Cement augmentation of the proximal femoral nail antirotation for the treatment of two intertrochanteric fractures - a comparative finite element study

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...

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Autores principales: Liqin Zheng, Xinmin Chen, Yongze Zheng, Xingpeng He, Jingxiong Wu, Ziling Lin
Formato: article
Lenguaje:EN
Publicado: BMC 2021
Materias:
Bone cement augmentation
Proximal femoral nail antirotation
Intertrochanteric fracture
Finite element analysis
Diseases of the musculoskeletal system
RC925-935
Acceso en línea:https://doaj.org/article/d77f71376cd441fd9e6e3f5187b533a8
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spelling oai:doaj.org-article:d77f71376cd441fd9e6e3f5187b533a82021-12-05T12:18:25ZCement augmentation of the proximal femoral nail antirotation for the treatment of two intertrochanteric fractures - a comparative finite element study10.1186/s12891-021-04878-21471-2474https://doaj.org/article/d77f71376cd441fd9e6e3f5187b533a82021-12-01T00:00:00Zhttps://doi.org/10.1186/s12891-021-04878-2https://doaj.org/toc/1471-2474Abstract 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.Liqin ZhengXinmin ChenYongze ZhengXingpeng HeJingxiong WuZiling LinBMCarticleBone cement augmentationProximal femoral nail antirotationIntertrochanteric fractureFinite element analysisDiseases of the musculoskeletal systemRC925-935ENBMC Musculoskeletal Disorders, Vol 22, Iss 1, Pp 1-13 (2021)
institution DOAJ
collection DOAJ
language EN
topic Bone cement augmentation
Proximal femoral nail antirotation
Intertrochanteric fracture
Finite element analysis
Diseases of the musculoskeletal system
RC925-935
spellingShingle Bone cement augmentation
Proximal femoral nail antirotation
Intertrochanteric fracture
Finite element analysis
Diseases of the musculoskeletal system
RC925-935
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
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.
format article
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
title 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_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_sort cement augmentation of the proximal femoral nail antirotation for the treatment of two intertrochanteric fractures - a comparative finite element study
publisher BMC
publishDate 2021
url https://doaj.org/article/d77f71376cd441fd9e6e3f5187b533a8
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AT xinminchen cementaugmentationoftheproximalfemoralnailantirotationforthetreatmentoftwointertrochantericfracturesacomparativefiniteelementstudy
AT yongzezheng cementaugmentationoftheproximalfemoralnailantirotationforthetreatmentoftwointertrochantericfracturesacomparativefiniteelementstudy
AT xingpenghe cementaugmentationoftheproximalfemoralnailantirotationforthetreatmentoftwointertrochantericfracturesacomparativefiniteelementstudy
AT jingxiongwu cementaugmentationoftheproximalfemoralnailantirotationforthetreatmentoftwointertrochantericfracturesacomparativefiniteelementstudy
AT zilinglin cementaugmentationoftheproximalfemoralnailantirotationforthetreatmentoftwointertrochantericfracturesacomparativefiniteelementstudy
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