Structure-mechanical analysis of various fixation constructs for basicervical fractures of the proximal femur and clinical implications; finite element analysis

Objective: This present study was conducted to determine the structural-mechanical stability of various fixation constructs through finite element (FE) analysis following simulation of a basicervical fracture and to introduce the clinical implications.Materials and Methods: We simulated fracture models by using a right synthetic femur (SAWBONES (R)). We imported the implant models into ANSYS (R) for placement in an optimal position. Five assembly mod-els were constructed: (1) multiple cancellous screws (MCS), (2) FNS (femoral neck system (R)), (3) dynamic hip screw (DHS), (4) DHS with anti-rotation 7.0 screw (DHS + screw), and PFNA-II (Proximal Femoral Nail Antirotation-II (R)). The femur model's distal end was completely fixed and 7 degrees abducted. We set the force vector at a 3 degrees angle laterally and 15 degrees posteriorly from the vertical ground. Analysis was done using Ansys (R) software with von Mises stress (VMS) in megapascals (MPa) and displacement (mm)Results: The displacements of the proximal femur were 10.25 mm for MCS, 9.66 mm for DHS, 9.44 mm for DHS + screw, 9.86 mm for FNS, and 9.31 mm for PFNA-II. The maximum implant VMS was 148.94 MPa for MCS, 414.66 MPa for DHS, 385.59 MPa for DSH + screw, 464.07 MPa for FNS, and 505.07 MPa for PFNA-II. The maximum VMS at the fracture site was 621.13 MPa for MCS, 464.14 MPa for DHS, 64.51 MPa for DHS + screw, 344.54 MPa for FNS, and 647.49 MPa for PFNA-II. The maximum VMS at the fracture site was in the superior area with the high point around the posterior screw in the MCS, anterosuperior corner in the DHS, the posteroinferior site of the FNS, and posterosuperior site around the entry point in the PFNA-II. In the DHS + screw, the stresses were distributed evenly and disappeared at the maximum VMS fracture site.Conclusion: Based on the fracture site and implant's stress distribution, the model receiving the optimal load was a DHS + screw construct, and the FNS implant could be applied to anatomically reduced frac-tures without comminution. Considering the high-stress concentration around the entry point, a PFNA-II fixation has a high probability of head-neck fragment rotational instability.(c) 2022 Published by Elsevier Ltd.

Automated summary

This study analyzed the mechanical stability of different fixation constructs for basicervical fractures using finite element analysis. The results showed that the DHS + screw construct had the optimal load distribution, and the FNS implant was suitable for anatomically reduced fractures without comminution.