ArticleJournal of orthopaedic surgery and research2025
Biomechanical and clinically controlled study of different fenestration positions in vascularized iliac bone flaps for treating femoral head necrosis.
Article in Journal of orthopaedic surgery and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- In stage II osteonecrosis, bone grafting delays femoral head collapse compared with core decompression in glucocorticoid-associated osteonecrosis of the femoral head.International orthopaedics · 2026Trial
- Clinical efficacy evaluation of pedicled vascularized iliac bone graft transfer for osteonecrosis of the femoral head: a retrospective study with DCE-MRI/CTP analysis.Frontiers in surgery · 2025Article
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7 authors.
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Abstract
backgroundNo appropriate studies have been conducted that compare the biomechanical properties of different fenestration positions in deep circumflex iliac artery (DCIA)-vascularized iliac bone grafts for femoral head necrosis (ONFH) treatment. In this study, we aimed to explore the fenestration locations of DCIA-vascularized iliac grafting in ONFH treatment using FEA and clinical retrospective analysis.
methodsWe simulated an iliac bone flap transplantation with a vascularized tip by finite element analysis (FEA). Patients were divided into four groups using different femur fenestration positions as follows: center-window group (C-group), superior-window group (S-group), medial-window group (M-group), and inferior-window group (I-group). In this study, we primarily observed the maximum femoral stress at different healing degrees (0, 25, 50, 75, and 100%). We retrospectively analyzed the changes in the postoperative Harris scores (HHS) and the imaging of 16 patients with iliac flaps for ONFH (11 and 5 cases in the center and other-positioned groups, respectively) at the final follow-up visit.
resultsThe FEA results showed that the peak von Mises stresses in the four groups at the time of complete healing were in the following order: group C (20.28 MPa) < group I (20.33 MPa) < group M (20.92 MPa) < group S (22.00 MPa). A clinical retrospective study following a comparison of the two groups found that the mean improvement in HHS was 18.00 ± 12.38 in the center-window group and 13.60 ± 25.55 in the other groups. However, no significant difference was observed in the rate of collapse (36.37 vs. 40.00%) or changes in the HHS between the two groups.
conclusionA fenestration at the center of the femoral neck resulted in improved biomechanical gain and clinical outcomes.
trial registrationapproval was granted by the Ethics Committee (II202418102).
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