Cement augmentation of the proximal femoral nail antirotation for the treatment of two intertrochanteric fractures - a comparative finite element study
Abstract Background There are concerns regarding initial stability and cutout effect in proximal femoral nail antirotation (PFNA) treating intertrochanteric fractures. No study have used finite element analysis (FEA) to investigate the biomechanics. This study aimed to compare the cutout effect, str...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-12-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-021-04878-2 |
| _version_ | 1818405707200856064 |
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| author | Liqin Zheng Xinmin Chen Yongze Zheng Xingpeng He Jingxiong Wu Ziling Lin |
| author_facet | Liqin Zheng Xinmin Chen Yongze Zheng Xingpeng He Jingxiong Wu Ziling Lin |
| author_sort | Liqin Zheng |
| collection | DOAJ |
| description | Abstract Background There are concerns regarding initial stability and cutout effect in proximal femoral nail antirotation (PFNA) treating intertrochanteric fractures. No study have used finite element analysis (FEA) to investigate the biomechanics. This study aimed to compare the cutout effect, stress and displacement between stable (AO31-A1.3) and unstable (AO31-A2.2) intertrochanteric fractures treated by cement augmented PFNA. Methods Four femoral finite element models (FEMs) were constructed and tested under the maximum loading during walking. Non-augmented and augmented PFNA in two different intertrochanteric fractures were respectively simulated, assuming Tip Apex Distance (TAD) < 25 mm within each FEM. The cutout effect, stress and displacement between femur and PFNA were compared in each condition. Results Cutout effect was observed in both non-augmented femoral head and was more apparently in unstable intertrochanteric fracture model. After reinforced by bone cement, no cutout effect occurred in two models. Stress concentration were observed on medial part of intertrochanteric region and the proximal part of helical blade before augmented while were observed on femoral shaft and the conjunction between blade and nail after augmented in both FEMs. Displacement mainly appeared on femoral head and the helical blade tip before augmented while distributed moderately on intertrochanteric region and the upper part of nail after augmented in both FEMs. The maximum stress and displacement value of femur decreased both in stable and unstable model after augmented but was more significantly in the unstable one. The maximum stress and displacement value of PFNA increased both in stable and unstable model after augmented but was more significantly in the unstable one. Conclusion Our FEA study indicated that the cement augmentation of the PFNA biomechanically enhances the cutout resistance in intertrochanteric fracture, this procedure is especially efficient for the unstable intertrochanteric fracture. |
| first_indexed | 2024-12-14T09:00:19Z |
| format | Article |
| id | doaj.art-d77f71376cd441fd9e6e3f5187b533a8 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-14T09:00:19Z |
| publishDate | 2021-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-d77f71376cd441fd9e6e3f5187b533a82022-12-21T23:08:50ZengBMCBMC Musculoskeletal Disorders1471-24742021-12-0122111310.1186/s12891-021-04878-2Cement augmentation of the proximal femoral nail antirotation for the treatment of two intertrochanteric fractures - a comparative finite element studyLiqin Zheng0Xinmin Chen1Yongze Zheng2Xingpeng He3Jingxiong Wu4Ziling Lin5The First Clinical Medical College, Guangzhou University of Chinese MedicineDepartment of Orthopedic, Zhongxiang People’s HospitalDepartment of Orthopedic, Puning Hospital of Traditional Chinese MedicineThe First Clinical Medical College, Guangzhou University of Chinese MedicineDepartment of Osteoarticular Surgery, Integrated Traditional Chinese and Western Medicine Hospital of Pengjiang District of Jiangmen CityDepartment of Orthopedic, The First Affiliated Hospital of Guangzhou University of Chinese MedicineAbstract Background There are concerns regarding initial stability and cutout effect in proximal femoral nail antirotation (PFNA) treating intertrochanteric fractures. No study have used finite element analysis (FEA) to investigate the biomechanics. This study aimed to compare the cutout effect, stress and displacement between stable (AO31-A1.3) and unstable (AO31-A2.2) intertrochanteric fractures treated by cement augmented PFNA. Methods Four femoral finite element models (FEMs) were constructed and tested under the maximum loading during walking. Non-augmented and augmented PFNA in two different intertrochanteric fractures were respectively simulated, assuming Tip Apex Distance (TAD) < 25 mm within each FEM. The cutout effect, stress and displacement between femur and PFNA were compared in each condition. Results Cutout effect was observed in both non-augmented femoral head and was more apparently in unstable intertrochanteric fracture model. After reinforced by bone cement, no cutout effect occurred in two models. Stress concentration were observed on medial part of intertrochanteric region and the proximal part of helical blade before augmented while were observed on femoral shaft and the conjunction between blade and nail after augmented in both FEMs. Displacement mainly appeared on femoral head and the helical blade tip before augmented while distributed moderately on intertrochanteric region and the upper part of nail after augmented in both FEMs. The maximum stress and displacement value of femur decreased both in stable and unstable model after augmented but was more significantly in the unstable one. The maximum stress and displacement value of PFNA increased both in stable and unstable model after augmented but was more significantly in the unstable one. Conclusion Our FEA study indicated that the cement augmentation of the PFNA biomechanically enhances the cutout resistance in intertrochanteric fracture, this procedure is especially efficient for the unstable intertrochanteric fracture.https://doi.org/10.1186/s12891-021-04878-2Bone cement augmentationProximal femoral nail antirotationIntertrochanteric fractureFinite element analysis |
| spellingShingle | Liqin Zheng Xinmin Chen Yongze Zheng Xingpeng He Jingxiong Wu Ziling Lin Cement augmentation of the proximal femoral nail antirotation for the treatment of two intertrochanteric fractures - a comparative finite element study BMC Musculoskeletal Disorders Bone cement augmentation Proximal femoral nail antirotation Intertrochanteric fracture Finite element analysis |
| title | Cement augmentation of the proximal femoral nail antirotation for the treatment of two intertrochanteric fractures - a comparative finite element study |
| title_full | Cement augmentation of the proximal femoral nail antirotation for the treatment of two intertrochanteric fractures - a comparative finite element study |
| title_fullStr | Cement augmentation of the proximal femoral nail antirotation for the treatment of two intertrochanteric fractures - a comparative finite element study |
| title_full_unstemmed | Cement augmentation of the proximal femoral nail antirotation for the treatment of two intertrochanteric fractures - a comparative finite element study |
| title_short | Cement augmentation of the proximal femoral nail antirotation for the treatment of two intertrochanteric fractures - a comparative finite element study |
| title_sort | cement augmentation of the proximal femoral nail antirotation for the treatment of two intertrochanteric fractures a comparative finite element study |
| topic | Bone cement augmentation Proximal femoral nail antirotation Intertrochanteric fracture Finite element analysis |
| url | https://doi.org/10.1186/s12891-021-04878-2 |
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