Journal of Mechanics in Medicine and Biology

Vol. 17, No. 2 (2017) 1750008 (12 pages)

°c World Scientific Publishing Company
DOI: 10.1142/S0219519417500087

BIOMECHANICAL EFFECT OF DIFFERENT LAG

SCREW LENGTHS WITH DIFFERENT BARREL
LENGTHS IN DYNAMIC HIP SCREW SYSTEM:
A FINITE ELEMENT ANALYSIS STUDY
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CHUNG-YUH TZENG*,†,‡, KUI-CHUO HUANG*,§, YUN-CHE WU*,

CHU-LING CHANG†, KUAN-RONG LEE‡ and KUO-CHIH SU¶,||,**,††
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*Department of Orthopedics
Taichung Veterans General Hospital, Taichung, Taiwan
†
Department of Nursing, Hung Kuang University, Taichung, Taiwan
‡Institute of Molecular Medicine, College of Life Science
National Tsing Hua University, HsinChu, Taiwan
§School of Medicine, National Yang-Ming University, Taipei, Taiwan
¶
Department of Medical Research, Taichung Veterans General Hospital
1650 Taiwan Boulevard Sector, Taichung City 40705, Taiwan
||Rong Hsing Research Center for Translational Medicine
National Chung Hsing University, Taichung, Taiwan
**Department of Biomedical Engineering
Hung Kuang University, Taichung, Taiwan
††
kcsu@vghtc.gov.tw

Received 10 September 2015

Revised 8 January 2016
Accepted 31 January 2016
Published 5 August 2016

The dynamic hip screw (DHS) system is commonly used to treat intertrochanteric fracture of the
hip joint. Breakage of the lag screw was noted in clinical practice and the length of lag screw as
well as the length of the side plate in the DHS system appeared to play a role in the risk of
breakage. Thus, the aim of this study was to investigate the biomechanical effect of different lag
screw lengths and barrel plate lengths in the DHS implant system by finite element analysis
(FEA). Four FEA simulation models were created according to different lengths of lag screw
(79 mm and 63 mm) and different lengths of barrel side plate (43 mm and 37 mm). The von Mises
stress was used as the observation indicator. The results showed that the maximum tensile stress
on the long lag screw was slightly greater than that of the shorter lag screw. Use of a shorter
barrel side plate may also cause high stress between the lag screw and the barrel side plate. This
finding provides biomechanical reference data that may be of value to orthopedic surgeons with
respect to choice of implant size and length in the treatment of intertrochanteric fracture with a
DHS system to prevent complications such as implant failure caused by broken lag screws.

Keywords: Biomechanics; finite element analysis; dynamic hip screw.

†† Corresponding author.

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1. Introduction
The dynamic hip screw (DHS) system is commonly used to treat intertrochanteric
fracture of the hip joint. Many clinical reports1–3 and biomechanical studies have
demonstrated that bone union can be achieved by preventing implant failure. Such
studies provide evidence for the ideal position of lag screws and the ideal implant for
different bone conditions and fracture patterns.4–7 Implant failure such as breakage
of cortical screw, plate, or cut out of femoral head is a common complications often
reported in the literature.4,8–10 The breakage of a lag screw is rarely seen and
reported in the literature.4 A case of breakage of a long lag screw with short barrel
side plate was seen in clinical practice (Fig. 1). Although rare in this kind of clinical
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case, it is worth further investigation to avoid operational failure. Thus, this study
investigated the effect of different lag screw and barrel lengths for DHS implanta-
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tion.
Many clinical papers and biomechanical research related to the treatment of
intertrochanteric fracture with extramedullary plating systems such as DHS or
intramedullary nailing systems such as proximal femoral nail have been pub-
lished.3,11–13 Although these studies have investigated the effect of DHS implanta-
tion, the effects and biomechanical analysis of lag screw length or barrel side plate
length have not been explored.
Finite element analysis (FEA) in solid biomechanical studies has been widely
applied in a variety of research fields including orthopedics, dentistry, and reha-
bilitation.14–17 The use of computer simulation in scientific research has provided

Fig. 1. Breakage of the long lag screw with short barrel side plate was seen in clinical practice.

