Finite element analysis of the optimal amount of bone cement in the treatment for elderly patients with severe osteoporotic intertrochanteric Evans Ⅱ fracture with reinforced screws
Maihesumu Abuduwake, Jin Gele, An Huigang, Feng Xingchao, Yeerzhati Hajiaheman, Cao Li, Yang Yi
Department of Orthopedics, the First Affiliated Hospital of Xinjiang Medical University, Wulumuqi 830000,China
Abstract：Objective This study aims to explore the optimal amount of bone cement in the treatment of severe osteoporotic intertrochanteric Evans Ⅱ fracture with reinforcing screws. Methods The CT data of a 73-year-old female patient with a left femoral intertrochanteric fracture from bilateral hip to upper leg in the First Affiliated Hospital of Xinjiang Medical University on October 5, 2020 were selected, and the three-dimensional model of the right femur was constructed by importing Mimics 20 and Geomagic Wrap 2017 software. The right femur model of the bone cement was simulated and established by Geomagic Wrap 2017 software. Solidworks 2017 software was used to establish the reinforced screw model, and the three-dimensional model of the right femur and the reinforced screw model were assembled and combined following the conventional standard-reinforced screw surgery technology. The Geomagic Wrap 2017 software was used to simulate Evans Ⅱ fracture on the combined model, and the model with different amounts of bone cement of reinforced screw was constructed to assemble with Evans Ⅱ fracture model, and the load was applied. Part of the cancellous bone around the proximal end of the strengthening screw was cut and redefined as bone cement components. According to the amount of cement wrapped, five model groups were named: A (2 mL), B (3 mL), C (4 mL), D (5 mL), and E (6 mL) models. After setting the material parameters, boundary conditions, and applying the load, it was stored as a K file, which was imported into ANSYS 2019 software for finite element analysis. The cutting of the cancellous bone of the proximal femoral head by the cement surface, the femoral neck varus and internal rotation angle, the stress distribution of the reinforcing screw, and the displacement of the proximal femur in the fixation model with different amounts of bone cement were observed and compared. Results In the model group of the femoral intertrochanteric fracture with different bone cement quantities, the cement surface of model groups A, B, C, and D cut the proximal cancellous bone of the femoral head the least, and the cutting degree of group E was the most serious. In model groups A, B, C, D, and E, the femoral neck varus angles were 5.2°, 6.0°, 4.5°, 5.1°, and 2.6°, respectively, and the femoral neck internal rotation angles were 1.1°, 1.4°, 0.9°, 1.0°, and 0.4°, respectively. The femoral neck varus and internal rotation angles in group E were the smallest. In groups A and B, the stress of the bone cement volume model was mainly concentrated on the connection between the screw and the main screw. In groups C and D, the stress of the bone cement volume model was mostly concentrated at the connection between the screw and the main screw, and the stress tended to disperse to the main screw. In group E, the stress of the bone cement model was mainly distributed at the tail end of the reinforcing screw after the 6-mL bone cement-reinforced screw model was loaded into the intertrochanteric fracture model, and a new fracture occurred at the greater trochanter of the femur. In groups A, B, C, D, and E, the proximal femoral displacement was 7.7, 8.4, 8.2, 8.1, and 13.7 mm, respectively. Among them, the proximal femur displacement of group E was the largest, with a bone cement leakage was observed, and a new fracture occurred at the greater trochanter of the femur. after the reinforced screw model was loaded into the intertrochanteric fracture model. Conclusion In the treatment of severe osteoporotic femoral intertrochanteric Evans II fracture with reinforced screws, 2-4 mL bone cement has a good biomechanical effect.
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Maihesumu Abuduwake, Jin Gele, An Huigang, Feng Xingchao, Yeerzhati Hajiaheman, Cao Li, Yang Yi. Finite element analysis of the optimal amount of bone cement in the treatment for elderly patients with severe osteoporotic intertrochanteric Evans Ⅱ fracture with reinforced screws. Chinese Journal of Anatomy and Clinics, 2022, 27(12): 823-830.
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2022, Vol. 27 
