{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T06:06:43Z","timestamp":1784700403700,"version":"3.55.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"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:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Poor bone quality in osteoporosis can compromise implant fixation and stability in intertrochanteric fractures. This study employed finite element analysis to evaluate the biomechanical performance of short (170\u00a0mm), medium (240\u00a0mm), and long (320\u00a0mm) proximal femoral nail antirotation (PFNA) implants in osteoporotic intertrochanteric A2.3 fractures. By modulating the elastic modulus of cancellous bone to simulate varying degrees of osteoporosis severity, we aimed to identify the optimal PFNA length for clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A three-dimensional finite-element model of an osteoporotic intertrochanteric A2.3 femoral fracture was established. The elastic modulus of cancellous bone was assigned six levels (588, 445, 260, 115, 63, and 34\u00a0MPa), representing different osteoporosis severities. PFNA implants of 170, 240, and 320\u00a0mm lengths were assembled, with the 170\u00a0mm nail further evaluated at diameters of 9.5, 10, and 11\u00a0mm. Single-leg stance loading was simulated. Von Mises peak stresses in the PFNA implant, cortical bone, and cancellous bone, along with maximum displacement, were calculated and compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The 240\u00a0mm PFNA exhibited the lowest von Mises peak stress (442.86\u2013560.44\u00a0MPa) across all bone quality conditions. The 170\u00a0mm PFNA exceeded 1000\u00a0MPa when bone quality was \u2264260\u00a0MPa, surpassing the yield strength of titanium alloy (approximately 900\u00a0MPa). The 320\u00a0mm PFNA demonstrated intermediate stress (618.60\u2013842.16\u00a0MPa). The 240\u00a0mm PFNA consistently produced the lowest cortical stress (85.191\u201391.948\u00a0MPa) and similar femoral displacement to the 320\u00a0mm PFNA, while cancellous bone stress decreased progressively with deteriorating bone quality (19.68\u21928.35\u00a0MPa). The 170\u00a0mm PFNA showed higher cortical stress (185.25\u2013211.7\u00a0MPa) and the greatest displacement (8.05\u20139.44\u00a0mm), whereas the 320\u00a0mm PFNA exhibited a sharp increase when bone quality was \u2264115\u00a0MPa, reaching 472.82\u00a0MPa at 34\u00a0MPa. For the 170\u00a0mm nail, increasing diameter from 9.5 mm to 11\u00a0mm reduced peak implant stress by 25.8%\u201349.0%, with the 11\u00a0mm nail remaining below the yield threshold in all but the most severe osteoporotic condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Within the constraints of the present finite element model, the 240\u00a0mm PFNA showed the most favorable overall comparative biomechanical performance among the tested configurations and may represent a reasonable biomechanical option for osteoporotic intertrochanteric A2.3 fractures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fbioe.2026.1887294","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:53:38Z","timestamp":1784699618000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Finite element analysis of PFNA in the treatment of osteoporotic intertrochanteric A2.3 fractures of the femur"],"prefix":"10.3389","volume":"14","author":[{"given":"Fan","family":"Wang","sequence":"first","affiliation":[{"name":"Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Liu","sequence":"additional","affiliation":[{"name":"Tianjin Walkman Biomaterial Co., Ltd., Newton Laboratory","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruohan","family":"Pan","sequence":"additional","affiliation":[{"name":"Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengdong","family":"Chen","sequence":"additional","affiliation":[{"name":"Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaochao","family":"Huang","sequence":"additional","affiliation":[{"name":"Tianjin Walkman Biomaterial Co., Ltd., Newton Laboratory","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Pudong New Area People\u2019s Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haihan","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Pudong New Area People\u2019s Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingpeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Pudong New Area People\u2019s Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e96","DOI":"10.1097\/BOT.0b013e3182a7131c","article-title":"Short versus long intramedullary nails for treatment of intertrochanteric femur fractures (OTA 31-A1 and A2)","volume":"28","author":"Boone","year":"2014","journal-title":"J. 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