1.Study on quantitative analysis of bracket-induced nonlinear response of labio-cheek soft tissue during the orthodontic process.
Jiahao HUA ; Li JI ; Qingyuan DAI ; Zhenyu LIANG ; Longmei GUO ; Taicong CHEN
Journal of Biomedical Engineering 2023;40(2):295-302
		                        		
		                        			
		                        			In the orthodontics process, intervention and sliding of an orthodontic bracket during the orthodontic process can arise large response of the labio-cheek soft tissue. Soft tissue damage and ulcers frequently happen at the early stage of orthodontic treatment. In the field of orthodontic medicine, qualitative analysis is always carried out through statistics of clinical cases, while quantitative explanation of bio-mechanical mechanism is lacking. For this purpose, finite element analysis of a three-dimensional labio-cheek-bracket-tooth model is conducted to quantify the bracket-induced mechanical response of the labio-cheek soft tissue, which involves complex coupling of contact nonlinearity, material nonlinearity and geometric nonlinearity. Firstly, based on the biological composition characteristics of labio-cheek, a second-order Ogden model is optimally selected to describe the adipose-like material of the labio-cheek soft tissue. Secondly, according to the characteristics of oral activity, a two-stage simulation model of bracket intervention and orthogonal sliding is established, and the key contact parameters are optimally set. Finally, the two-level analysis method of overall model and submodel is used to achieve efficient solution of high-precision strains in submodels based on the displacement boundary obtained from the overall model calculation. Calculation results with four typical tooth morphologies during orthodontic treatment show that: ① the maximum strain of soft tissue is distributed along the sharp edges of the bracket, consistent with the clinically observed profile of soft tissue deformation; ② the maximum strain of soft tissue is reduced as the teeth align, consistent with the clinical manifestation of common damage and ulcers at the beginning of orthodontic treatment and reduced patient discomfort at the end of treatment. The method in this paper can provide reference for relevant quantitative analysis studies in the field of orthodontic medical treatment at home and abroad, and further benefit to the product development analysis of new orthodontic devices.
		                        		
		                        		
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Periodontal Ligament/physiology*
		                        			;
		                        		
		                        			Orthodontic Wires
		                        			;
		                        		
		                        			Cheek
		                        			;
		                        		
		                        			Ulcer
		                        			;
		                        		
		                        			Tooth
		                        			;
		                        		
		                        			Finite Element Analysis
		                        			
		                        		
		                        	
2.Macroscopic and mesoscopic biomechanical analysis of the bone unit in idiopathic scoliosis.
Zhaoyao WANG ; Rongchang FU ; Yuan MA ; Peng YE
Journal of Biomedical Engineering 2023;40(2):303-312
		                        		
		                        			
		                        			To investigate the effects of postoperative fusion implantation on the mesoscopic biomechanical properties of vertebrae and bone tissue osteogenesis in idiopathic scoliosis, a macroscopic finite element model of the postoperative fusion device was developed, and a mesoscopic model of the bone unit was developed using the Saint Venant sub-model approach. To simulate human physiological conditions, the differences in biomechanical properties between macroscopic cortical bone and mesoscopic bone units under the same boundary conditions were studied, and the effects of fusion implantation on bone tissue growth at the mesoscopic scale were analyzed. The results showed that the stresses in the mesoscopic structure of the lumbar spine increased compared to the macroscopic structure, and the mesoscopic stress in this case is 2.606 to 5.958 times of the macroscopic stress; the stresses in the upper bone unit of the fusion device were greater than those in the lower part; the average stresses in the upper vertebral body end surfaces were ranked in the order of right, left, posterior and anterior; the stresses in the lower vertebral body were ranked in the order of left, posterior, right and anterior; and rotation was the condition with the greatest stress value in the bone unit. It is hypothesized that bone tissue osteogenesis is better on the upper face of the fusion than on the lower face, and that bone tissue growth rate on the upper face is in the order of right, left, posterior, and anterior; while on the lower face, it is in the order of left, posterior, right, and anterior; and that patients' constant rotational movements after surgery is conducive to bone growth. The results of the study may provide a theoretical basis for the design of surgical protocols and optimization of fusion devices for idiopathic scoliosis.
		                        		
