{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T20:03:48Z","timestamp":1793649828839,"version":"4.5.1"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T00:00:00Z","timestamp":1676937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:p>\n                    <jats:bold>Purpose:<\/jats:bold>\n                    The existing implants for fixation of femoral neck fractures have poor biomechanical stability, so the failure rate is high. We designed two modified intramedullary implants for treating unstable femoral neck fractures (UFNFs). We tried to improve the biomechanical stability of fixation by shortening the moment and reducing stress concentration. Each modified intramedullary implant was compared with cannulated screws (CSs) through finite element analysis (FEA).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    Five different models were included: three cannulated screws (CSs, Model 1) in an inverted triangle configuration, the dynamic hip screw with an anti-rotation screw (DHS + AS, Model 2), the femoral neck system (FNS, Model 3), the modified intramedullary femoral neck system (IFNS, Model 4), and the modified intramedullary interlocking system (IIS, Model 5). Three-dimensional (3D) models of femur and implants were constructed by using 3D modelling software. Three load cases were simulated to assess the maximal displacement of models and fracture surface. The maximal stress at the bone and implants was also evaluated.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    FEA data showed that Model 5 had the best performance in terms of maximum displacement while Model 1 had the worst performance for this index under axial load of 2100\u00a0N. With respect to Maximum stress, Model 4 had the best performance while Model 2 had the worst performance under axial load. The general trends under bending and torsion load were consistent with that under axial load. Our data demonstrated that the two modified intramedullary implants exhibited the best biomechanical stability, followed by FNS and DHS + AS, and then three cannulated screws in axial, bending, and torsion load cases.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    The two modified intramedullary designs showed the best biomechanical performance among the five implants included in this study. Therefore, this might provide some new options for trauma surgeons to deal with unstable femoral neck fractures.\n                  <\/jats:p>","DOI":"10.3389\/fbioe.2023.1116976","type":"journal-article","created":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T00:48:08Z","timestamp":1676940488000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":34,"title":["Biomechanical evaluation of two modified intramedullary fixation system for treating unstable femoral neck fractures: A finite element analysis"],"prefix":"10.3389","volume":"11","author":[{"given":"Qiang","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CongMing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HuanAn","family":"Bai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teng","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,2,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"104062","DOI":"10.1016\/j.compbiomed.2020.104062","article-title":"Biomechanical evaluation of three different configurations of external fixators for treating distal third tibia fracture: Finite element analysis in axial, bending and torsion load","volume":"127","author":"Abdul Wahab","year":"2020","journal-title":"Comput. Biol. Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1302\/0301-620x.87b4.15764","article-title":"Internal fixation versus hemiarthroplasty for displaced fractures of the femoral neck in elderly patients with severe cognitive impairment","volume":"87","author":"Blomfeldt","year":"2005","journal-title":"J. Bone. Jt. Surg. Br."},{"key":"B3","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1016\/j.injury.2021.11.064","article-title":"Biomechanical performance of short and long cephalomedullary nail constructs for stabilizing different levels of subtrochanteric fracture","volume":"53","author":"Chantarapanich","year":"2022","journal-title":"Injury"},{"key":"B4","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1016\/s0268-0033(01)00029-8","article-title":"Finite element analysis of the mechanical behavior of a scapula implanted with a glenoid prosthesis","volume":"16","author":"Couteau","year":"2001","journal-title":"Clin. Biomech. (Bristol, Avon)"},{"key":"B5","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1177\/0300060518816185","article-title":"Intramedullary nails with cannulated screw fixation for the treatment of unstable femoral neck fractures","volume":"47","author":"Guo","year":"2019","journal-title":"J. Int. Med. Res."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1711","DOI":"10.2106\/00004623-200408000-00015","article-title":"Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years","author":"Haidukewych","year":"2004","journal-title":"J. Bone. Jt. Surg. Am."