Torsional Stability of the Femoral Neck System for Pauwels Type III Femoral Neck Fracture Fixation: A Finite-element Analysis
1
Issued Date
2026-05-01
Resource Type
eISSN
24747661
Scopus ID
2-s2.0-105038889408
Pubmed ID
42134711
Journal Title
Journal of the American Academy of Orthopaedic Surgeons Global Research Reviews
Volume
10
Issue
5
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of the American Academy of Orthopaedic Surgeons Global Research Reviews Vol.10 No.5 (2026)
Suggested Citation
Chantarapanich N., Jitprapaikulsarn S., Mahaisavariya B., Mahaisavariya C. Torsional Stability of the Femoral Neck System for Pauwels Type III Femoral Neck Fracture Fixation: A Finite-element Analysis. Journal of the American Academy of Orthopaedic Surgeons Global Research Reviews Vol.10 No.5 (2026). Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/116932
Title
Torsional Stability of the Femoral Neck System for Pauwels Type III Femoral Neck Fracture Fixation: A Finite-element Analysis
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Corresponding Author(s)
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Abstract
INTRODUCTION: Femoral neck fracture fixation remains challenging, particularly for Pauwels type III fractures that require robust implants to withstand vertical shear forces. The femoral neck system (FNS) offers greater stiffness and more stable load sharing than multiple screw fixation; however, it has a lower load-to-failure than plate systems. We evaluated the torsional stability of the FNS using finite-element analysis. METHODS: We analyzed a transcervical Pauwels type III femoral neck fracture without a fracture gap, fixed with one of three constructs: multiple screw fixation, a dynamic hip screw (DHS) with an antirotation screw, or an FNS. Finite-element simulations incorporated muscle forces during the leg-swing phase, with constraints applied at the fovea capitis. Cortical-cancellous interfaces were fully bonded, except at the reduced fracture interface where relative translation was allowed. RESULTS: The DHS with an antirotation screw had the highest equivalent von Mises stress and strain energy density (SED) (1130.11 MPa/1,000) and the greatest fragment displacement (0.44 mm). Multiple screw fixation produced the lowest SED (151.73 MPa/1,000), and the FNS showed similar displacement with an intermediate SED (201.96 MPa/1,000). In the FNS, peak stress localized near the lateral cortex of the proximal femur, with reduced stress at the barrel-screw interface. CONCLUSIONS: The FNS provides rotational stability for Pauwels type III fractures comparable with multiple screw fixation and reduces stress at the fracture site. The DHS with an antirotation screw was less stable during hip rotation. Given its greater compressive strength than multiple screw fixation, the FNS is the preferred fixation option.