulated screws. OriginalPaper Journal of Experimental Orthopaedics, 6(1), 1–9.

    Article  Google Scholar 

  9. Imren, Y., Gurkan, V., Bilsel, K., Desteli, E. E., Tuna, M., Gurcan, C., Tuncay, I., & Sen, C. (2015). Biomechanical comparison of dynamic hip screw, proximal femoral nail, cannulated screw, and monoaxial external fixation in the treatment of basicervical femoral neck fractures. Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca, 82(2), 140–144.

    CAS  PubMed  Google Scholar 

  10. Röderer, G., Moll, S., Gebhard, F., Claes, L., & Krischak, G. (2011). Side plate fixation vs. intramedullary nailing in an unstable medial femoral neck fracture model: A comparative biomechanical study. Clinical Biomechanics, 26(2), 141–146.

    Article  Google Scholar 

  11. Rupprecht, M., Grossterlinden, L., Ruecker, A. H., de Oliveira, A. N., Sellenschloh, K., Nüchtern, J., Püschel, K., Morlock, M., Rueger, J. M., & Lehmann, W. (2011). A comparative biomechanical analysis of fixation devices for unstable femoral neck fractures: The Intertan versus cannulated screws or a dynamic hip screw. The Journal of Trauma, 71(3), 625–634.

    PubMed  Google Scholar 

  12. Ye, Y., Hao, J., Mauffrey, C., Hammerberg, E. M., Stahel, P. F., & Hak, D. J. (2015). Optimizing stability in femoral neck fracture fixation. Orthopedics, 38(10), 625–630.

    Article  Google Scholar 

  13. Noda, M., Saegusa, Y., Takahashi, M., Tezuka, D., Adachi, K., & Naoi, K. (2015). Biomechanical study using the finite element method of internal fixation in Pauwels type III vertical femoral neck fractures. Archives of Trauma Research, 4(3), e23167.

    Article  Google Scholar 

  14. Guo, J., Dong, W., Yin, B., Jin, L., Lin, Z., Hou, Z., & Zhang, Y. (2019). Intramedullary nails with cannulated screw fixation for the treatment of unstable femoral neck fractures. The Journal of International Medical Research., 47(2), 557–568.

    Article  Google Scholar 

  15. Giordano, V., Paes, R. P., Alves, D. D., Amaral, A. B., Belangero, W. D., Giordano, M., Freitas, A., & Koch, H. A. (2018). Stability of L-shaped and inverted triangle fixation assemblies in treating Pauwels type II femoral neck fracture: A comparative mechanical study. OriginalPaper European Journal of Orthopaedic Surgery & Traumatology, 28(7), 1359–1367.

    Article  Google Scholar 

  16. Curtis, M. J., Jinnah, R. H., Wilson, V., & Cunningham, B. W. (1994). Proximal femoral fractures: a biomechanical study to compare intramedullary and extramedullary fixation. Injury, 25(2), 99–104.

    Article  CAS  Google Scholar 

  17. Bannister, G. C., Gibson, A. G., Ackroyd, C. E., & Newman, J. H. (1990). The fixation and prognosis of trochanteric fractures: A randomized prospective controlled trial. Clinical Orthopaedics and Related Research, 1990(254), 242–246.

    Google Scholar 

  18. Mir, H., & Collinge, C. (2015). Application of a medial buttress plate may prevent many treatment failures seen after fixation of vertical femoral neck fractures in young adults. Medical Hypotheses, 84(5), 429–433.

    Article  Google Scholar 

  19. Henschel, J., Eberle, S., & Augat, P. (2016). Load distribution between cephalic screws in a dual lag screw trochanteric nail. OriginalPaper. Journal of Orthopaedic Surgery and Research, 11(1), 1–10.

    Article  Google Scholar 

Download references

Funding

No funding.

Author information

Authors and Affiliations

  1. Research and Education Institute of the Orthopedics and Specialized Medicine Hospital IPE-HOME—Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada, SGAS Quadra 613 - Conjunto C, Brasília - Distrito Federal, CEP-70200-730, Brazil

    Anderson Freitas, Fabrício Reichert Barin, Hélio Ismael da Costa, Eduardo Duarte Santos & Hugo Amando Rosado

  2. Department of Orthopedics and Anesthesiology, São Paulo University (FMRP/USP), São Paulo, Brazil

    Anderson Freitas, Leonardo Rigobello Battaglion & Antonio Carlos Shimano

  3. Galeão Area Force Hospital (HFAG), Rio de Janeiro, Brazil

    Marcos Giordano

  4. Orthopedics and Traumatology Service Nova Monteiro - Miguel Couto Municipal Hospital, Rio de Janeiro, Brazil

    Vincenzo Giordano

Authors
  1. Anderson Freitas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabrício Reichert Barin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leonardo Rigobello Battaglion
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hélio Ismael da Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eduardo Duarte Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hugo Amando Rosado
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marcos Giordano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Vincenzo Giordano
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antonio Carlos Shimano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fabrício Reichert Barin.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Standard Statement

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study, informed consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Freitas, A., Barin, F.R., Battaglion, L.R. et al. Proposal for a New Fixation Method for Pauwels Type III Femoral Neck Fracture-Metaphyseal Stem: A Finite-Element Analysis. JOIO 55 (Suppl 2), 378–384 (2021). https://doi.org/10.1007/s43465-021-00420-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-021-00420-7

Keywords

Search

Navigation