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Peer-reviewedCC BY 4.0Frontiers in Surgery

Effects of variable bolt position of femoral neck system on Pauwels III fractures with superior femoral neck bone defect: multimodal biomechanical and clinical study

  • Qing Zhang1,2
  • Xu Zhang1,2
  • Jiawen Wang1,2
  • Liudong Zhang1,2
  • Xiangyu Qi1,2
  • Yongxiang Lv1
  • Wenbo Li1
  • Yazhong Zhang1
  • Junqiang Wang3
  • Zhian Liu4
  • Ziqiang Zhu1
4 affiliations
  1. 1Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, China
  2. 2Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
  3. 3Department of Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
  4. 4Department of Anatomy, School of Basic Medical Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China
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Abstract

Introduction: There is currently a lack of biomechanical evidence regarding whether the central position recommended by guidelines outperforms eccentric positions when using the Femoral Neck System (FNS) for Pauwels type III femoral neck fractures with superior neck defects. This study evaluated the biomechanical stability of FNS placement at different positions (anterior, posterior, central, and inferior) to guide clinical practice.

Methods: A multimodal study combining finite element analysis (FEA) and cadaveric biomechanical testing was conducted on Pauwels III fracture models with 30° wedge-shaped defects in the superior neck. Furthermore, a retrospective analysis was performed on 27 patients who underwent robot-assisted precise central FNS fixation between 2021 and 2025, evaluating postoperative Garden alignment index and the 12-month Harris Hip Score (HHS).

Results: FEA and mechanical testing revealed that eccentric FNS placements caused pronounced stress concentration and structural instability. Conversely, central FNS placement provided maximum structural stiffness and ideal stress distribution. Clinical application of this defect-oriented central strategy yielded excellent Garden alignment, 100% fracture union at the 12-month follow-up, and a mean HHS of 88.41.

Discussion: In conclusion, for Pauwels type III fractures with superior femoral neck bone defects, precisely placing the bolt in the center of the femoral neck using an orthopedic surgical robot optimizes biomechanical properties and significantly improves fixation stability.

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Cite

BibTeXRIS
BibTeX
@article{zhang2026effects,
  title = {{Effects of variable bolt position of femoral neck system on Pauwels III fractures with superior femoral neck bone defect: multimodal biomechanical and clinical study}},
  author = {Qing Zhang and Xu Zhang and Jiawen Wang and Liudong Zhang and Xiangyu Qi and Yongxiang Lv and Wenbo Li and Yazhong Zhang and Junqiang Wang and Zhian Liu and Ziqiang Zhu},
  journal = {Frontiers in Surgery},
  year = {2026},
  month = oct,
  doi = {10.3389/fsurg.2026.1914575},
  url = {https://doi.org/10.3389/fsurg.2026.1914575},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Effects of variable bolt position of femoral neck system on Pauwels III fractures with superior femoral neck bone defect: multimodal biomechanical and clinical study
AU  - Qing Zhang
AU  - Xu Zhang
AU  - Jiawen Wang
AU  - Liudong Zhang
AU  - Xiangyu Qi
AU  - Yongxiang Lv
AU  - Wenbo Li
AU  - Yazhong Zhang
AU  - Junqiang Wang
AU  - Zhian Liu
AU  - Ziqiang Zhu
PY  - 2026
DA  - 2026/10/21
JO  - Frontiers in Surgery
DO  - 10.3389/fsurg.2026.1914575
UR  - https://doi.org/10.3389/fsurg.2026.1914575
AB  - Introduction: There is currently a lack of biomechanical evidence regarding whether the central position recommended by guidelines outperforms eccentric positions when using the Femoral Neck System (FNS) for Pauwels type III femoral neck fractures with superior neck defects. This study evaluated the biomechanical stability of FNS placement at different positions (anterior, posterior, central, and inferior) to guide clinical practice.  Methods: A multimodal study combining finite element analysis (FEA) and cadaveric biomechanical testing was conducted on Pauwels III fracture models with 30° wedge-shaped defects in the superior neck. Furthermore, a retrospective analysis was performed on 27 patients who underwent robot-assisted precise central FNS fixation between 2021 and 2025, evaluating postoperative Garden alignment index and the 12-month Harris Hip Score (HHS).  Results: FEA and mechanical testing revealed that eccentric FNS placements caused pronounced stress concentration and structural instability. Conversely, central FNS placement provided maximum structural stiffness and ideal stress distribution. Clinical application of this defect-oriented central strategy yielded excellent Garden alignment, 100% fracture union at the 12-month follow-up, and a mean HHS of 88.41.  Discussion: In conclusion, for Pauwels type III fractures with superior femoral neck bone defects, precisely placing the bolt in the center of the femoral neck using an orthopedic surgical robot optimizes biomechanical properties and significantly improves fixation stability.
SN  - 2296-875X
ER  -