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 Biomechanics of Different DHS Sizes

time- and cost-saving benefits. FEA is a useful tool to analyze and study medical
devices such as prostheses or internal fixation devices that are commonly used in
clinical settings.14–16,18,19
Breakage of the lag screw was noted in our clinical practice. The effects of dif-
ferent lengths of lag screw and different lengths of the side plate in the DHS system
have rarely been reported. Thus, the aim of this study was to investigate the bio-
mechanical effect of different lag screw lengths and barrel plate lengths in the DHS
implant system by FEA. The result may help physicians choose the ideal length of
the lag screw and the side plate to prevent implant failure of the lag screw.
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2. Materials and Methods

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2.1. Build a simulation geometry model

This study was conducted to explore the biomechanical effects of different lengths of
lag screw and different barrel lengths using three-dimensional (3D) FEA and
computerized simulation. Four finite element simulation models were created
according to different lengths of lag screw (79 mm and 63 mm) and different lengths
of barrel side plate (43 mm and 37 mm) (divided subgroups showing in Figs. 2(a)–
2(d)). Bone models were also developed based on two different clinical conditions:
cortical bone and cancellous bone. The four components of the model in this study
included the cortical bone component of proximal femur, cancellous bone of prox-
imal femur, lag screw and side plate of DHS system, and four cortical screws. The
bone model was developed using the computerized tomography (CT) image model
provided by the Visible Human Project of the National Institutes of Health, USA.
Two bone conditions were set up, namely, cortical bone and cancellous bone of the
proximal femur. The lag screw and side plate of the DHS system and four cortical
screws were drawn with the aid of 3D computer-aided design (CAD) software
(Solidworks 2015, Dassault Syst
emes SolidWorks Corp., Waltham, MA, USA).

2.2. Convergence test

Before the FEA, a convergence test was done using a pre-built model in order to
achieve a more concise result. In this study, controlled mesh size was typically used
to achieve the convergence effect. Different sizes of mesh were applied individually:
5, 4, 3 and 2 mm. The mesh mainly used quadratic tetrahedral elements available in
the ANSYS Workbench software. In the ANSYS workbench FEA software, 100 N
downward force (z-axis) was applied onto the femoral head. This z-axis force was
defined as the loading condition. The distal part of the femoral shaft was well fixed
as the boundary condition (Fig. 2(e)). The maximum value of von Mises stress at a
certain point in the lag screw (tension side) of the DHS system was used as the index
of convergence to assess whether the model met the convergence criteria. After the
convergence test, four FEA models were used in this study with a quadratic tet-
rahedral element mesh size of 3 mm used as the standard. Then, the simulation test

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Fig. 2. Four different sizes of FEA models of the DHS system. (a) Group 1: long lag screw (79 mm) with
short barrel side plate (37 mm); (b) Group 2: short lag screw (63 mm) with short barrel side plate
(37 mm); (c) Group 3: long lag screw (79 mm) with long barrel side plate (43 mm); (d) Group 4: short lag
screw (63 mm) with long barrel side plate (43 mm); (e) loading and boundary conditions in this FEA
simulation.

was performed in the ANSYS Workbench FEA software. The mesh of four different
models was composed of approximately 110,000 nodes and 65,000 elements
(Table 1).

2.3. Loading conditions and boundary conditions

This study mainly simulated the condition of force on the femoral head in a standing
person whose body weight was approximately 80 kg. In order to simulate the femoral
head loading force condition, a load condition and a boundary condition were given

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 Biomechanics of Different DHS Sizes

Table 1. Number of nodes and elements of finite element mesh model.