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1692","DOI":"10.3892\/etm.2017.4629","article-title":"Biomechanical assessment and 3D finite element analysis of the treatment of tibial fractures using minimally invasive percutaneous plates","volume":"14","author":"Hu","year":"2017","journal-title":"Exp. Ther. Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1007\/s00590-020-02868-z","article-title":"Single lag screw and reverse distal femur locking compression plate for concurrent cervicotrochanteric and shaft fractures of the femur: Biomechanical study validated with a clinical series","volume":"31","author":"Jitprapaikulsarn","year":"2021","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1097\/00005131-199903000-00001","article-title":"Internal fixation of femoral neck fractures with posterior comminution: A biomechanical study","volume":"13","author":"Kauffman","year":"1999","journal-title":"J. Orthop. Trauma."},{"key":"B10","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1007\/s00264-017-3587-y","article-title":"Screw-blade fixation systems in Pauwels three femoral neck fractures: A biomechanical evaluation","volume":"42","author":"Knobe","year":"2018","journal-title":"Int. Orthop."},{"key":"B11","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1016\/j.injury.2018.10.038","article-title":"Is bone-cement augmentation of screw-anchor fixation systems superior in unstable femoral neck fractures? A biomechanical cadaveric study","volume":"50","author":"Knobe","year":"2019","journal-title":"Injury"},{"key":"B12","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1007\/s00264-006-0243-3","article-title":"Surgical treatment of undisplaced femoral neck fractures in the elderly","volume":"31","author":"Lee","year":"2007","journal-title":"Int. Orthop."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e3278","DOI":"10.1002\/cnm.3278","article-title":"Performance evaluation of surgical techniques for treatment of scapholunate instability in a type II wrist","volume":"36","author":"Leonardo-Diaz","year":"2020","journal-title":"Int. J. Numer. Methods. Biomed. Eng."},{"key":"B14","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1186\/s13018-018-0970-3","article-title":"Finite element analysis of different configurations of fully threaded cannulated screw in the treatment of unstable femoral neck fractures","volume":"13","author":"Li","year":"","journal-title":"J. Orthop. Surg. Res."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1895","DOI":"10.1016\/j.injury.2019.08.024","article-title":"Medial anatomical buttress plate in treating displaced femoral neck fracture A finite element analysis","volume":"50","author":"Li","year":"2019","journal-title":"Injury"},{"key":"B16","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1177\/2280800017750357","article-title":"A theoretical analysis and finite element simulation of fixator-bone system stiffness on healing progression","volume":"16","author":"Li","year":"","journal-title":"J. Appl. Biomater. Funct. Mater."},{"key":"B17","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.bone.2014.07.001","article-title":"Human proximal femur bone adaptation to variations in hip geometry","volume":"67","author":"Machado","year":"2014","journal-title":"Bone"},{"key":"B18","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/s12917-018-1416-1","article-title":"Pelvic modelling and the comparison between plate position for double pelvic osteotomy using artificial cancellous bone and finite element analysis","volume":"14","author":"McCartney","year":"2018","journal-title":"Bmc. Vet. Res."},{"key":"B19","doi-asserted-by":"publisher","first-page":"303","DOI":"10.3109\/17453670902967281","article-title":"A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year","volume":"80","author":"Palm","year":"2009","journal-title":"Acta. Orthop."},{"key":"B20","first-page":"490","article-title":"Results of internal fixation of Pauwels type-3 vertical femoral neck fractures","volume":"91","author":"Parker","year":"2009","journal-title":"J. Bone. Jt. Surg. Am."},{"key":"B21","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1302\/0301-620x.82b7.0820937","article-title":"The management of intracapsular fractures of the proximal femur","volume":"82","author":"Parker","year":"2000","journal-title":"J. Bone. Jt. Surg. Br."},{"key":"B22","doi-asserted-by":"publisher","first-page":"105491","DOI":"10.1016\/j.cmpb.2020.105491","article-title":"Biomechanical analysis for five fixation techniques of pauwels-III fracture by finite element modeling","volume":"193","author":"Peng","year":"2020","journal-title":"Comput. Methods. Programs. Biomed."},{"key":"B23","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1097\/00005131-199206000-00004","article-title":"Factors influencing postoperative movement in displaced femoral neck fractures: Evaluation by conventional radiography and stereoradiography","volume":"6","author":"Ragnarsson","year":"1992","journal-title":"J. Orthop. Trauma."