		                        		
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Scoliosis/surgery*
		                        			;
		                        		
		                        			Spinal Fusion/methods*
		                        			;
		                        		
		                        			Lumbar Vertebrae/surgery*
		                        			;
		                        		
		                        			Osteogenesis
		                        			;
		                        		
		                        			Biomechanical Phenomena/physiology*
		                        			;
		                        		
		                        			Finite Element Analysis
		                        			
		                        		
		                        	
3.Biomechanical effects of three internal fixation modes on femoral subtrochanteric spiral fractures in osteoporotic patients by finite element analysis.
Chinese Journal of Reparative and Reconstructive Surgery 2023;37(6):688-693
		                        		
		                        			OBJECTIVE:
		                        			The biomechanical characteristics of three internal fixation modes for femoral subtrochanteric spiral fracture in osteoporotic patients were compared and analyzed by finite element technology, so as to provide the basis for the optimization of fixation methods for femoral subtrochanteric spiral fracture.
		                        		
		                        			METHODS:
		                        			Ten female patients with osteoporosis and femoral subtrochanteric spiral fractures caused by trauma, aged 65-75 years old, with a height of 160-170 cm and a body weight mass of 60-70 kg, were selected as the study subjects. The femur was scanned by spiral CT and a three-dimensional model of the femur was established by digital technology. The computer aided design models of proximal intramedullary nail (PFN), proximal femoral locking plate (PFLP), and the combination of the two (PFLP+PFN) were constructed under the condition of subtrochanteric fracture. Then the same load of 500 N was applied to the femoral head, and the stress distribution of the internal fixators, the stress distribution of the femur, and the displacement of femur after fracture fixation were compared and analyzed under the three finite element internal fixation modes, so as to evaluate the fixation effect.
		                        		
		                        			RESULTS:
		                        			In the PFLP fixation mode, the stress of the plate was mainly concentrated in the main screw channel, the stresses of the different part of the plate were not equal, and gradually decreased from the head to the tail. In the PFN fixation mode, the stress was concentrated in the upper part of the lateral middle segment. In the PFLP+PFN fixation mode, the maximum stress appeared between the first and the second screws in the lower segment, and the maximum stress appeared in the lateral part of the middle segment of the PFN. The maximum stress of PFLP+PFN fixation mode was significantly higher than that of PFLP fixation mode, but significantly lower than that of PFN fixation mode ( P<0.05). In PFLP and PFN fixation modes, the maximum stress of femur appeared in the medial and lateral cortical bone of the middle femur and the lower side of the lowest screw. In PFLP+PFN fixation mode, the stress of femur concentrated in the medial and lateral of the middle femur. There was no significant difference in the maximum stress of femur among the three finite element fixation modes ( P>0.05). The maximum displacement occurred at the femoral head after three finite element fixation modes were used to fix subtrochanteric femoral fractures. The maximum displacement of femur in PFLP fixation mode was the largest, followed by PFN, and PFLP+PFN was the minimum, with significant differences ( P<0.05).
		                        		
		                        			CONCLUSION
		                        			Under static loading conditions, the PFLP+PFN fixation mode produces the smallest maximum displacement when compared with the single PFN and PFLP fixation modes, but its maximum plate stress is greater than the single PFN and PFLP fixation mode, suggesting that the combination mode has higher stability, but the plate load is greater, and the possibility of fixation failure is higher.
		                        		
