Background The purpose of this study is to determine the biomechanical stability of a novel prototype femoral neck locking plate (FNLP) for treatment of Pauwels type C femoral neck fractures compared with other current fixation methods. Methods Forty femur sawbones were divided into groups and a vertical femoral neck fracture was made. Each group was repaired with one of the following: (CS) three parallel cancellous screws; (XCS) two cancellous lag screws into the head and one transverse lag screw into the calcar; and (FNLP) a novel FNLP with two 5.7 mm locking, one lag screw into the calcar and two screws into the shaft; and (AMBI) a two-hole, 135° AMBI plate with a derotation screw. All groups were tested for change in axial stiffness over 20 000 cycles, and rotational stiffness was measured before and after cyclic testing. A maximum load to failure test was also conducted. Results were compared with one-way analysis of variance (ANOVA) and Fisher protected least significant difference (PLSD). Results Results for axial stiffness show that AMBI, CS, XCS and FNLP are 2779.0, 2207.2, 3029.9 and 3210.7 N-m mm−1, respectively. Rotational rigidity results are 4.5, 4.1, 17.1 and 18.7 N-m mm−1. The average cyclic displacements were 0.75, 0.88, 0.80 and 0.65 mm, respectively. Destructive failure loads for AMBI, CS, XCS and FNLP were 2.3, 1.7, 1.6 and 1.9 kN, respectively. Conclusions The results of this experiment show statistically significant increases in axial stiffness for the FNLP compared with three traditional fixation methods. The FNLP demonstrates increased mechanical stiffness and combines the desirable features of current fixation methods.

Biomechanical analysis of a novel femoral neck locking plate for treatment of vertical shear Pauwel's type C femoral neck fractures.

The biomechanical behavior of Pauwels type III fractures should be taken into consideration when performing internal fixation, since this repair should resist the shear force inherent in the vertical fracture line to the greatest extent possible. Recently, the use of a small fragment plate on the medial face of the femoral neck has been proposed by some authors, with satisfactory initial results. In the current study we analyze the mechanical role a medial plate used as a buttress plate for Pauwels type III femoral neck fractures, comparing the resistance of two fixation configurations using three cannulated screws. Pauwels type III fractures were simulated in synthetic bones models and two groups were created, one of those using two parallel screws at the bottom of the femoral neck and the third screw crossing the fracture horizontally (G1), and the other fixed in the same arrangement as G1, but with the addition of a medial side plate at the apex of the fracture (G2). The constructs were subjected to axial loading until catastrophic failure. The addition of a medial plate buttressing the femoral neck increased significantly the resistance to maximum loading (p = 0.003). Use of a medial buttress plate results in a mechanically superior construction for Pauwels type III fractures fixed with multiple cannulated screws. Level IV. Biomechanical comparative study.

/pdf/the-role-of-the-medial-plate-for-pauwels-type-iii-femoral-373y5y9gna.pdf

The role of the medial plate for Pauwels type III femoral neck fracture : a comparative mechanical study using two fixations with cannulated screws

근위 대퇴부의 만곡으로 대퇴 경부는 높은 기계적 압력을 받는 해부학적 구조를 가지고 있다. 대퇴 경부 골절은 전체 고관절 골 절의 약 50% 정도를 차지할 정도로 빈도가 높은 골절이다. 최근 평균 수명의 연장으로 인한 노령 인구의 증가 및 현대 사회에서 교통사고의 증가 등으로 인해 그 발생 빈도가 증가 추세에 있으 며 2050년에는 전 세계적으로 약 600만 명 이상의 고관절 골절 환 자가 발생할 것이라고 예측된다. 대퇴 경부 골절의 발생은 두 가지 연령 분포를 보이며 손상기 전 또한 차이가 있다. 일반적으로 65세 이하 또는 골절 발생 전에 생리적으로 활동적인 사람을 젊은 환자로 분류한다. 젊은 연령 의 대퇴 경부 골절은 전체 대퇴 경부 골절의 3%-5%로 고령에 비 해 훨씬 적게 발생하는 것으로 보고되고 있으며, 주로 교통사고 나 추락과 같은 고 에너지 외상으로 발생하고 고관절이 외반된 상태에서 대퇴 간부의 축을 따라 축방향 힘이 가해져 발생한다. 젊은 환자에서의 대퇴부 골절의 형태는 고령의 환자에서와 다른 양상을 보이는데, 고령의 환자의 경우 주로 대퇴전자간부 골절 또는 수평 방향의 골절부 감입 형태의 대퇴 경부 골두하 골절이 많이 발생하고 젊은 환자의 경우는 대퇴 경부 중간 골절이나 생역 학적으로 보다 불안정한 수직 방향의 골절이 많이 발생한다. 젊 은 환자에서의 대퇴 경부 골절은 골절 유합이 문제없이 이루어진 경우에도 종종 골절부 단축이나 고관절 역학의 변화로 인해 좋지 않은 기능적 결과를 나타낼 수 있으며, 불유합이나 대퇴 골두 무 혈성 괴사와 같은 합병증 발생 비율이 상대적으로 높은 편이다.

/pdf/current-treatment-strategy-for-young-adult-femur-neck-3ya2pb8huy.pdf

Current Treatment Strategy for Young Adult Femur Neck Fractures

Objective: To analyze statistically results in biomechanical testing of fixation of femoral neck Pauwels type III fractures, on synthetic bone, with dynamic condylar screw (DCS) and control group. Methods: Ten synthetic bones of a national brand were used. Test Group: fixation was performed after osteotomy at 70 o tilt using DCS plate with four holes. We analyzed the resistance of this fixation with 5 mm displacement and rotational deviation (Step 1) and with10 mm (Step 2). Control group: the models were tested in their integrity until the femoral neck fracture occurred. Results: The values of the test group in Step 1 showed a mean of 974N and SD = 114N. In Stage 2, we obtained on average 1335N and SD = 98N. The values in the control group were: 1544N, 1110N, 1359N, 1194N, 1437N, respectively. Statistical analysis using the Mann-Whitney test for comparison of the maximum force (N) between the test group and the control, in Step 2, demonstrated that there is no significant difference between the DCS and control plates (p = 0.91). Conclusion: There is no significant difference between the DCS boards and the control group exposed to full resistance. Level of Evidence III, Case Control.

Análise mecânica na fixação da fratura do colo femoral com parafuso dinâmico condilar em osso sintético mechanical analysis of femoral neck fracture fixation with dynamic condylar screw in synthetic bone

Displaced Femoral Neck Fractures in Young Healthy Patients: The Technique

A biomechanical analysis of fixation constructs in high angle femoral neck fractures

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A biomechanical analysis of fixation constructs in high angle femoral neck fractures