Group 1 Group 2 Group 3 Group 4

Numbers of nodes 115,447 114,283 116,553 115,711

Numbers of elements 65,687 64,957 66,324 65,828

in this model (Fig. 2(e)). A downward force of 400 N (z-axis force) was set as the
loading force condition while the subject was standing on one leg. In addition to this
loading condition, a boundary condition was set as a fixation force on the distal
portion of the femoral shaft, at which time the translation points are 0 on the x-axis,
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y-axis, and z-axis. The contact between the lag screw and barrel side plate was set
with no separation, which simulated the lag screw being well engaged in the barrel of
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side plate. This allowed micro-movement without friction force.20

2.4. Material properties of the model

The model was composed of four parts that included cortical bone component of the
femur, cancellous bone component of the femur, lag screw and barrel side plate, and
four cortical screws. The DHS system was composed of stainless steel and the four
cortical screws were made of titanium alloy. The characteristics of the femur bone
were set up according to descriptions published by other research teams. All of
the materials were hypothetically homogenous, isotropic, and linear elastic.
Young’s modulus and Poisson’s ratio were used to determine the characteristics of
the material.21 The characteristics of the material were simulated and are listed in
Table 2.
After the FEA simulation, the study used the von Mises stress distribution map
as the observation indicator.
The von Mises stress equation is as follows:
rffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
1

von ¼ ½ð


2 Þ2 þ ð
1

3 Þ2 þ ð
2

3 Þ2 :
2 1
(The values
1 ,
2 , and
3 represent the force exerted on the three axes of the
principal stress, respectively. The von Mises stress on the lag screw, barrel side
plate, and femoral head was evaluated to explore the effect of the loading force on
the different sizes of dynamic lag screws.)

Table 2. Material properties of bone and implants.21

Material Young’s modulus (MPa) Poisson’s ratio

Cortical bone



17,000 0.3
Cancellous bone



1000 0.3
DHS Stainless steel 200,000 0.3
Screw Titanium alloy 118,000 0.3

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 C.-Y. Tzeng et al.

3. Results
In this study, different mesh sizes were used to perform the convergence test. Two
different lengths of lag screw (79 mm and 63 mm) and two different lengths of barrel
side plate (43 mm and 37 mm) were paired with each other in four different models.
This study used the maximal values of von Mises stress as an indicator of the
convergence values, which are listed in Table 3. The mesh size was defined as 3 mm
in each simulation model in this study. The convergence values of von Mises stress of
the lag screw were observed in the four models. The difference in convergence of
these four different groups was approximately 2.29%, 2.99%, 2.96%, and 3.10%. The
level of convergence reached 97.7%, 97.00%, 97.03%, and 96.89% individually.
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Based on previous research, the result of convergence in this study is acceptable.22

This result showed that the model type built in this study was the converged type.
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Therefore, it is reasonable to explore different length lag screws paired with different
length barrel side plates by using these finite element mesh models.
From this FEA simulation, Fig. 3 shows the distribution of von Mises stress in
the four different models with different lengths of lag screw and barrel side plates.
Tension stress was noted on the upper side of the lag screw and compression stress
was noted on the lower side of lag screw. Peak tensile stress from the highest to
lowest was as follows: group 1 (347.68 MPaÞ > group 2 (347.54 MPaÞ > group 3
(285.74 MPaÞ > group 4 (257.97 MPa). Peak compressive stress from the
highest to lowest was group 1 (363.77 MPaÞ > group 2 (350.85 MPaÞ > group 4
(287.66 MPaÞ > group 3 (283.89 MPa).
Figure 4 shows the von Mises stress distribution on the barrel side plate in four
different groups that were grouped according to different lengths of lag screw paired
with different lengths of barrel side plate. High stress was mainly distributed on
the upper ring part of the barrel. Stress from highest to lowest was as follows:
group 1 (439.58 MPaÞ > group 2 (337.58 MPaÞ > group 3 (252.34 MPaÞ > group 4
(238.69 MPa).
Figure 5 shows the stress distribution on the barrel side plate in four different
groups that were paired according to different length of lag screw paired with dif-
ferent length of barrel side plate. High stress was mainly distributed over the area of

Table 3. Results of convergence test values.