		                        		
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Aged
		                        			;
		                        		
		                        			Finite Element Analysis
		                        			;
		                        		
		                        			Biomechanical Phenomena
		                        			;
		                        		
		                        			Fracture Fixation, Internal/methods*
		                        			;
		                        		
		                        			Hip Fractures/surgery*
		                        			;
		                        		
		                        			Bone Plates
		                        			;
		                        		
		                        			Femur Head
		                        			;
		                        		
		                        			Femoral Fractures/surgery*
		                        			
		                        		
		                        	
4.Establishment of finite element model of varus-type ankle arthritis and biomechanical analysis of different correction models for tibial anterior surface angle.
Cheng CHEN ; Yunfeng YANG ; Bing LI ; Jiang XIA ; Youguang ZHAO ; Hui ZHU ; Haichao ZHOU ; Yongqi LI ; Zhendong LI ; Wenbao HE ; Yi ZHANG ; Hui HUANG
Chinese Journal of Reparative and Reconstructive Surgery 2023;37(7):796-801
		                        		
		                        			OBJECTIVE:
		                        			To establish the finite element model of varus-type ankle arthritis and to implement the finite element mechanical analysis of different correction models for tibial anterior surface angle (TAS) in supramalleolar osteotomy.
		                        		
		                        			METHODS:
		                        			A female patient with left varus-type ankle arthritis (Takakura stage Ⅱ, TAS 78°) was taken as the study object. Based on the CT data, the three-dimensional model of varus-type ankle arthritis (TAS 78°) and different TAS correction models [normal (TAS 89°), 5° valgus (TAS 94°), and 10° valgus (TAS 99°)] were created by software Mimics 21.0, Geomagic Wrap 2021, Solidworks 2017, and Workbench 17.0. The 290 N vertical downward force was applied to the upper surface of the tibia and 60 N vertical downward force to the upper surface of the fibula. Von Mises stress distribution and stress peak were calculated.
		                        		
		                        			RESULTS:
		                        			The finite element model of normal TAS was basically consistent with biomechanics of the foot. According to biomechanical analysis, the maximum stress of the varus model appeared in the medial tibiotalar joint surface and the medial part of the top tibiotalar joint surface. The stress distribution of talofibular joint surface and the lateral part of the top tibiotalar joint surface were uniform. In the normal model, the stress distributions of the talofibular joint surface and the tibiotalar joint surface were uniform, and no obvious stress concentration was observed. The maximum stress in the 5° valgus model appeared at the posterior part of the talofibular joint surface and the lateral part of the top tibiotalar joint surface. The stress distribution of medial tibiotalar joint surface was uniform. The maximum stress of the 10° valgus model appeared at the posterior part of the talofibular joint surface and the lateral part of the top tibiotalar joint surface. The stress on the medial tibiotalar joint surface increased.
		                        		
		                        			CONCLUSION
		                        			With the increase of valgus, the stress of ankle joint gradually shift outwards, and the stress concentration tends to appear. There was no obvious obstruction of fibula with 10° TAS correction. However, when TAS correction exceeds 10° and continues to increase, the obstruction effect of fibula becomes increasingly significant.
		                        		
		                        		
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Tibia/surgery*
		                        			;
		                        		
		                        			Finite Element Analysis
		                        			;
		                        		
		                        			Ankle
		                        			;
		                        		
		                        			Arthritis
		                        			;
		                        		
		                        			Fibula/surgery*
		                        			;
		                        		
		                        			Ankle Joint/surgery*
		                        			
		                        		
		                        	
5.Three-dimensional finite element model construction and biomechanical analysis of customized titanium alloy lunate prosthesis.
Bin WANG ; Xingbo CAI ; Yue ZHANG ; Bihuan ZHANG ; Yongqing XU
Chinese Journal of Reparative and Reconstructive Surgery 2023;37(7):821-826
		                        		
		                        			OBJECTIVE:
		                        			To design customized titanium alloy lunate prosthesis, construct three-dimensional finite element model of wrist joint before and after replacement by finite element analysis, and observe the biomechanical changes of wrist joint after replacement, providing biomechanical basis for clinical application of prosthesis.
		                        		
