Biomechanical Study on the Treatment of Femoral Neck Fractures with a Novel Proximal Femoral Bionic Nail
Authors: Zhang Yi-Fan , Ren Chuan , Yao Meng-Xuan , Zhao Shu-Guang , Ding Kai , Wang Hai-Cheng , Chen Wei , Zhang Qi , Zhang Yin-Ze 
Published: March 2024

Abstract
Objective: A novel Proximal Femoral Bionic Nail (PFBN) has been developed by a research team for the treatment of femoral neck fractures. This study aims to compare the biomechanical properties of the innovative PFBN with those of the conventional Inverted Triangular Cannulated Screw (ITCS) fixation method through biomechanical testing.
Methods: Sixteen male femoral specimens preserved in formalin were selected, with the donors’ age at death averaging 56.1±6.3 years (range 47–64 years), and a mean age of 51.4 years. The femurs showed no visible damage and were examined by X-rays to exclude diseases affecting bone quality such as tumors, severe osteoporosis, and deformities. The 16 femoral specimens were randomly divided into an experimental group (n=8) and a control group (n=8). All femurs were prepared with Pauwels type III femoral neck fractures, fixed with PFBN in the experimental group and ITCS in the control group. Displacement and stress limits of each specimen were measured through cyclic compression tests and failure experiments, and vertical displacement and strain values under a 600N vertical load were measured in all specimens through vertical compression tests.
Results: In the vertical compression test, the average displacement at the anterior head region of the femur was 0.362mm for the PFBN group, significantly less than the 0.480mm for the ITCS group (p<0.001). At the fracture line area, the average displacement for the PFBN group was also lower than that of the ITCS group (0.196mm vs. 0.324mm, p<0.001). The difference in displacement in the shaft area was smaller, but the average displacement for the PFBN group (0.049mm) was still significantly less than that for the ITCS group (0.062mm, p=0.016). The situation was similar on the posterior side of the femur. The average displacements in the head area, fracture line area, and shaft area for the PFBN group were 0.300mm, 0.168mm, and 0.081mm, respectively, while those for the ITCS group were 0.558mm, 0.274mm, and 0.041mm, with significant differences in all areas (p<0.001). The average strain in the anterior head area for the PFBN group was 4947μm/m, significantly less than the 1540μm/m for the ITCS group (p<0.001). Likewise, in the fracture line and shaft areas, the average strains for the PFBN group were significantly less than those for the ITCS group (p<0.05). In the posterior head area, the average strain for the PFBN group was 4861μm/m, significantly less than the 1442μm/m for the ITCS group (p<0.001). The strain conditions in the fracture line and shaft areas also showed the PFBN group was superior to the ITCS group (p<0.001). In cyclic loading experiments, the PFBN fixation showed smaller maximum displacement (1.269mm vs. 1.808mm, p<0.001), indicating better stability. In the failure experiments, the maximum failure load that the PFBN-fixated fracture block could withstand was significantly higher than that for the ITCS fixation (1817N vs. 1116N, p<0.001).
Conclusion: The PFBN can meet the biomechanical requirements for internal fixation of femoral neck fractures. PFBN is superior in biomechanical stability compared to ITCS, particularly showing less displacement and higher failure resistance in cyclic load and failure experiments. While there are differences in strain performance in different regions between the two fixation methods, overall, PFBN provides superior stability.