Objective To compare the biomechanical properties of multi-dimensional locking retrograde intramedullary nail (new nail), traditional single plane locking retrograde intramedullary nail (traditional nail), and locking plate fixation for AO/OTA 33A3 distal femoral fractures using three-dimensional finite element method. Methods Models of AO/OTA 33A3 distal femoral fractures and 3D models of internal fixation devices were established using Creo 5.0 software. Then the finite element models were created and the same boundary conditions and three types of loads were applied for computation. The stress distribution of the internal fixation, as well as the overall and localized deformation of the femur, were analyzed under different loading conditions to evaluate the stability of the three fixation methods for treating distal femoral fractures. Results (1) Under vertical load conditions, the maximum stress values of femur internal fixation, as well as the overall displacement of the femur, interfragmental gap, and fracture angle, were significantly higher than those of traditional and new nails. Although the maximum stress value of the new nail was higher than that of the traditional nail, its femoral stress value, overall femoral displacement, interfragmental gap, and fracture angle were all smaller than those of the traditional nail. (2) Under load conditions, the maximum stress value of internal fixation of the locking plate was not significantly different from that of the new nail. However, its maximum stress value of the femur, overall displacement of the femur, interfragmental gap, and fracture angle were all much greater than those of traditional and new nails. The maximum stress values of the femur and internal fixation of the new nail were both greater than those of the traditional nail, but its overall displacement, interfragmental gap, and fracture angle were all smaller than those of the traditional intramedullary nail. (3) Under torsional load conditions, the new nail had significantly lower maximum stress values for internal fixation and overall torsional displacement of the femur compared with traditional nails and locking plate, except for the maximum stress value of the femur, which is greater than that of traditional nails. Conclusions Compared with the locking plate and traditional nail, the new nail provides better stability in the treatment of AO/OTA 33A3 distal femoral fractures under vertical, horizontal, or rotational loads. This demonstrates certain advantages and lays theoretical foundation for further clinical application and promotion.
Key words
Distal femoral fracture /
/
/
Locking plate /
/
/
Retrograde femoral nail /
/
/
Finite element analysis /
/
/
Biomechanics
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Elsoe R, Ceccotti AA, Larsen P. Population-based epidemiology and incidence of distal femur fractures[J].Int Orthop, 2018, 42(1):191-196. DOI:10.1007/s00264-017-3665-1.
[2] Hake ME, Davis ME, Perdue AM,et al. Modern implant options for the treatment of distal femur fractures[J].J Am Acad Orthop Surg, 2019, 27(19):e867-e875. DOI：10.5435/JAAOS-D-17-00706.
[3] 周楠, 王志刚. 股骨远端骨折闭合复位内固定术中辅助复位技术的研究进展[J]. 中华骨科杂志, 2020, 40(7): 445-452. DOI:10.3760/cma.j.cn121113-20190322-00117.
Zhou N, Wang ZG. Research progress on assisted reduction techniques in closed reduction and internal fixation of distal femoral fractures [J]. Chinese Journal of Orthopedics, 2020, 40 (7): 445-452. DOI:10.3760/cma.j.cn121113-20190322-00117.
[4]李华平, 赵世杰, 姚裴, 等.锁定钢板与逆行髓内钉固定股骨远端骨折比较[J].中国矫形外科杂志, 2022, 30(18):1654-1659. DOI:10.3977/j.issn.1005-8478.2022.18.05.
Li HP, Zhao SJ, Yao P, et al. Comparison of Locking Plate and Retrograde Intramedullary Nail Fixation for Distal Femoral Fractures [J]. Chinese Journal of Orthopedics, 2022, 30(18):1654-1659. DOI: 10.3977/j.issn.1005-8478.2022.18.05.
[5]段旭洲, 王光超. 逆行交锁髓内钉与锁定钢板内固定治疗AO-A型股骨远端骨折疗效分析[J].中国骨与关节损伤杂志, 2023, 38(6):623-625. DOI:10.7531/j.issn.1672-9935.2023.06.016.
Duan XZ, Wang GC. Analysis of the therapeutic effect of retrograde interlocking intramedullary nail and locking plate internal fixation for AO-A type distal femoral fracture [J]. Chinese Journal of Bone and Joint Injury, 2023, 38(6):623-625. DOI:10.7531/j.issn.1672-9935. 2023. 06.016.
[6] Nester M, Borrelli J Jr.Distal femur fractures management and evolution in the last century[J]. Int Orthop, 2023, 47(8):2125-2135. DOI：10.1007/s00264-023-05782-1.
[7] 张金辉,刘晖,徐维臻,等. 三种内固定方式治疗AO/OTA A3型股骨远端骨折的有限元分析[J].中国组织工程研究, 2025, 29(27):5728-5734.DOI: 10.12307/2025.805.
Zhang JH, Liu H, Xu WZ, et al. Finite element analysis of three internal fixation methods for treating AO/OTA A3 type distal femoral fractures [J]. Chinese Journal of Tissue Engineering Research, 2025, 29(27): 5728-5734. DOI:10.12307/2025.805.
[8] 黄培镇, 董航, 蔡群斌, 等. 顺行和逆行髓内钉治疗不同部位股骨干骨折的有限元分析[J].中国组织工程研究, 2024, 28(6):868-872. DOI:10.12307/2023.786.
Huang PZ, Dong H, Cai QB, et al. Finite element analysis of anterograde and retrograde intramedullary nail treatment for different parts of femoral shaft fractures [J]. Chinese Journal of Tissue Engineering Research, 2024, 28(6): 868-872.DOI: 10.12307/2023.786.
[9] Wright DJ, De Santo DJ, McGarry MH, et al. Supplemental fixation of supracondylar distal femur fractures: a biomechanical comparison of dual-plate and plate-nail constructs[J]. J Orthop Trauma, 2020, 34(8):434-440. DOI:10.1097/BOT.0000000000001749.