		                        			METHODS:
		                        			One fresh frozen human forearm was collected, and the maximum range of motions in flexion, extension, ulnar deviation, and radialis deviation tested by cortex motion capture system were 48.42°, 38.04°, 35.68°, and 26.41°, respectively. The wrist joint data was obtained by CT scan and imported into Mimics21.0 software and Magics21.0 software to construct a wrist joint three-dimensional model and design customized titanium alloy lunate prosthesis. Then Geomagic Studio 2017 software and Solidworks 2017 software were used to construct the three-dimensional finite element models of a normal wrist joint (normal model) and a wrist joint with lunate prosthesis after replacement (replacement model). The stress distribution and deformation of the wrist joint before and after replacement were analyzed for flexion at and 15°, 30°, 48.42°, extension at 15°, 30°, and 38.04°, ulnar deviation at 10°, 20°, and 35.68°, and radial deviation at 5°, 15°, and 26.41° by the ANSYS 17.0 finite element analysis software. And the stress distribution of lunate bone and lunate prosthesis were also observed.
		                        		
		                        			RESULTS:
		                        			The three-dimensional finite element models of wrist joint before and after replacement were successfully constructed. At different range of motion of flexion, extension, ulnar deviation, and radial deviation, there were some differences in the number of nodes and units in the grid models. In the four directions of flexion, extension, ulnar deviation, and radial deviation, the maximum deformation of wrist joint in normal model and replacement model occurred in the radial side, and the values increased gradually with the increase of the range of motion. The maximum stress of the wrist joint increased gradually with the increase of the range of motion, and at maximum range of motion, the stress was concentrated on the proximal radius, showing an overall trend of moving from the radial wrist to the proximal radius. The maximum stress of normal lunate bone increased gradually with the increase of range of motion in different directions, and the stress position also changed. The maximum stress of lunate prosthesis was concentrated on the ulnar side of the prosthesis, which increased gradually with the increase of the range of motion in flexion, and decreased gradually with the increase of the range of motion in extension, ulnar deviation, and radialis deviation. The stress on prosthesis increased significantly when compared with that on normal lunate bone.
		                        		
		                        			CONCLUSION
		                        			The customized titanium alloy lunate prosthesis does not change the wrist joint load transfer mode, which provided data support for the clinical application of the prosthesis.
		                        		
		                        		
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Lunate Bone/surgery*
		                        			;
		                        		
		                        			Finite Element Analysis
		                        			;
		                        		
		                        			Titanium
		                        			;
		                        		
		                        			Wrist Joint/surgery*
		                        			;
		                        		
		                        			Artificial Limbs
		                        			;
		                        		
		                        			Range of Motion, Articular
		                        			;
		                        		
		                        			Biomechanical Phenomena
		                        			
		                        		
		                        	
6.Finite element analysis of different reconstruction methods of coracoclavicular ligament for acromioclavicular joint dislocation.
Hao CHEN ; Jia-Hu FANG ; Guo-Yong YIN
China Journal of Orthopaedics and Traumatology 2023;36(6):543-549
		                        		
		                        			OBJECTIVE:
		                        			This study aims to examine the biomechanical effects of different reconstruction methods, including single-bundle, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of the coracoclavicular ligament on the acromioclavicular joint using finite element analysis, to provide a theoretical basis for the clinical application of truly anatomical coracoclavicular ligament reconstruction.
		                        		
		                        			METHODS:
		                        			One volunteer, aged 27 years old, with a height of 178 cm and a weight of 75 kg, was selected for CT scanning of the shoulder joint. Three-dimensional finite element models of single-bundle reconstruction, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of coracoclavicular ligament were established by using Mimics17.0, Geomagic studio 2012, UG NX 10.0, HyperMesh 14.0 and ABAQUS 6.14 software. The maximum displacement of the middle point of the distal clavicle in the main loading direction and the maximum equivalent stress of the reconstruction device under different loading conditions were recorded and compared.
		                        		