The peak The peak The peak The peak

von Mises von Mises von Mises von Mises
stress on stress on stress on stress on
lag screw Levels of lag screw Levels of lag screw Levels of lag screw Levels of
Element in group 1 conver- in group 2 conver- in group 3 conver- in group 4 conver-
size (MPa) gence (%) (MPa) gence (%) (MPa) gence (%) (MPa) gence (%)

5 mm 70.401 89.91 89.085 92.09 61.636 99.38 66.030 99.77

4 mm 80.428 96.35 78.604 95.62 55.842 90.30 64.927 98.52
3 mm 75.764 97.70 84.577 97.00 63.130 97.03 67.992 96.89
2 mm 77.500



82.043



61.255



65.883

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 Biomechanics of Different DHS Sizes

(a) (b)
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(c) (d)

Fig. 3. The von Mises stress distribution on the lag screw in four different groups paired according
to different lengths of lag screw with different length of barrel side plate in (a) group 1, (b) group 2,
(c) group 3, and (d) group 4.

(a) (b)

(c) (d)

Fig. 4. The von Mises stress distribution over the barrel side plate in (a) group 1, (b) group 2,
(c) group 3, and (d) group 4.

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 C.-Y. Tzeng et al.

(a) (b)
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(c) (d)

Fig. 5. The von Mises stress distribution on cortical bone in different lengths of the DHS system in
(a) group 1, (b) group 2, (c) group 3, and (d) group 4.

the lag screw engaged within the barrel side plate, and lower part of the lag
screw and barrel side plate, but there was little variance (approximately 20 MPa).
There was no high stress over the contact area located between the barrel side
plate and femoral bone. The peak stress values from highest to lowest was group 2
(26.32 MPaÞ > group 1 (26.23 MPaÞ > group 4 (25.43 MPaÞ > group 3 (21.83 MPa).
Table 4 shows the values of simulation analysis of different length of lag screws
paired with different lengths of barrel side plate. The observed values are the max

Table 4. Results of the maximum von Mises stress (unit in MPa) on different
sides of lag screw.

Tension side of Compression side of

lag screw lag screw Barrel plate Femur side

Group 1 347.68 363.77 439.58 26.23

Group 2 347.54 350.85 337.58 26.32
Group 3 285.74 283.89 252.34 21.83
Group 4 257.97 287.66 238.69 25.43

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von Mises stress on the tension side of the lag screw, compression side of the lag
screw, barrel side plate, and individual femurs, respectively. The highest stress
value on the DHS was found in group 1.

4. Discussion
FEA simulation is commonly applied in the biomechanical study of orthopedic and
dental research. FEA was successfully used in this study to explore the bio-
mechanical analysis of different lengths of lag screw paired with different lengths of
barrel side plate. The result of this study can be used to determine the condition of
stress between the lag screw and barrel side plate and the stress distribution when
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the DHS is fixed into the femur. These experimental data and values cannot be
observed in clinical cases. FEA conducted using a computer to simulate the bio-
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mechanical behavior of the implant can provide a more accurate method of com-
paring differences. Therefore, FEA is a suitable analytic tool. When different sizes of
lag screws are implanted in the femur (Fig. 3), the maximum tension stress of the
long lag screw (79 mm) will be greater than that of the short lag screw (63 mm). The
lag screw may be affected by tension force, which could lead to cracking and/or
breakage. From a biomechanical perspective, the main reason for this phenomenon
is the greater moment arm in the longer lag screw when a downward force is applied
onto the femoral head. When the same force is applied, it leads to a greater tran-
sition caused by force transited in the longer lag screw. According to Hooke’s law,
the amount of deformation will increase in the same material, resulting in a greater
stress force. Therefore, a crack or fracture could happen when a longer lag screw is
used. This concept is consistent with the result of this study. On the other hand, if
there was a greater force applied on the lag screw, it could cause the lag screw to
bend. Therefore, it would cause the lag screw difficult to slide on the DHS system
smoothly, which would lower the healing possibility of the femoral intertrochanteric
fracture.
Regarding the different lengths of barrel side plate of the DHS implant (Fig. 4), it
was found that the maximum stress was less in the long barrel side plate (43 mm)
compared with that of the short barrel side plate. The main reason is that the longer
barrel side plate covers more surface area of the lag screw. This reduces the tran-
sition force due to the increased contact surface area between the barrel side and lag
screw. According to Hooke’s law, a smaller displacement will be produced with
smaller stress force in a longer side plate paired with a lag screw. This phenomenon
is consistent with the results of this study.
Another observation of the distribution of stress on bone found no significant
difference in any area of the biomechanical structure (Fig. 5). The major portion of
the DHS implant (lag screw) was placed within the center of the femoral head and
femoral neck which is in the neutral axis area. Therefore, there was no difference in
the whole biomechanical structure. The value of maximal stress was approximately
20 MPa. It was also found that there was no high stress force in the contact area

