Biomechanical study of femoral neck system for young patients with nonanatomically reduced femoral neck fractures: a finite element

BackgroundA consensus regarding the optimal approach for treating femoral neck fractures is lacking. We aimed to investigate the biomechanical outcomes of Femoral Neck System (FNS) internal fixation components in the treatment of nonanatomically reduced femoral neck fractures.MethodWe constructed two types of femoral neck fractures of the Pauwels classification with angles of 30 degrees and 50 degrees, and three models of anatomic reduction, positive buttress reduction and negative buttress reduction were constructed. Subgroups of 1 to 4 mm were divided according to the distance of displacement in the positive buttress reduction and negative buttress reduction models. The von Mises stress and displacements of the femur and FNS internal fixation components were measured for each fracture group under 2100-N axial loads.ResultsWhen the Pauwels angle was 30 degrees, the positive 1-mm and 2-mm models had lower FNS stress than the negative buttress model. The positive 3- and 4-mm models showed FNS stress similar to that of the negative buttress model. But the four positive buttress models had similar stresses on the femur as the negative buttress model. When the Pauwels angle was 50 degrees, the four positive buttress models had higher FNS stress than the negative buttress model. Three positive buttress models (2 mm, 3 and 4 mm) resulted in lower stress of the femur than the negative buttress model, though the 1-mm model did not. When the Pauwels angle was 30 degrees, the positive buttress model had a lower displacement of the FNS than the negative buttress model and a similar displacement of the femur with the negative buttress model. When the Pauwels angle was 50 degrees, the positive buttress model had a higher displacement of the FNS and femur than the negative buttress model. Our study also showed that the von Mises stress and displacement of the internal fixation and the femur increased as the fracture angle increased.ConclusionFrom the perspectiveof biomechanics, when the Pauwels angle was 30 degrees, positive buttress was morestable to negative buttress. However, when the Pauwels angle was 50 degrees, this advantage weakens.In our opinion, the clinical efficacy of FNS internal fixation with positivebuttress may be related to the fracture angle, neck-shaft angle and alignmentin the lateral view. This result needs verification in further clinicalstudies.

Automated summary

This study aimed to evaluate the biomechanical outcomes of FNS internal fixation in the treatment of nonanatomically reduced femoral neck fractures. The results showed that the positive buttress model had lower FNS stress at a Pauwels angle of 30 degrees, but higher FNS stress at a Pauwels angle of 50 degrees. Therefore, the clinical efficacy of FNS internal fixation may be influenced by the fracture angle.