Biomechanical design prognosis of two extramedullary fixation devices for subtrochanteric femur fracture: a finite element study.

The design rationale of extramedullary fixation for femur fracture has remained a matter of debate in the orthopaedic community. The present work provides a comparative preclinical assessment between two standard fracture fixation techniques: dynamic hip screw (DHS) and proximal femoral locking plate (PFLP), by employing finite element (FE)-based in silico models. The study attempts to evaluate and compare the two implants on following biomechanical behaviours: (1) stress variation on the femur and implant, (2) axial displacement of the fixated femur constructs, (3) postoperative stress shielding and longer term external remodelling of the host bone. We hypothesised that, of the two implants, PFLP has better biomechanical characteristics when used for subtrochanteric femoral fracture (SFF) fixation considering long-term adaptation. A comminuted fracture, simulated as two-part fracture gap of 20 mm, was created in the subtrochanteric region of a femur CAD model. Non-uniform physiological load cases were considered. External bone adaptation was modelled mathematically using stress analysis coupled with a growth model, in which strain energy density (SED) acted as feedback control variable. The computational results predicted lower stress shielding (by ~ 6%) and relatively less cortical thinning beneath the plate for PFLP as compared to DHS. DHS-fixated femur, on the other hand, predicted superior postoperative rigidity. Graphical Abstract FE-based comparative assessment between two extramedullary femur fixation devices-dynamic hip screw (DHS) and proximal femoral locking plate (PFLP).