		                        			RESULTS:
		                        			The maximum forward displacement and the maximum backward displacement of the middle point of the distal clavicle in the double-bundle truly anatomic reconstruction were the lowest, which were 7.76 mm and 7.27 mm respectively. When an upward load was applied, the maximum displacement of the distal clavicle midpoint in the double-beam anatomic reconstruction was the lowest, which was 5.12 mm. Applying three different loads forward, backward, and upward, the maximum equivalent stress of the reconstruction devices in the double-beam reconstruction was lower than that in the single-beam reconstruction. The maximum equivalent stress of the trapezoid ligament reconstruction device in the double-bundle truly anatomical reconstruction was lower than that in the double-bundle anatomical reconstruction, which was 73.29 MPa, but the maximum equivalent stress of the conoid ligament reconstruction device was higher than that of the double-bundle anatomical reconstruction.
		                        		
		                        			CONCLUSION
		                        			The truly anatomical reconstruction of coracoclavicular ligament can improve the horizontal stability of acromioclavicular joint and reduce the stress of the trapezoid ligament reconstruction device. It can be a good method for the treatment of acromioclavicular joint dislocation.
		                        		
		                        		
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Adult
		                        			;
		                        		
		                        			Acromioclavicular Joint/surgery*
		                        			;
		                        		
		                        			Finite Element Analysis
		                        			;
		                        		
		                        			Ligaments, Articular/surgery*
		                        			;
		                        		
		                        			Shoulder Joint/surgery*
		                        			;
		                        		
		                        			Plastic Surgery Procedures
		                        			;
		                        		
		                        			Joint Dislocations/surgery*
		                        			
		                        		
		                        	
7.Development and global validation of a 1-week-old piglet head finite element model for impact simulations.
Zhong-Qing SU ; Da-Peng LI ; Rui LI ; Guang-Liang WANG ; Lang LIU ; Ya-Feng WANG ; Ya-Zhou GUO ; Zhi-Gang LI
Chinese Journal of Traumatology 2023;26(3):147-154
		                        		
		                        			PURPOSE:
		                        			Child head injury under impact scenarios (e.g. falls, vehicle crashes, etc.) is an important topic in the field of injury biomechanics. The head of piglet was commonly used as the surrogate to investigate the biomechanical response and mechanisms of pediatric head injuries because of the similar cellular structures and material properties. However, up to date, piglet head models with accurate geometry and material properties, which have been validated by impact experiments, are seldom. We aim to develop such a model for future research.
		                        		
		                        			METHODS:
		                        			In this study, first, the detailed anatomical structures of the piglet head, including the skull, suture, brain, pia mater, dura mater, cerebrospinal fluid, scalp and soft tissue, were constructed based on CT scans. Then, a structured butterfly method was adopted to mesh the complex geometries of the piglet head to generate high-quality elements and each component was assigned corresponding constitutive material models. Finally, the guided drop tower tests were conducted and the force-time histories were ectracted to validate the piglet head finite element model.
		                        		
		                        			RESULTS:
		                        			Simulations were conducted on the developed finite element model under impact conditions and the simulation results were compared with the experimental data from the guided drop tower tests and the published literature. The average peak force and duration of the guide drop tower test were similar to that of the simulation, with an error below 10%. The inaccuracy was below 20%. The average peak force and duration reported in the literature were comparable to those of the simulation, with the exception of the duration for an impact energy of 11 J. The results showed that the model was capable to capture the response of the pig head.
		                        		
		                        			CONCLUSION
		                        			This study can provide an effective tool for investigating child head injury mechanisms and protection strategies under impact loading conditions.
		                        		