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between the side plate and the cortical bone of the femur. From a biomechanical
perspective, this is due to the stress shielding effect. This phenomenon can be
explained by the significant difference between the Young’s modulus
(E ¼ 1700 MPa) in the femoral head and the Young’s modulus (E ¼ 200; 000 MPa)
of the DHS implant. When a force is applied, it will be transmitted via the DHS
system and bypass the femoral shaft. This effect will cause bone loss over the
femoral shaft area, and osteopenia or osteolysis will be seen clinically.
This stress shielding effect will cause osteopenia or osteolysis. As a consequence,
loosening of the implant could occur. To prevent this stress shielding effect, a similar
value of Young’s modulus of implant and femoral bone is recommended in clinical
practice. Thus, this study supports the recommendation that in the treatment of
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intertrochanteric fracture, the DHS material should be selected according to the

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properties of the femoral bone. Implants in the femoral bone should share similar
properties to avoid implant loosening. These findings could be of value to
manufacturing firms that produce DHS systems.
There were several limitations in this FEA study. The 3D FEA was done using a
computerized simulation study of the effect of pairing different sizes and lengths of
DHS. All of the materials were hypothetically homogenous, isotropic, and linearly
elastic. This hypothesis was made according to previous research reported in the
literature.19,22 Based on the experience of previous study in simulation experiments
of finite element, the friction coefficient of the bone-metal interface was set to 0.3.23
The aim of this study is to explore the biomechanical effect of different lag screw
lengths with different barrel lengths in a DHS system. Models were used to simulate
the effect of metallic implantations in the body over a period of time. The interface
between metallic implants and bone is bounded. In this simulated bound condition,
it can avoid the situation to solve nonlinear problem when contact condition was
simulated. In this study, the contact area between the lag screw and barrel of DHS
system was defined as no separation. With regard to the femoral model, only the
proximal half of femoral bone was used for observation in this study in order to
reduce the calculation time of the computerized simulation. Through the process of
this simplification, a clear trend emerges which make the research results more
valuable in clinical practice.
Based on the results of FEA in this study, the interactive effect of different sizes
and lengths of DHS was explored. This study also analyzed the trends related to the
effects of different sizes of lag screw and barrel side plate. Although there were some
differences between the analyzed values and real conditions, the results of this study
can represent real-world clinical situations. This study may provide useful reference
data that can be used in future designs of the DHS with respect to shape and
material choice. This advantage may also improve the treatment result and prevent
possible complications in patients receiving treatment for intertrochanteric frac-
ture. Reduced implant failure rate can be expected when these study results are
applied in clinical practice to achieve better quality treatment outcomes.

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5. Conclusion
In this study, FEA was successfully employed to explore the effect of different
lengths of lag screw and side barrel plates in a DHS system. The results showed that
the maximum tensile stress on the long lag screw was slightly greater than that of
the shorter lag screw. Usage of a shorter barrel side plate may also cause high stress
between the lag screw and barrel side plate. When implanted, the plate of the DHS
system may produce the stress shielding effect and lead to atrophy of the femur
bone. The results of this study provide biomechanical reference data to help or-
thopedic surgeons select the optimal implant size and length when treating inter-
trochanteric fracture with the DHS system. This may prevent complications such as
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implant failure caused by broken lag screw.

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Acknowledgments
The authors acknowledge the United States National Library of Medicine (NLM)
and the Visible Human Project as the source of the image data used to create the
finite element analysis model in this study.

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