Parametric Finite Element Analysis of Intramedullary Nail Fixation of Proximal Femur Fractures

Scott M. Tucker, Hwabok Wee, Edward Fox, John Reid, Gregory Lewis

Research output: Contribution to journalArticle

Abstract

Proximal femur fracture fixation with intramedullary nailing relies on stability at the fracture site and integrity of the fixation construct to achieve union. The biomechanics that dictate fracture site stability and implant stress depend on fracture type as well as implant features such as nail length, nail diameter, presence of distal fixation screws, and material composition of the implant. When deciding how to fix a fracture, surgeons have choices in these implant-related design variables. This study models all combinations of a range of implant variables for nine standard AO/OTA proximal femur fractures using finite element analysis. Under simulated maximum load during gait, the maximum stress in the implant and screws as well as interfragmentary motions at the fracture site in the axial and shear directions were computed. The results were separated by fracture type to show the influence of each design variable on measured biomechanical outcomes. Filling the reamed canal with the largest fitting nail diameter reduced axial and shear interfragmentary motion for all fracture types. Nail length was less predictive of shear interfragmentary motion for most simulated fracture types than other construct variables. Furthermore, gapping at the fracture site predisposed the construct to higher implant stresses and larger interfragmentary motions. Clinical significance: Biomechanical outcomes from this computational study can aid in surgical decision-making for optimizing hip fracture fixation with IM nailing.

Original languageEnglish (US)
Pages (from-to)2358-2366
Number of pages9
JournalJournal of Orthopaedic Research
Volume37
Issue number11
DOIs
StatePublished - Nov 1 2019

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Finite Element Analysis
Nails
Femur
Fracture Fixation
Intramedullary Fracture Fixation
Hip Fractures
Gait
Biomechanical Phenomena
Decision Making
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine

Cite this

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abstract = "Proximal femur fracture fixation with intramedullary nailing relies on stability at the fracture site and integrity of the fixation construct to achieve union. The biomechanics that dictate fracture site stability and implant stress depend on fracture type as well as implant features such as nail length, nail diameter, presence of distal fixation screws, and material composition of the implant. When deciding how to fix a fracture, surgeons have choices in these implant-related design variables. This study models all combinations of a range of implant variables for nine standard AO/OTA proximal femur fractures using finite element analysis. Under simulated maximum load during gait, the maximum stress in the implant and screws as well as interfragmentary motions at the fracture site in the axial and shear directions were computed. The results were separated by fracture type to show the influence of each design variable on measured biomechanical outcomes. Filling the reamed canal with the largest fitting nail diameter reduced axial and shear interfragmentary motion for all fracture types. Nail length was less predictive of shear interfragmentary motion for most simulated fracture types than other construct variables. Furthermore, gapping at the fracture site predisposed the construct to higher implant stresses and larger interfragmentary motions. Clinical significance: Biomechanical outcomes from this computational study can aid in surgical decision-making for optimizing hip fracture fixation with IM nailing.",
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Parametric Finite Element Analysis of Intramedullary Nail Fixation of Proximal Femur Fractures. / Tucker, Scott M.; Wee, Hwabok; Fox, Edward; Reid, John; Lewis, Gregory.

In: Journal of Orthopaedic Research, Vol. 37, No. 11, 01.11.2019, p. 2358-2366.

Research output: Contribution to journalArticle

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