		                        		
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Swine
		                        			;
		                        		
		                        			Finite Element Analysis
		                        			;
		                        		
		                        			Skull/injuries*
		                        			;
		                        		
		                        			Craniocerebral Trauma/diagnostic imaging*
		                        			;
		                        		
		                        			Brain
		                        			;
		                        		
		                        			Biomechanical Phenomena
		                        			;
		                        		
		                        			Scalp
		                        			
		                        		
		                        	
8.Three-dimensional finite element analysis of cement flow in abutment margin-crown platform switching.
Meng En OU ; Yun DING ; Wei Feng TANG ; Yong Sheng ZHOU
Journal of Peking University(Health Sciences) 2023;55(3):548-552
		                        		
		                        			OBJECTIVE:
		                        			To analyze the cement flow in the abutment margin-crown platform switching structure by using the three-dimensional finite element analysis, in order to prove that whether the abutment margin-crown platform switching structure can reduce the inflow depth of cement in the implantation adhesive retention.
		                        		
		                        			METHODS:
		                        			By using ANSYS 19.0 software, two models were created, including the one with regular margin and crown (Model one, the traditional group), and the other one with abutment margin-crown platform switching structure (Model two, the platform switching group). Both abutments of the two models were wrapped by gingiva, and the depth of the abutment margins was 1.5 mm submucosal. Two-way fluid structure coupling calculations were produced in two models by using ANSYS 19.0 software. In the two models, the same amount of cement were put between the inner side of the crowns and the abutments. The process of cementing the crown to the abutment was simulated when the crown was 0.6 mm above the abutment. The crown was falling at a constant speed in the whole process spending 0.1 s. Then we observed the cement flow outside the crowns at the time of 0.025 s, 0.05 s, 0.075 s, 0.1 s, and measured the depth of cement over the margins at the time of 0.1 s.
		                        		
		                        			RESULTS:
		                        			At the time of 0 s, 0.025 s, 0.05 s, the cements in the two models were all above the abutment margins. At the time of 0.075 s, in Model one, the gingiva was squeezed by the cement and became deformed, and then a gap was formed between the gingiva and the abutment into which the cement started to flow. In Model two, because of the narrow neck of the crown, the cement flowed out from the gingival as it was pressed by the upward counterforce from the gingival and the abutment margin. At the time of 0.1 s, in Model one, the cement continued to flow deep inside with the gravity force and pressure, and the depth of the cement over the margin was 1 mm. In Model two, the cement continued to flow out from the gingival at the time of 0.075 s, and the depth of the cement over the margin was 0 mm.
		                        		
		                        			CONCLUSION
		                        			When the abutment was wrapped by the gingiva, the inflow depth of cement in the implantation adhesive retention can be reduced in the abutment margin-crown platform switching structure.
		                        		
		                        		
		                        		
		                        			Finite Element Analysis
		                        			;
		                        		
		                        			Cementation/methods*
		                        			;
		                        		
		                        			Gingiva
		                        			;
		                        		
		                        			Crowns
		                        			;
		                        		
		                        			Dental Abutments
		                        			;
		                        		
		                        			Dental Cements
		                        			;
		                        		
		                        			Dental Stress Analysis
		                        			
		                        		
		                        	
9.Biomechanical characteristics of retinaculum in the treatment of femoral neck fractures.
China Journal of Orthopaedics and Traumatology 2023;36(3):251-255
		                        		
		                        			OBJECTIVE:
		                        			To investigate the biomechanical characteristics of retinaculum in the treatment of femoral neck fractures.
		                        		
		                        			METHODS:
		                        			The CT data of a 75-year-old female volunteer was processed by software to construct an intact femur model and femoral neck fracture model fixed with three cannulated screws, which were divided into models with retinaculum or not. The Von-Mises stress distribution and displacement were compared to analyze the stability differences between the different models to study the mechanical characteristics of the retinaculum in the treatment of femoral neck fractures.
		                        		
