{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T23:46:41Z","timestamp":1783468001139,"version":"3.55.0"},"reference-count":44,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T00:00:00Z","timestamp":1648425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>A stabilization method of pertrochanteric femur fractures is a contentious issue. Here, we assess the feasibility of rapid in silico 2D finite element modeling (FEM) to predict the distribution of stresses arising during the two most often used stabilization methods: gamma nail fixation (GNF) and dynamic hip screw (DHS). The modeling was based on standard pre-surgery radiographs of hip joints of 15 patients with pertrochanteric fractures of type A1, A2, and A3 according to the AO\/OTA classification. The FEM showed that the stresses were similar for both GNF and DHS, with the medians ranging between 53\u201360 MPa and consistently lower for A1 than A3 fractures. Stresses also appeared in the fixation materials being about two-fold higher for GNF. Given similar bone stresses caused by both GNF and DHS but shorter surgery time, less extensive dissection, and faster patient mobilization, we submit that the GNF stabilization appears to be the most optimal system for pertrochanteric fractures. In silico FEM appears a viable perioperative method that helps predict the distribution of compressive stresses after osteosynthesis of pertrochanteric fractures. The promptness of modeling fits well into the rigid time framework of hip fracture surgery and may help optimize the fixation procedure for the best outcome. The study extends the use of FEM in complex orthopedic management. However, further datasets are required to firmly position the FEM in the treatment of pertrochanteric fractures.<\/jats:p>","DOI":"10.3390\/jcm11071885","type":"journal-article","created":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T21:44:52Z","timestamp":1648590292000},"page":"1885","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["In Silico Finite Element Modeling of Stress Distribution in Osteosynthesis after Pertrochanteric Fractures"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5985-9790","authenticated-orcid":false,"given":"Jacek","family":"Lorkowski","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Traumatology, and Sports Medicine, Central Clinical Hospital of the Ministry of the Internal Affairs and Administration, 137 Woloska Street, 02-507 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8710-9775","authenticated-orcid":false,"given":"Mieczyslaw","family":"Pokorski","sequence":"additional","affiliation":[{"name":"Institute of Health Sciences, Opole University, 68 Katowicka Street, 45-060 Opole, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.rbo.2014.01.006","article-title":"Transtrochanteric fractures: Evaluation of data between hospital admission and discharge","volume":"49","author":"Uliana","year":"2014","journal-title":"Rev. Bras. Ortop."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1093\/jhps\/hnz054","article-title":"Subchondral insufficiency fractures of the femoral head: Systematic review of diagnosis, treatment and outcomes","volume":"7","author":"Gaudiani","year":"2019","journal-title":"J. Hip Preserv. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1177\/230949901402200304","article-title":"Proximal femoral locking compression plate for proximal femoral fractures","volume":"22","author":"Lee","year":"2014","journal-title":"J. Orthop. Surg."},{"key":"ref_4","first-page":"1","article-title":"Falls as one of the atypical presentations of COVID-19 in older population","volume":"12","author":"Lorkowski","year":"2021","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1111\/os.12524","article-title":"Hip fractures: Therapy, timing, and complication spectrum","volume":"11","author":"Saul","year":"2019","journal-title":"Orthop. Surg."},{"key":"ref_6","first-page":"410","article-title":"Examining implant superiority in the treatment of simple pertrochanteric fractures of the proximal femur in elderly patients","volume":"25","year":"2019","journal-title":"Ulus. Travma. Acil. Cerrahi. Derg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1186\/s13018-020-01943-9","article-title":"Optimal surgical methods to treat intertrochanteric fracture: A Bayesian network meta-analysis based on 36 randomized controlled trials","volume":"15","author":"Cheng","year":"2020","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s00264-009-0783-4","article-title":"A meta-analysis of the Gamma nail and dynamic hip screw in treating pertrochanteric fractures","volume":"34","author":"Xiang","year":"2010","journal-title":"Int. Orthop."