},{"key":"B24","doi-asserted-by":"publisher","first-page":"201","DOI":"10.3109\/17453679108993593","article-title":"Stability of femoral neck fracture. Roentgen stereophotogrammetry of 29 hook-pinned fractures","volume":"62","author":"Ragnarsson","year":"1991","journal-title":"Acta. Orthop. Scand."},{"key":"B25","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.clinbiomech.2010.09.020","article-title":"Side Plate fixation vs. Intramedullary nailing in an unstable medial femoral neck fracture model: A comparative biomechanical study","volume":"26","author":"R\u00f6derer","year":"2011","journal-title":"Clin. Biomech."},{"key":"B26","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1097\/TA.0b013e31820e86e6","article-title":"A comparative biomechanical analysis of fixation devices for unstable femoral neck fractures: The intertan versus cannulated screws or a dynamic hip screw","volume":"71","author":"Rupprecht","year":"2011","journal-title":"J. Trauma."},{"key":"B27","doi-asserted-by":"publisher","first-page":"174","DOI":"10.4103\/0019-5413.108912","article-title":"Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients","volume":"47","author":"Satish","year":"2013","journal-title":"Indian. J. Orthop."},{"key":"B28","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.rboe.2017.03.003","article-title":"Treatment of displaced femoral neck fractures in young patients with DHS and its association to osteonecrosis","volume":"53","author":"Schwartsmann","year":"2018","journal-title":"Rev. Bras. Ortop."},{"key":"B29","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1016\/j.injury.2014.10.010","article-title":"Complications following young femoral neck fractures","volume":"46","author":"Slobogean","year":"2015","journal-title":"Injury"},{"key":"B30","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1097\/BOT.0000000000000739","article-title":"Biomechanical evaluation of the femoral neck system in unstable Pauwels III femoral neck fractures: A comparison with the dynamic hip screw and cannulated screws","volume":"31","author":"Stoffel","year":"2017","journal-title":"J. Orthop. Trauma."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1016\/s0021-9290(00)00140-8","article-title":"Large-sliding contact elements accurately predict levels of bone implant micromotion relevant to osseointegration","volume":"33","author":"Viceconti","year":"2000","journal-title":"J. Biomech."},{"key":"B32","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s12938-022-01006-6","article-title":"Biomechanical comparison of the femoral neck system versus InterTan nail and three cannulated screws for unstable Pauwels type III femoral neck fracture","volume":"10","author":"Wang","year":"2022","journal-title":"Biomed. Eng. Online."},{"key":"B33","doi-asserted-by":"publisher","first-page":"100067","DOI":"10.1016\/j.medntd.2021.100067","article-title":"An instrument for methodological quality assessment of single-subject finite element analysis used in computational orthopaedics","volume":"11","author":"Wong","year":"2021","journal-title":"Med. Nov. Technol. And. Devices"},{"key":"B34","doi-asserted-by":"publisher","first-page":"2189","DOI":"10.1016\/j.injury.2017.08.017","article-title":"Medial buttress plate augmentation of cannulated screw fixation in vertically unstable femoral neck fractures: Surgical technique and preliminary results","volume":"48","author":"Ye","year":"2017","journal-title":"Injury"},{"key":"B35","doi-asserted-by":"publisher","first-page":"105714","DOI":"10.1016\/j.cmpb.2020.105714","article-title":"Biomechanical evaluation of internal fixation implants for femoral neck fractures: A comparative finite element analysis","volume":"196","author":"Zeng","year":"2020","journal-title":"Comput. Methods. Programs. Biomed."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1372","DOI":"10.1016\/j.injury.2011.07.004","article-title":"Biomechanical evaluation of the expansive cannulated screw for fixation of femoral neck fractures","volume":"42","author":"Zhang","year":"2011","journal-title":"Injury"},{"key":"B37","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1007\/s00068-018-0972-1","article-title":"Anteromedial femoral neck plate with cannulated screws for the treatment of irreducible displaced femoral neck fracture in young patients: A preliminary study","volume":"45","author":"Zhuang","year":"2018","journal-title":"Eur. J. Trauma. Emerg. Surg."}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2023.1116976\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T00:48:12Z","timestamp":1676940492000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2023.1116976\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,21]]},"references-count":37,"alternative-id":["10.3389\/fbioe.2023.1116976"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2023.1116976","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,21]]},"article-number":"1116976"}}