Impact of intraprosthetic drilling on the strength of the femoral stem in periprosthetic fractures: A finite element investigation
Bibliographic record
Abstract
Treatment of periprosthetic femur fractures after total hip arthroplasty remains a major challenge in orthopedic surgery. Recently, a novel surgical technique using intraprosthetic screw fixation has been suggested. The purpose of this study was to evaluate the influence of drilling the femoral hip stem on integrity and strength of the implant. The hypothesis was that intraprosthetic drilling and screw fixation would not cause the load limit of the prosthesis to be exceeded and that deformation would remain within the elastic limit. A sawbone model with a conventional straight hip stem was used and a Vancouver C periprosthetic fracture was created. The fracture was fixed with a nine-hole less invasive stabilization system plate with two screws drilled and inserted through the femoral hip stem. Three different finite element models were created using ANSYS software. The models increased in complexity including joint forces and stress risers from three different dimensions. A variation of drilling positions was analyzed. Due to the complexity of the physiological conditions in the human femur, the most complex finite element model provided the most realistic results. Overall, significant changes in the stresses to the prosthesis caused by the drilling procedure were observed. While the stresses at the site of the bore hole decreased, the load increased in the surrounding stem material. This effect is more pronounced and further the holes were apart, and it was found that increasing the number of holes could counteract this. The maximum load was still found to be in the area of the prosthesis neck. No stresses above the load limit of titanium alloy were detected. All deformations of the prosthesis stem remained in the elastic range. These results may indicate a potential role for intraprosthetic screw fixation in the future treatment of periprosthetic femur fractures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".