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/j.injury.2020.01.019","article-title":"Medial wall fragment involving large posterior cortex in pertrochanteric femur fractures: A notable preoperative risk factor for implant failure","volume":"51","author":"Li","year":"2020","journal-title":"Injury"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/5584_2020_610","article-title":"In silico analysis of bone tension during fixation of the medial malleolus fracture after ankle joint endoprosthesis","volume":"1335","author":"Lorkowski","year":"2021","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.medengphy.2011.08.008","article-title":"Predicting fracture using 2D finite element modelling","volume":"34","author":"MacNeil","year":"2012","journal-title":"Med. Eng. Phys."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1055\/s-0040-1716758","article-title":"Minimally invasive osteosynthesis of transtrochanteric fractures with dynamic hip screw (DHS)","volume":"56","author":"Machado","year":"2021","journal-title":"Rev. Bras. Ortop."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.rbo.2015.04.025","article-title":"Effectiveness of treatment of transtrochanteric fractures with dynamic hip screws using minimally invasive access","volume":"51","author":"Sena","year":"2016","journal-title":"Rev. Bras. Ortop."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Fracture and dislocation classification compendium-2018","volume":"32","author":"Meinberg","year":"2018","journal-title":"J. Orthop. Trauma"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"737","DOI":"10.2106\/00004623-196951040-00012","article-title":"Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. An end-result study using a new method of result evaluation","volume":"51","author":"Harris","year":"1969","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"G\u0142owacki, D., Mo\u0107ko, W., Marczak, M., G\u0142owacka, A., and Kra\u015bkiewicz, C. (2021). Energy absorbing properties analysis of layers structure of titanium alloy Ti6Al4V during dynamic impact loading tests. Materials, 14.","DOI":"10.3390\/ma14237209"},{"key":"ref_17","first-page":"171","article-title":"Huber\u2019s yield criterion and strength hypothesis centennial","volume":"56","author":"Olesiak","year":"2004","journal-title":"Arch. Mech."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1177\/2151458512450707","article-title":"Outcome of the dynamic helical hip screw system for intertrochanteric hip fractures in the elderly patients","volume":"3","author":"Deeb","year":"2012","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1097\/00005131-200207000-00004","article-title":"Pertrochanteric fractures: Is there an advantage to an intramedullary nail?: A randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail","volume":"16","author":"Saudan","year":"2002","journal-title":"J. Orthop. Trauma"},{"key":"ref_20","first-page":"803","article-title":"Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: A meta-analysis","volume":"10","author":"Liu","year":"2015","journal-title":"Clin. Interv. Aging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.2106\/JBJS.N.01007","article-title":"Intramedullary versus extramedullary fixation for unstable intertrochanteric fractures: A prospective randomized controlled trial","volume":"97","author":"Reindl","year":"2015","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_22","first-page":"14888","article-title":"Biomechanical evaluation of improved PFNA fixation devices for intertrochanteric hip fracture with finite element analysis","volume":"10","author":"Jiang","year":"2017","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s13018-016-0377-y","article-title":"Load distribution between cephalic screws in a dual lag screw trochanteric nail","volume":"11","author":"Henschel","year":"2016","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Zheng, L., Chen, X., Zheng, Y., He, X., Wu, J., and Lin, Z. (2021). Cement augmentation of the proximal femoral nail antirotation for the treatment of two intertrochanteric fractures\u2014A comparative finite element study. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04878-2"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1007\/s00590-020-02824-x","article-title":"New fixation method for Pauwels type III femoral neck fracture: A finite element analysis of sliding hip screw, L-shaped, and L-shaped with medial plate","volume":"31","author":"Freitas","year":"2021","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1148\/radiol.2016142796","article-title":"Prediction of hip failure load: In vitro study of 80 femurs using three imaging methods and finite element models\u2014The European Fracture Study (EFFECT)","volume":"280","author":"Pottecher","year":"2016","journal-title":"Radiology"},{"key":"ref_27","first-page":"815","article-title":"Comparison of proximal femoral nail (PFN) and dynamic hip screw (DHS) for the treatment of AO type A2 and A3 pertrochanteric fractures of femur","volume":"70","author":"Adeel","year":"2020","journal-title":"J. Pak. Med. Assoc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1007\/s00590-017-1964-2","article-title":"Comparative outcome of PFNA, Gamma