		                        			RESULTS:
		                        			In the intact femur, the most obvious displacement appeared in the weight-bearing area of the femoral head, with retinaculum 0.381 37 mm, and without retinaculum 0.381 68 mm. The most concentrated part of the Von-Mises stress distribution was located in the medial and inferior part of the femoral neck, with retinaculum 11.80 MPa, without retinaculum 11.91 MPa. In the femoral neck fracture fixed with three cannulated screws model, the most obvious position of displacement also appeared in the weight-bearing area of the femoral head, with retinaculum 0.457 27 mm, without retinaculum 0.458 63 mm. The most concentrated part of the Von-Mises located at the medical and inferior part of the femoral neck, with retinaculum 59.22 MPa, without retinaculum 59.14 MPa. For the cannulated screws, the Von-Mises force peaks all appeared in the posterior and superior screw, with retinaculum 107.48 MPa, without retinaculum 110.84 MPa. Among the three screws, the Von-Mises stress of the anterior-superior screw was the smallest, which was 67.88 MPa vs 68.76 MPa in the retinaculum and non-retinaculum groups, respectively.
		                        		
		                        			CONCLUSION
		                        			The complete retinaculum has little effect on the stability of intact femur and femoral neck fractures with anatomical reduction after internal fixation, and cannot effectively improve the stability of the fracture end after the fracture.
		                        		
		                        		
		                        		
		                        			Female
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Aged
		                        			;
		                        		
		                        			Finite Element Analysis
		                        			;
		                        		
		                        			Femoral Neck Fractures/surgery*
		                        			;
		                        		
		                        			Fracture Fixation, Internal
		                        			;
		                        		
		                        			Bone Screws
		                        			;
		                        		
		                        			Femur Neck
		                        			;
		                        		
		                        			Biomechanical Phenomena
		                        			
		                        		
		                        	
10.Biomechanical analysis of four internal fixations for Pauwels Ⅲ femoral neck fractures with defects.
Zhi-Hao SU ; Hong-Li TAN ; Zi-Huan XU ; Peng-Fei LI ; Yong-Qin WANG ; Shuang LI ; Ming NI
China Journal of Orthopaedics and Traumatology 2023;36(3):255-261
		                        		
		                        			OBJECTIVE:
		                        			To investigate the biomechanical characteristics of different internal fixations for Pauwels type Ⅲ femoral neck fracture with defect, and provide reference for the treatment of femoral neck fracture.
		                        		
		                        			METHODS:
		                        			Three-dimensional (3D) finite element models of femoral neck fractures were established based on CT images, including fracture and fracture with defects. Four internal fixations were simulated, namely, inverted cannulated screw(ICS), ICS combined with medial buttress plate, the femoral neck system (FNS) and FNS combined with medial buttress plate. The von Mises stress, model stiffness and fracture displacements of fracture models under 2 100 N axial loads were measured and compared.
		                        		
		                        			RESULTS:
		                        			When femoral neck fracture was fixed by ICS and FNS, the peak stress was mainly concentrated on the surface of the screw near the fracture line, and the peak stress of FNS is higher than that of ICS;When the medial buttress plate was combined, the peak stress was increased and transferred to medial buttress plate, with more obvious of ICS fixation. For the same fracture model, the stiffness of FNS was higher than that of ICS. Compared with femoral neck fracture with defects, fracture model showed higher stiffness in the same internal fixation. The use of medial buttress plate increased model stiffness, but ICS increased more than FNS. The fracture displacement of ICS model exceeded that of FNS.
		                        		
		                        			CONCLUSION
		                        			For Pauwels type Ⅲ femoral neck fracture with defects, FNS had better biomechanical properties than ICS. ICS combined with medial buttress plate can better enhance fixation stability and non-locking plate is recommended. FNS had the capability of shear resistance and needn't combine with medial buttress plate.
		                        		
		                        		
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Femoral Neck Fractures/surgery*
		                        			;
		                        		
		                        			Fracture Fixation, Internal/methods*
		                        			;
		                        		
		                        			Bone Screws
		                        			;
		                        		
		                        			Bone Plates
		                        			;
		                        		
		                        			Biomechanical Phenomena
		                        			;
		                        		
		                        			Finite Element Analysis
		                        			
		                        		
		                        	
            
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