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Despite the availability of multiple fixation strategies, optimal surgical management remains a subject of ongoing debate and comparative biomechanical data are lacking. This study evaluated the stability of four commonly used constructs for internal fixation using patient-specific finite element analysis (FEA) to provide a robust biomechanical rationale for surgical decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patient-specific FEA models were reconstructed using computed tomography imaging data of eight patients to simulate a complex injury pattern involving an ipsilateral Pauwels type III femoral neck fracture combined with a comminuted femoral shaft fracture. Four distinct internal fixation strategies were evaluated: proximal femoral nail antirotation, compression plate with cannulated screws, antegrade intramedullary nail with cannulated screws (AN-CS), and long proximal femoral locking plate. Stability parameters were quantified under simulated axial and torsional loading conditions to assess the mechanical performance of each construct.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Under both loading conditions, the AN-CS group consistently maintained low levels of femoral and implant displacement while demonstrating a more uniform stress distribution and minimum interfragmentary motion at the femoral neck fracture site.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Of the four fixation methods evaluated in this simulation study, the AN-CS construct exhibited the best biomechanical performance overall. The AN-CS fixation effectively balanced interfragmentary stability with a uniform stress distribution, thereby providing a biomechanical basis to guide subsequent clinical decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13018-026-07040-7","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T09:25:59Z","timestamp":1783416359000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Four different fixation strategies for ipsilateral femoral neck and shaft fractures: a finite element analysis"],"prefix":"10.1186","volume":"21","author":[{"given":"Yuan","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A\u00efcha Noura Y\u00e9l\u00e8en","family":"Traor\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujan","family":"Shakya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guichen","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"issue":"21","key":"7040_CR1","doi-asserted-by":"publisher","first-page":"e448","DOI":"10.5435\/JAAOS-D-17-00497","volume":"26","author":"CB Jones","year":"2018","unstructured":"Jones CB, Walker JB. 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