{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T15:13:01Z","timestamp":1789398781408,"version":"build-2803163510"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T00:00:00Z","timestamp":1665964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aims to establish the coronal configuration of the proximal femur as an independent factor for its mechanical properties and provide validation for the theoretical model \u201cfulcrum\u2010balance\u2010reconstruction.\u201d<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The digital 3D femur model constructed with the lower extremity high\u2010resolution computed tomography of a senior subject was applied with the axial compression of 2100N under 5 different <jats:italic>\u03b1<\/jats:italic> angles of 10\u00b0, 5\u00b0, 0\u00b0, \u22125\u00b0, \u221210\u00b0. The equivalent stress distribution of the femoral geometric model under each angle were calculated. Under the same five <jats:italic>\u03b1<\/jats:italic> angles, fatigue test was performed on 15 composite artificial left femurs (three specimens in each angle group) to obtain the failure cycle and fracture site. The statistical analysis was accomplished using One\u2010Way ANOVA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The maximum stress of the entire femur in physiological angle (<jats:italic>\u03b1<\/jats:italic>\u00a0=\u00a010\u00b0) occurred below femoral neck with a value of 63.91\u2009MPa. When the proximal femur is in extreme abducted angle (<jats:italic>\u03b1<\/jats:italic>\u00a0=\u00a0\u221210\u00b0), the maximum stress shift to the lower medial cortex of femoral shaft with a value of 105.2\u2009MPa. As the <jats:italic>\u03b1<\/jats:italic> angle changed from 10\u00b0 to \u221210\u00b0, the greater trochanteric region had the largest increment in maximum stress (2.78 times for cortex and 1.67 times for cancellous bone) locally at the proximal femur. The failure cycles of the artificial femurs with a variety of abduction angle were averagely 9126\u2009\u00b1\u20092453.87 (<jats:italic>\u03b1<\/jats:italic>\u00a0=\u00a0\u221210\u00b0), 58,112.33\u2009\u00b1\u20091293.84 (<jats:italic>\u03b1<\/jats:italic>\u00a0=\u00a0\u22125\u00b0), 92,879.67\u2009\u00b1\u20092398.54 (<jats:italic>\u03b1<\/jats:italic>\u00a0=\u00a00\u00b0), 172,045.3\u2009\u00b1\u200911011.11 (<jats:italic>\u03b1<\/jats:italic>\u00a0=\u00a05\u00b0), and 264,949.3\u2009\u00b1\u200935,067.26 (<jats:italic>\u03b1<\/jats:italic>\u00a0=\u00a010\u00b0), and the statistical analysis revealed that the <jats:italic>\u03b1<\/jats:italic> angle of the group of concern is proportional to the P value of the corresponding group compared to the 10\u00b0 group(<jats:italic>\u03b1<\/jats:italic>\u00a0=\u00a05\u00b0 &amp; <jats:italic>\u03b1<\/jats:italic>\u00a0=\u00a010\u00b0, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.01; <jats:italic>\u03b1<\/jats:italic>\u00a0=\u00a00 &amp; <jats:italic>\u03b1<\/jats:italic>\u00a0=\u00a010\u00b0, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.001; <jats:italic>\u03b1<\/jats:italic>\u00a0=\u00a0\u22125\u00b0, \u221210\u00b0 &amp; <jats:italic>\u03b1<\/jats:italic>\u00a0=\u00a010\u00b0, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). In fatigue test, the fracture appeared on femoral neck for the <jats:italic>\u03b1<\/jats:italic> angles of 10\u00b0 (three subcapital), 5\u00b0 (two basal; one transcervical), and 0\u00b0 (one transcervical). Fracture sites located at trochanteric region were observed with the more abducted angles including 0\u00b0 (two subtrochanteric) and \u22125\u00b0 (two intertrochanteric; one subtrochanteric). The fracture line was only found on femoral shaft in the \u221210\u00b0 group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>With increasing hip abduction, the proximal femur shows declining mechanical properties, which suggests higher risk of hip fracture and increasement in the fraction of trochanteric fracture subtype. Furthermore, the hypothesis of \u201cfulcrum\u2010balance\u2010reconstruction\u201d was validated by our study to a certain extent.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.13537","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T10:52:34Z","timestamp":1666003954000},"page":"62-69","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["The Impact of Coronal Configuration of the Proximal Femur on its Mechanical Properties and the Validation of a New Theoretical Model: Finite Element Analysis and Biomechanical Examination"],"prefix":"10.1111","volume":"15","author":[{"given":"Lijia","family":"Zhang","sequence":"first","affiliation":[{"name":"4+4 Medical Doctor Program Chinese Academy of Medical Science &amp; Peking Union Medical College  Beijing China"},{"name":"Department of Orthopaedics Peiking Union Medical College Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baozhang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Beijing Naton Medical Institute Co., Ltd, Haidian District  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liwan","family":"Chen","sequence":"additional","affiliation":[{"name":"Beijing Naton Medical Institute Co., Ltd, Haidian District  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenqing","family":"Wang","sequence":"additional","affiliation":[{"name":"Beijing Naton Medical Institute Co., Ltd, Haidian District  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Beijing Naton Medical Institute Co., Ltd, Haidian District  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianguo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Peiking Union Medical College Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01623184"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2016.11.060"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9290(93)90058-M"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2012.11.013"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004424-199001000-00004"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199210000-00034"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.5650110921"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medengphy.2013.04.008"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-006-0074-5"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0215405"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medengphy.2020.03.005"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.2568"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.910876"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(96)00383-3"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.22478"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2016142796"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00132-007-1179-z"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780381017"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11517-015-1254-2"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/0954411920951033"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.13308"},{"key":"e_1_2_8_23_1","first-page":"23","article-title":"Femoral iatrogenic subtrochanteric fatigue fracture risk is not increased by placing drill holes below the level of the lesser trochanter","volume":"37","author":"Tsai AG","year":"2017","journal-title":"Iowa Orthop J"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9290(96)00159-5"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.13021"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-016-4338-0"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.12974"},{"issue":"10","key":"e_1_2_8_28_1","first-page":"841","article-title":"Reviewing the past and future of internal fixation for femoral intertrochanteric fractures based on fulcrum reconstruction theory","volume":"22","author":"Zhang DY","year":"2020","journal-title":"Chin J Orthop Trauma"},{"issue":"7","key":"e_1_2_8_29_1","first-page":"647","article-title":"New understanding of lever\u2010fulcrum balance theory in the treatment of femoral 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Chin","volume":"36","author":"Zhang DY","year":"2020","journal-title":"J Trauma"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.13537","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/os.13537","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.13537","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T10:34:58Z","timestamp":1692441298000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.13537"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,17]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1111\/os.13537"],"URL":"https:\/\/doi.org\/10.1111\/os.13537","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,17]]},"assertion":[{"value":"2022-07-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-09","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}