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ORIGINAL RESEARCH article
Front. Bioeng. Biotechnol.
Sec. Biomechanics
Volume 13 - 2025 |
doi: 10.3389/fbioe.2025.1441026
This article is part of the Research Topic Use of Digital Human Modeling for Promoting Health, Care and Well-Being View all 8 articles
Evaluating Femoral Head Collapse Risk Post-Fixation Removal: A Finite Element Analysis
Provisionally accepted- University Medical Center Göttingen, Department of Trauma, Orthopaedic and Plastic Surgery, Göttingen, Germany
Background: Femoral neck fractures are prevalent in orthopedic injuries, often leading to complications such as nonunion and osteonecrosis of the femoral head (ONFH). Studies indicate that after healing and removal of internal fixation devices, some patients develop ONFH, while others experience osteosclerosis around the screw holes due to prolonged fixation, increasing ONFH risk. Despite such observations, biomechanical studies on this phenomenon are limited. This study assesses the risk of femoral head collapse post-internal fixation device removal and investigates the biomechanical effects of bone grafting at screw removal sites.Methods: Using CT data, femoral anatomy was reconstructed. For control, the femoral head's the collapse area was identified. Experimental models, divided into those with and without bone grafts in screw holes, incorporated three fixation techniques: triple cannulated screws (3CS), dynamic hip screws with cannulated screws (DHS+CS), and the femoral neck system (FNS), further subclassified into normal and sclerotic screw hole models. Stress distribution, stress values, stress index and strain range were assessed.In both models, DHS+CS showed the highest stress in the overall model, while 3CS had the highest stress in the collapse area. The 3CS configuration also resulted in the largest strain range, observed in the central pillar of Normal screw hole models and the lateral pillar of Sclerotic screw hole models. The Bone graft models exhibited lower peak, average stress, and strain values than the Normal and Sclerotic screw hole models.The FNS screw hole demonstrates a relatively lower mechanical risk of femoral head collapse. In contrast, sclerotic screw holes increase this risk, while bone grafting may improve biomechanical behavior after fixation removal, potentially reducing the likelihood of femoral head collapse.
Keywords: Finite Element Analysis, Femoral head collapse, Screw hole configuration, Internal fixation removal, Femoral neck fracture
Received: 30 May 2024; Accepted: 03 Feb 2025.
Copyright: © 2025 Li, Zhou, Yang, Böker, Schilling and Lehmann. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xiang Zhou, University Medical Center Göttingen, Department of Trauma, Orthopaedic and Plastic Surgery, Göttingen, Germany
Wolfgang Lehmann, University Medical Center Göttingen, Department of Trauma, Orthopaedic and Plastic Surgery, Göttingen, Germany
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