In silico analysis of fixation device strain patterns in the postoperative proximal femur: Effects of bone quality during gait.

IF 1.8 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-11-27 DOI:10.1016/j.clinbiomech.2025.106724

Yogesh Kumaran, Sophia Soehnlen, Christopher Haritos, Sanam Jhaveri, Sudharshan Tripathi, Humza Shaikh, Stephanie Di Stasi, Carmen E Quatman

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引用次数: 0

Abstract

Background: Proximal femur fracture fixation fundamentally alters load transfer, which can trigger adverse bone remodeling, particularly after healing in osteoporotic bone. While previous studies have focused on early fixation stability or acute fracture healing, the long-term mechanical environment after fracture consolidation remains poorly understood. This study examines implant-specific strain behavior in the post-healed state to identify patterns that may predispose to late-stage implant failure or remodeling.

Methods: Subject-specific finite-element models were created from CT scans of a healthy 22-year-old and an osteoporotic 90-year-old female. Cannulated screws (CS), a dynamic hip screw (DHS), and a femoral neck system (FNS) were virtually implanted in each model and subjected to simulated gait loading. Maximum implant stresses and regional principal strains across the proximal femur were quantified throughout the stance phase.

Findings: The FNS demonstrated the highest maximum von Mises stresses in both normal and osteoporotic bone, notably at the anti-rotation screw and bolt interface. In osteoporotic bone, the FNS exhibited significantly higher tensile (mean 0.36 % ± 0.22 %) and compressive strains (mean - 0.41 % ± 0.28 %) compared to CS and DHS implants, while in normal bone, FNS strains were comparable to intact femur strains. The CS model showed reduced peak strains and stresses throughout the gait cycle compared to DHS and FNS.

Interpretation: This study provides a comparative assessment of healed-state strain distributions across common fixation constructs. By characterizing these environments, these data establish a biomechanical framework and highlight the interplay between implant design and bone quality. Further population-based studies are required to refine implant selection.

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股骨术后近端固定装置应变模式的计算机分析：步态中骨质量的影响。

背景：股骨近端骨折固定从根本上改变了负荷转移，这可能引发不利的骨重塑，特别是在骨质疏松骨愈合后。虽然以前的研究主要集中在早期固定稳定性或急性骨折愈合，但骨折巩固后的长期力学环境仍然知之甚少。本研究检查了愈合后状态下种植体特有的应变行为，以确定可能导致晚期种植体失败或重塑的模式。方法：对一名健康的22岁女性和一名骨质疏松的90岁老年女性进行CT扫描，建立特定对象的有限元模型。在每个模型中虚拟植入空心螺钉（CS）、动态髋关节螺钉（DHS）和股骨颈系统（FNS），并进行模拟步态负荷。在整个站立阶段，对股骨近端最大种植体应力和区域主应变进行量化。结果：FNS在正常骨和骨质疏松骨中均显示最大von Mises应力，特别是在防旋转螺钉和螺栓界面处。在骨质疏松性骨中，FNS的拉伸应变（平均0.36%±0.22%）和压缩应变（平均- 0.41%±0.28%）明显高于CS和DHS植入物，而在正常骨中，FNS应变与完整股骨应变相当。与DHS和FNS相比，CS模型显示整个步态周期的峰值应变和应力降低。解释：本研究对不同固定结构的愈合状态应变分布进行了比较评估。通过描述这些环境，这些数据建立了生物力学框架，并强调了种植体设计与骨质量之间的相互作用。需要进一步的以人群为基础的研究来完善植入物的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.