Influence of the proximal screws of buttress plates on the stability of vertical femoral neck fractures: a finite element analysis

BACKGROUND: The treatment of vertical femoral neck fractures (vFNFs) in young patients remains challenging, with a high complication rate by using traditional techniques. The use of cannulated screws (CSs) combined with a buttress plate represents an alternative approach for treating vFNFs. However,...

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Autores principales: Zhan, Shi, Jiang, Dajun, Xu, Jian, Ling, Ming, Yang, Kai, Li, Yuehua, Jia, Weitao, Hu, Hai, Zhang, Changqing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733615/
https://www.ncbi.nlm.nih.gov/pubmed/33308185
http://dx.doi.org/10.1186/s12891-020-03853-7
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author Zhan, Shi
Jiang, Dajun
Xu, Jian
Ling, Ming
Yang, Kai
Li, Yuehua
Jia, Weitao
Hu, Hai
Zhang, Changqing
author_facet Zhan, Shi
Jiang, Dajun
Xu, Jian
Ling, Ming
Yang, Kai
Li, Yuehua
Jia, Weitao
Hu, Hai
Zhang, Changqing
author_sort Zhan, Shi
collection PubMed
description BACKGROUND: The treatment of vertical femoral neck fractures (vFNFs) in young patients remains challenging, with a high complication rate by using traditional techniques. The use of cannulated screws (CSs) combined with a buttress plate represents an alternative approach for treating vFNFs. However, the biomechanical influence of the use or non-use of the proximal screws of buttress plates on vFNFs stability remains unclear. This study aims to analyse the biomechanics of buttress plate fixation with or without the use of proximal screws through finite element analysis (FEA) to further understand this approach. METHODS: We built five vFNFs (Pauwels angle 70°) finite element models treated using three cannulated screws (CS group) or three cannulated screws plus a locking buttress plate (buttress group). In the buttress group, use or non-use of proximal screws was carried out on two types of plates (4-hole & 6-hole). The following seven parameters were analysed to compare biomechanical properties of the five models: the stiffness; the maximal stress of the plate system (plate and screws), CSs and bone (MPS, MCS, MBS); the maximal displacement of internal fixations (plate system & CSs) and bone (MIFD, MBD); and the maximal relative displacement of interfragments (MID). RESULTS: Compared with CS model, the buttress models exhibited improved biomechanical properties, with increased stiffness and decreased MCS, MBS, MIFD, MBD and MID. The models fixed using buttress plates combined with a proximal screw showed greater stiffness (+ 3.75% & + 8.31% vs + 0.98% & + 4.57%) and MPS (795.6 & 947.2 MPa vs 294.9 & 556.2 MPa) values, and smaller MCS, MBS, MIFD, MBD and MID (− 3.41% to − 15.35% vs − 0.07% to − 4.32%) values than those using the same length plates without a proximal screw. CONCLUSIONS: Based on the FEA results, buttress plates can improve construct mechanics, help to resist shear force and prevent varus collapse; under the modelling conditions, the use of a proximal screw on buttress plate may be a key technical feature in improving anti-shearing ability; additionally, this screw may be essential to reduce stress and prevent re-displacement of cannulated screws and fracture fragments.
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spelling pubmed-77336152020-12-14 Influence of the proximal screws of buttress plates on the stability of vertical femoral neck fractures: a finite element analysis Zhan, Shi Jiang, Dajun Xu, Jian Ling, Ming Yang, Kai Li, Yuehua Jia, Weitao Hu, Hai Zhang, Changqing BMC Musculoskelet Disord Research Article BACKGROUND: The treatment of vertical femoral neck fractures (vFNFs) in young patients remains challenging, with a high complication rate by using traditional techniques. The use of cannulated screws (CSs) combined with a buttress plate represents an alternative approach for treating vFNFs. However, the biomechanical influence of the use or non-use of the proximal screws of buttress plates on vFNFs stability remains unclear. This study aims to analyse the biomechanics of buttress plate fixation with or without the use of proximal screws through finite element analysis (FEA) to further understand this approach. METHODS: We built five vFNFs (Pauwels angle 70°) finite element models treated using three cannulated screws (CS group) or three cannulated screws plus a locking buttress plate (buttress group). In the buttress group, use or non-use of proximal screws was carried out on two types of plates (4-hole & 6-hole). The following seven parameters were analysed to compare biomechanical properties of the five models: the stiffness; the maximal stress of the plate system (plate and screws), CSs and bone (MPS, MCS, MBS); the maximal displacement of internal fixations (plate system & CSs) and bone (MIFD, MBD); and the maximal relative displacement of interfragments (MID). RESULTS: Compared with CS model, the buttress models exhibited improved biomechanical properties, with increased stiffness and decreased MCS, MBS, MIFD, MBD and MID. The models fixed using buttress plates combined with a proximal screw showed greater stiffness (+ 3.75% & + 8.31% vs + 0.98% & + 4.57%) and MPS (795.6 & 947.2 MPa vs 294.9 & 556.2 MPa) values, and smaller MCS, MBS, MIFD, MBD and MID (− 3.41% to − 15.35% vs − 0.07% to − 4.32%) values than those using the same length plates without a proximal screw. CONCLUSIONS: Based on the FEA results, buttress plates can improve construct mechanics, help to resist shear force and prevent varus collapse; under the modelling conditions, the use of a proximal screw on buttress plate may be a key technical feature in improving anti-shearing ability; additionally, this screw may be essential to reduce stress and prevent re-displacement of cannulated screws and fracture fragments. BioMed Central 2020-12-12 /pmc/articles/PMC7733615/ /pubmed/33308185 http://dx.doi.org/10.1186/s12891-020-03853-7 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Zhan, Shi
Jiang, Dajun
Xu, Jian
Ling, Ming
Yang, Kai
Li, Yuehua
Jia, Weitao
Hu, Hai
Zhang, Changqing
Influence of the proximal screws of buttress plates on the stability of vertical femoral neck fractures: a finite element analysis
title Influence of the proximal screws of buttress plates on the stability of vertical femoral neck fractures: a finite element analysis
title_full Influence of the proximal screws of buttress plates on the stability of vertical femoral neck fractures: a finite element analysis
title_fullStr Influence of the proximal screws of buttress plates on the stability of vertical femoral neck fractures: a finite element analysis
title_full_unstemmed Influence of the proximal screws of buttress plates on the stability of vertical femoral neck fractures: a finite element analysis
title_short Influence of the proximal screws of buttress plates on the stability of vertical femoral neck fractures: a finite element analysis
title_sort influence of the proximal screws of buttress plates on the stability of vertical femoral neck fractures: a finite element analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733615/
https://www.ncbi.nlm.nih.gov/pubmed/33308185
http://dx.doi.org/10.1186/s12891-020-03853-7
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