Comparative finite element analysis of four different internal fixation implants for Pauwels type III femoral neck fractures in various fracture angles in the sagittal plane

ÖZER A., ÖNER K., Okutan A. E., AYAS M. S.

JOINT DISEASES AND RELATED SURGERY, vol.33, no.2, pp.352-358, 2022 (SCI-Expanded) identifier identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 33 Issue: 2
  • Publication Date: 2022
  • Doi Number: 10.52312/jdrs.2022.676
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, TR DİZİN (ULAKBİM)
  • Page Numbers: pp.352-358
  • Keywords: Femoral neck fractures, finite element analysis, dynamic hip screw plate, three cannulated screws
  • Karadeniz Technical University Affiliated: Yes


Objectives: This study aimed to evaluate the performance of four different fixation techniques for Pauwels type III femoral neck fractures considering the fracture morphology in the sagittal plane. Materials and methods: We constructed three different fracture morphologies in the sagittal plane in Pauwels type III femoral neck fractures: posteriorly angled at 20 degrees, neutral, and anteriorly angled at 20 degrees. We set up four fixation devices, including three cannulated screws (3CS), a dynamic hip screw with an antirotational screw (DHS+CS), a proximal femoral locking plate (PFLP), and three cannulated screws with a medial buttress plate (3CS+MBP). The twelve models were created and analyzed using the finite element analysis. Results: The finite element analysis revealed that 3CS+MBP yields better results in total vertical and rotational displacements, regardless of the fracture angle in the sagittal plane. For the anterior and posterior angled fractures in the sagittal plane, the PFLP was superior to the DHS+CS. However, the DHS+CS exhibited less displacement than the PFLP in the neutral fracture line in the sagittal plane. The 3CS group demonstrated poor mechanical stability for Pauwels type III fractures. Conclusion: Regardless of the fracture line in the sagittal plane, the 3CS+MBP showed better biomechanical behaviors than the 3CS, DHS+CS, and PFLP. In addition, in contrast to the DHS+CS, the PFLP displayed less vertical and rotational displacement in the anterior and posterior fracture lines in the sagittal plane.