nails, PCCP, Medoff plate, LISS and dynamic hip screws for fixation in elderly trochanteric fractures: A systematic review and network meta-analysis of randomized controlled trials","volume":"27","author":"Arirachakaran","year":"2017","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1186\/s13018-018-0852-8","article-title":"Comparing surgical interventions for intertrochanteric hip fracture by blood loss and operation time: A network meta-analysis","volume":"13","author":"Hao","year":"2018","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S44","DOI":"10.1016\/S0020-1383(17)30657-5","article-title":"Blood loss in trochanteric fractures: Multivariate analysis comparing dynamic hip screw and Gamma nail","volume":"48","author":"Ronga","year":"2017","journal-title":"Injury"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1177\/2151458513518343","article-title":"Role of fracture and repair type on pain and opioid use after hip fracture in the elderly","volume":"4","author":"Strike","year":"2013","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_32","unstructured":"Hadeed, A., Werntz, R.L., and Varacallo, M. (2021). External Fixation Principles and Overview, StatPearls Publishing."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1080\/17453674.2019.1711323","article-title":"Deep learning in fracture detection: A narrative review","volume":"91","author":"Kalmet","year":"2020","journal-title":"Acta Orthop."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Lorkowski, J., Kolaszy\u0144ska, O., and Pokorski, M. (2021). Artificial intelligence and precision medicine: A perspective. Advances in Experimental Medicine and Biology, Springer.","DOI":"10.1007\/5584_2021_652"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1302\/2058-5241.5.190092","article-title":"Machine Learning Consortium. Artificial intelligence in orthopaedics: False hope or not? A narrative review along the line of Gartner\u2019s hype cycle","volume":"5","author":"Oosterhoff","year":"2020","journal-title":"EFFORT Open. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2358","DOI":"10.1002\/jor.24401","article-title":"Parametric finite element analysis of intramedullary nail fixation of proximal femur fractures","volume":"37","author":"Tucker","year":"2019","journal-title":"J. Orthop. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1001\/jamasurg.2019.4917","article-title":"Artificial intelligence and surgical decision-making","volume":"155","author":"Loftus","year":"2020","journal-title":"JAMA Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1080\/17453674.2017.1344459","article-title":"Artificial intelligence for analyzing orthopedic trauma radiographs. Deep learning algorithms\u2014Are they on par with humans for diagnosing fractures?","volume":"88","author":"Olczak","year":"2017","journal-title":"Acta Orthop."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.7150\/ijbs.58855","article-title":"Artificial intelligence in the diagnosis of COVID-19: Challenges and perspectives","volume":"17","author":"Huang","year":"2021","journal-title":"Int. J. Biol. Sci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1007\/s00586-017-4956-3","article-title":"Genodisc Consortium. ISSLS prize in bioengineering science 2017: Automation of reading of radiological features from magnetic resonance images (MRI\u2019s) of the lumbar spine without human intervention is comparable with an expert radiologist","volume":"26","author":"Jamaludin","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1007\/s00068-014-0476-6","article-title":"Does lesser trochanter implication affect hip flexion strength in proximal femur fracture?","volume":"41","author":"Aprato","year":"2015","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1007\/s00264-009-0840-z","article-title":"Internal fixation of pertrochanteric fractures using DHS with a two-hole side-plate","volume":"34","year":"2010","journal-title":"Int. Orthop."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1007\/s00068-020-01511-0","article-title":"Focus on proximal femur fractures: Surgical options and outcome","volume":"46","author":"Bonnaire","year":"2020","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s13018-020-02193-5","article-title":"Cephalo-medullary nailing versus dynamic hip screw with trochanteric stabilisation plate for the treatment of unstable per-trochanteric hip fractures: A meta-analysis","volume":"16","author":"Selim","year":"2021","journal-title":"J. Orthop. Surg. Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/7\/1885\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:45:00Z","timestamp":1760136300000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/7\/1885"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,28]]},"references-count":44,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["jcm11071885"],"URL":"https:\/\/doi.org\/10.3390\/jcm11071885","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,28]]}}}