Biomechanical study on parallel cannulated compression screw combined with medial buttress plate fixation and F-type cannulated compression screw fixation in Pauwels III femoral neck fracture：A finite element analysis.

Abstract

Pauwels III fracture is a kind of femoral neck fractures, in which the angle of the fracture line in the coronal plane and the upper edge of the acetabulum is more than 50°. Internal fixation for the treatment of femoral neck fractures is largely performed by cannulated compression screw (CCS), dynamic hip screw, or locking plate. This study aims to compare the biomechanical properties of parallel CCS combined with medial buttress plate fixation and F-type CCS fixation in the treatment of Pauwels III femoral neck fracture by finite element modeling and to determinate the most suitable procedure for such fractures. A 52-year-old male volunteer, 176 cm in height and 72 kg in weight, with no history of hip joint, was selected. X-ray and CT examination confirmed that the morphology and bone condition of the right hip of the volunteer were normal. A simulation model of Pauwels III femoral neck fracture was established from the collected CT data of the right proximal femur of the volunteer by the finite element method. Four internal fixations were developed to treat the finite element model: Three CCSs in an inverted triangular parallel configuration combined with medial buttress plate model served as Group A, 2 CCSs in a vertical parallel configuration combined with medial buttress plate model served as Group B, 2 CCSs in a horizontal parallel configuration combined with medial buttress model served as Group C, and the "F" shaped CCS model served as Group D. The distribution of stress, the peak stress, the distribution and maximum of displacement of internal fixations and fracture ends in different models were evaluated. For Groups A, B, C, and D, the peak stresses on the internal fixation were 362.74, 586.84, 558.25, and 208.66 mPa, respectively, all of which occurred near the fractures and the stress distribution in Group D was the most uniform. The maximum displacements of internal fixations in Groups A, B, C, and D were 0.39, 0.45, 0.44, and 0.41 mm, respectively; the peak stresses on the fracture ends were 70.62, 98.48, 55.84, and 65.39 mPa, respectively, all of which were concentrated on the base of femoral neck and lateral cortex of the femoral shaft, and the stresses of Groups C and D were more evenly distributed than those of Groups A and B. The maximum displacements of fracture ends in Groups A, B, C, and D were 0.44, 0.52, 0.50, and 0.44 mm, respectively. The biomechanical stability of F-type CCS fixation is similar to that of 3 CCSs in an inverted triangular parallel configuration combined with medial buttress plate, with a better dispersion of stress. F-type CCS fixation may be a well option for the treatment of femoral neck fracture of Pauwels III.