Biomechanics of subtrochanteric fracture fixation using short cephalomedullary nails: A finite element analysis.

Biomechanics of subtrochanteric fracture fixation using short cephalomedullary nails: A finite element analysis.

A finite element analysis was performed to evaluate the stresses around nails and cortical bones in subtrochanteric (ST) fracture models fixed using short cephalomedullary nails (CMNs). A total 96 finite element models (FEMs) were simulated on a transverse ST fracture at eight levels with three diff...

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Autores principales: Dae-Kyung Kwak, Sun-Hee Bang, Won-Hyeon Kim, Sung-Jae Lee, Seunghun Lee, Je-Hyun Yoo
Formato: article
Lenguaje:EN
Publicado: Public Library of Science (PLoS) 2021
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Acceso en línea:https://doaj.org/article/f19566d1aaea423a862b6ffd2062ebd4
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spelling oai:doaj.org-article:f19566d1aaea423a862b6ffd2062ebd42021-12-02T20:09:42ZBiomechanics of subtrochanteric fracture fixation using short cephalomedullary nails: A finite element analysis.1932-620310.1371/journal.pone.0253862https://doaj.org/article/f19566d1aaea423a862b6ffd2062ebd42021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0253862https://doaj.org/toc/1932-6203A finite element analysis was performed to evaluate the stresses around nails and cortical bones in subtrochanteric (ST) fracture models fixed using short cephalomedullary nails (CMNs). A total 96 finite element models (FEMs) were simulated on a transverse ST fracture at eight levels with three different fracture gaps and two different distal locking screw configurations in both normal and osteoporotic bone. All FEMs were fixed using CMNs 200 mm in length. Two distal locking screws showed a wider safe range than 1 distal screw in both normal and osteoporotic bone at fracture gaps ≤ 3 mm. In normal bone FEMs fixed even with two distal locking screws, peak von Mises stresses (PVMSs) in cortical bone and nail constructs reached or exceeded 90% of the yield strength at fracture levels 50 mm and 0 and 50 mm, respectively, at all fracture gaps. In osteoporotic bone FEMs, PVMSs in cortical bone and nail constructs reached or exceeded 90% of the yield strength at fracture levels 50 mm and 0 and 50 mm, respectively, at a 1-mm fracture gap. However, at fracture gaps ≥ 2 mm, PVMSs in cortical bone reached or exceeded 90% of the yield strength at fracture levels ≥ 35 mm. PVMSs in nail showed the same results as 1-mm fracture gaps. PVMSs increased and safe range reduced, as the fracture gap increased. Short CMNs (200 mm in length) with two distal screws may be considered suitable for the fixation of ST transverse fractures at fracture levels 10 to 40 mm below the lesser trochanter in normal bone and 10 to 30 mm in osteoporotic bone, respectively, under the assumptions of anatomical reduction at fracture gap ≤ 3 mm. However, the fracture gap should be shortened to the minimum to reduce the risk of refracture and fixation failure, especially in osteoporotic fractures.Dae-Kyung KwakSun-Hee BangWon-Hyeon KimSung-Jae LeeSeunghun LeeJe-Hyun YooPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0253862 (2021)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Dae-Kyung Kwak
Sun-Hee Bang
Won-Hyeon Kim
Sung-Jae Lee
Seunghun Lee
Je-Hyun Yoo
Biomechanics of subtrochanteric fracture fixation using short cephalomedullary nails: A finite element analysis.
description A finite element analysis was performed to evaluate the stresses around nails and cortical bones in subtrochanteric (ST) fracture models fixed using short cephalomedullary nails (CMNs). A total 96 finite element models (FEMs) were simulated on a transverse ST fracture at eight levels with three different fracture gaps and two different distal locking screw configurations in both normal and osteoporotic bone. All FEMs were fixed using CMNs 200 mm in length. Two distal locking screws showed a wider safe range than 1 distal screw in both normal and osteoporotic bone at fracture gaps ≤ 3 mm. In normal bone FEMs fixed even with two distal locking screws, peak von Mises stresses (PVMSs) in cortical bone and nail constructs reached or exceeded 90% of the yield strength at fracture levels 50 mm and 0 and 50 mm, respectively, at all fracture gaps. In osteoporotic bone FEMs, PVMSs in cortical bone and nail constructs reached or exceeded 90% of the yield strength at fracture levels 50 mm and 0 and 50 mm, respectively, at a 1-mm fracture gap. However, at fracture gaps ≥ 2 mm, PVMSs in cortical bone reached or exceeded 90% of the yield strength at fracture levels ≥ 35 mm. PVMSs in nail showed the same results as 1-mm fracture gaps. PVMSs increased and safe range reduced, as the fracture gap increased. Short CMNs (200 mm in length) with two distal screws may be considered suitable for the fixation of ST transverse fractures at fracture levels 10 to 40 mm below the lesser trochanter in normal bone and 10 to 30 mm in osteoporotic bone, respectively, under the assumptions of anatomical reduction at fracture gap ≤ 3 mm. However, the fracture gap should be shortened to the minimum to reduce the risk of refracture and fixation failure, especially in osteoporotic fractures.
format article
author Dae-Kyung Kwak
Sun-Hee Bang
Won-Hyeon Kim
Sung-Jae Lee
Seunghun Lee
Je-Hyun Yoo
author_facet Dae-Kyung Kwak
Sun-Hee Bang
Won-Hyeon Kim
Sung-Jae Lee
Seunghun Lee
Je-Hyun Yoo
author_sort Dae-Kyung Kwak
title Biomechanics of subtrochanteric fracture fixation using short cephalomedullary nails: A finite element analysis.
title_short Biomechanics of subtrochanteric fracture fixation using short cephalomedullary nails: A finite element analysis.
title_full Biomechanics of subtrochanteric fracture fixation using short cephalomedullary nails: A finite element analysis.
title_fullStr Biomechanics of subtrochanteric fracture fixation using short cephalomedullary nails: A finite element analysis.
title_full_unstemmed Biomechanics of subtrochanteric fracture fixation using short cephalomedullary nails: A finite element analysis.
title_sort biomechanics of subtrochanteric fracture fixation using short cephalomedullary nails: a finite element analysis.
publisher Public Library of Science (PLoS)
publishDate 2021
url https://doaj.org/article/f19566d1aaea423a862b6ffd2062ebd4
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