[10] 黄培镇, 陈心敏, 郑利钦, 等. 骨水泥增强股骨近端防旋髓内钉治疗高龄不稳定型股骨转子间骨折的有限元分析[J].天津医药, 2020, 48(5): 385-390, 466. DOI: 10.11958/20193661.
Huang PZ, Chen XM, Zheng LQ, et al. Finite element analysis of bone cement enhanced proximal femoral anti rotation intramedullary nail for the treatment of unstable intertrochanteric fractures in elderly patients [J]. Tianjin Pharmaceutical, 2020, 48(5): 385-390, 466. DOI: 10.11958/20193661.
[11]蔡群斌, 姜自伟, 林梓凌, 等. 股骨近端防旋髓内钉不同进钉点治疗外侧壁破裂型股骨转子间骨折的有限元分析[J].天津医药, 2020, 48(5):105-109，163-164.DOI: 10.11958/20192589.
Cai QB, Jiang ZW, Lin ZL, et al. Finite element analysis of proximal femoral anti rotation intramedullary nail with different entry points for the treatment of lateral wall ruptured intertrochanteric fractures [J]. Tianjin Pharmaceutical, 2020, 48(5): 105-109, 163-164. DOI: 10.11958/20192589.
[12]Daher M, Tarchichi J, Zalaquett Z, et al. Antegrade vs retrograde intra-medullary nailing in femoral shaft fractures: A systematic review and meta-analysis[J].Arch Bone Jt Surg, 2024,12(8):535-545. DOI: 10.22038/ABJS.2024.78871.3623.
[13]汪金平, 杨天府, 钟凤林, 等. 股骨生物力学特性的有限元分析[J].中华创伤骨科杂志, 2005, 7(10):931-934.DOI:CNKI:SUN:ZCGK. 0.2005-10-007.
Wang JP, Yang TF, Zhong FL, et al. Finite Element Analysis of Femoral Biomechanical Characteristics[J]. Chin J Orthop Trauma, 2005, 7(10): 931-934. DOI: CNKI:SUN:ZCGK.0.2005-10-007.
[14] 陈柄泽. 不同骨折复位质量下垂直型股骨颈骨折四种不同内固定方式治疗的有限元分析[D]. 南方医科大学, 2022.
Chen BZ. Finite element analysis of four different internal fixation methods for vertical femoral neck fractures with different reduction masses[D]. Southern Medical University, 2022.
[15]徐志, 仲鹤鹤, 向浩, 等.股骨干骨折3种不同固定方式的有限元分析[J].中国组织工程研究, 2022, 26(33):5271-5277. DOI:10.12307/2022.717.
Xu Z, Zhong HH, Xiang H, et al. Finite element analysis of three different fixation methods for femoral shaft fractures [J]. Chinese Journal of Tissue Engineering Research, 2022, 26(33): 5271-5277. DOI:10.12307/2022.717.
[16]Kim JW, Oh CW, Oh JK, et al.Treatment of infra-isthmal femoral fracture with an intramedullary nail: Is retrograde nailing a better option than antegrade nailing [J] ?Arch Orthop Trauma Surg, 2018,138 (9):1241-1247. DOI:10.1007/s00402-018-2961-6.
[17]He M, Tian S, Liu J, et al. Imaging evaluation of insertion point accuracy in retrograde intramedullary femoral nailing[J]. Biomed Res Int, 2022, 2022: 6068490. DOI:10.1155/2022/6068490.
[18]Liporace FA, Yoon RS. Nail Plate Combination Technique for Native and Periprosthetic Distal Femur Fractures[J]. J Orthop Trauma, 2019, 33(2): e64-e68. DOI: 10.1097/BOT.0000000000001332.
[19]王宇钏, 程晓东, 朱燕宾, 等. 股骨近端仿生髓内钉远端不同锁定方式固定股骨转子间骨折的生物力学研究[J].中华创伤骨科杂志, 2024, 26(2): 138-142. DOI:10.3760/cma.j.cn115530-20231114-00196.
Wang YC, Cheng XD, Zhu YB, et al. Distal dynamic locking and distal static locking of proximal femoral bionic intramedullary nails: a biomechanical finite element analysis[J]. Chin J Orthop Trauma, 2024,26(2):138-142. DOI:10.3760/cma.j.cn115530-20231114-00196.
[20]Kerr MS, Young EG, Shaath MK, et al. Periprosthetic distal femur fractures treated by retrograde intramedullary nails with a 10-degree distal bend achieve significantly better post-operative radiographic alignment when compared to conventional retrograde nails[J].Injury,2023,54(2):694-697. DOI: 10.1016/j.injury.2022.11.029.
[21]Bhale R, Campbell ST, Fitzpatrick E, et al. Rates of interlock screw back-out are high with the retrograde femoral nailing advanced system for distal femur fractures[J].Eur J Orthop Surg Traumatol, 2024,34(6): 2909-2913. DOI:10.1007/s00590-024-04006-5.
[22]陈立翔, 娄博, 王焕. 基于有限元法的数字化建模在拇外翻研究中的应用[J].医用生物力学, 2022, 37(4): 972-977. DOI:10.16156/j.1004-7220.2022.05.031.
Chen LX, Lou B, Wang H. Application of digital modeling based on finite element method in the study of hallux valgus [J]. Medical Biomechanics, 2022, 37(4): 972-977. DOI:10.16156/j.1004-7220.2022. 05.031.
[23]国婷婷, 谢红.有限元法在足踝生物力学研究中的应用进展[J].医用生物力学, 2022, 37(4): 766-770. DOI:10.16156/j.1004-7220.2022.04. 029.
PDF(7671 KB)
