Evaluating three internal fixation techniques for Pauwels III femoral neck fractures via finite element analysis.

The selection of implants for fixing unstable femoral neck fractures (FNF) remains contentious. This study employs finite element analysis to examine the biomechanics of treating Pauwels type III femoral neck fractures using cannulated compression screws (3CS), biplane double-supported screw fixation (BDSF), and the femoral neck system (FNS). A three-dimensional model of the proximal femur was developed using computed tomography scans. Fracture models of the femoral neck were created with 3CS, BDSF, and FNS fixations. Von Mises stress on the proximal femur, fracture ends, internal fixators, and model displacements were assessed and compared across the three fixation methods (3CS, BDSF, and FNS) during the heel strike of normal walking. The maximum Von Mises stress in the proximal fragment was significantly higher with 3CS fixation compared to BDSF and FNS fixations (120.45 MPa vs. 82.44 MPa and 84.54 MPa, respectively). Regarding Von Mises stress distribution at the fracture ends, the highest stress in the 3CS group was 57.32 MPa, while BDSF and FNS groups showed 51.39 MPa and 49.23 MPa, respectively. Concerning implant stress, the FNS model exhibited greater Von Mises stress compared to the 3CS and BDSF models (236.67 MPa vs. 134.86 MPa and 140.69 MPa, respectively). Moreover, BDSF displayed slightly lower total displacement than 3CS fixation (7.19 mm vs. 7.66 mm), but slightly higher displacement than FNS (7.19 mm vs. 7.03 mm). This study concludes that BDSF outperforms 3CS fixation in terms of biomechanical efficacy and demonstrates similar performance to the FNS approach. As a result, BDSF stands as a dependable alternative for treating Pauwels type III femoral neck fractures.

Comparison of femoral neck system to multiple cancellous screws and dynamic hip screws in the treatment of femoral neck fractures.

OBJECTIVE: To compare the short-term outcomes of the femoral neck system (FNS) with multiple cancellous screws (MCS) and dynamic hip screws (DHS) in the treatment of femoral neck fractures. METHODS: A retrospective analysis was performed on 157 patients with fresh femoral neck fractures treated with FNS (from September 2019 to October 2020), MCS, and DHS (from January 2018 to October 2020). According to internal fixation methods, all patients were divided into the FNS group (54 cases), MCS group (51 cases), and DHS group (52 cases). Demographic data were also collected, recorded, and compared, including the follow-up time, days of hospitalization, operation time, blood loss, intraoperative fluoroscopy times (IFT), weight-bearing time (WBT), length of femoral neck shortening (LFNS), Harris hip score, and complications (such as internal fixation failure, bone nonunion, and avascular necrosis of the femoral head) between the three groups. RESULTS: Overall, 157 patients with a mean age of 61.8 (range, 18-89) years were analyzed. In the FNS group, IFT (median 10.5) was significantly lower than that in the MCS group (median 21) and DHS group (median 20.5) (P<0.05), and WBT was significantly earlier than that of the MCS group (P<0.05). In the FNS group, the median hospitalization time, operation time, and blood loss were 2 (2, 4) days, 45 (40-59) min, and 30 (20, 50) ml, respectively. They were all significantly less than 3.5 (3, 6) days, 72 (55-88.75) min, and 50 (30, 50) ml in the DHS group, respectively (P < 0.05). There was no statistical difference in LFNS, quality of reduction, internal fixation failure rate, and Harris hip score at the latest follow-up (P>0.05). No surgical complications such as incision infection, deep infection, pulmonary embolism, or femoral head necrosis were found in any of the three groups. CONCLUSION: FNS, MCS, and DHS are all effective for femoral neck fractures. However, a lower IFT of FNS shortens the operation time. Compared to MCS, FNS has the advantages of being a simple operation, with early WBT; compared to DHS, a minimally invasive operation is the main advantage of FNS.

Is It Necessary to Remove the Implants After Fixation of Thoracolumbar and Lumbar Burst Fractures Without Fusion? A Retrospective Cohort Study of Elderly Patients.

Objective: Fractures of the thoracolumbar spine are the most common fractures of the spinal column. This retrospective cohort study aimed to determine whether it is necessary to remove implants of patients aged over 65 years after the fixation of thoracolumbar and lumbar burst fractures without fusion. Methods: This retrospective cohort study included 107 consecutive patients aged ≥65 years without neurological deficits, who underwent non-fusion short posterior segmental fixation for thoracolumbar or lumbar burst fractures. Outcome measures included the visual analog score (VAS), Oswestry Disability Index (ODI), residual symptoms, complications, and imaging parameters. Patients were divided into groups A (underwent implant removal) and B (implant retention) and were examined clinically at 1, 3, 6, and 12 months postoperatively and annually thereafter, with a final follow-up at 48.5 months. Results: Overall, 96 patients with a mean age of 69.4 (range, 65-77) years were analyzed. At the latest follow-up, no significant differences were observed in functional outcomes and radiological parameters between both groups, except in the local motion range (LMR) (P = 0.006). Similarly, between preimplant removal and the latest follow-up in group A, significant differences were found only in LMR (P < 0.001). Two patients experienced screw breakage without clinical symptoms. Significant differences were only found in operation time, blood loss, ODI, and fracture type between minimally invasive group and open group. Conclusions: Similar radiological and functional outcomes were observed in elderly patients, regardless of implant removal. Implant removal may not be necessary after weighing the risks and benefits for elderly patients. Patients should be informed about the possibility of implant breakage and accelerating degeneration of adjacent segments in advance.

Non-sliding Fixation Shows Improved Clinical Outcomes for Displaced Femoral Neck Fractures as Compared to Sliding Fixation.

Objective: To compare the clinical outcomes between use of sliding fixation (three cannulated screws, TCS) and non-sliding fixation (four cannulated screws, FCS) in the treatment of femoral neck fractures. Methods: We retrospectively analyzed 102 patients with fresh femoral neck fractures treated with TCS (60 cases) and FCS (42 cases) between January, 2018 and December, 2019. The demographic data, follow-up time, hospitalization time, operation time, blood loss, length of femoral neck shortening (LFNS), soft tissue irritation of the thigh (STIT), Harris hip score, and complications (such as internal fixation failure, non-union, and avascular necrosis of the femoral head) were also collected, recorded, and compared between the two groups. Results: A total of 102 patients with an average age of 60.9 (range, 18-86) years were analyzed. The median follow-up time was 25 (22 to 32) months. The LFNS in the FCS group (median 1.2 mm) was significantly lower than that in the TCS group (median 2.8 mm) (P < 0.05). In the Garden classification, the number of displaced fractures in the TCS group was significantly lower than that in the FCS group (P < 0.05). The median hospitalization time, operation time, blood loss, reduction quality, internal fixation failure rate (IFFR), STIT, and Harris hip score were not statistically different between the two groups (P > 0.05). However, in the subgroup analysis of displaced fractures, the LFNS (median 1.2 mm), STIT (2/22, 13.6%), and Harris hip score (median 91.5) of the FCS group at the last follow-up were significantly better than the LFNS (median 5.7 mm), STIT (7/16, 43.8%), and Harris hip score (median 89) of the TCS group (P < 0.05). No complications such as incision infection, deep infection, pulmonary embolism, or femoral head necrosis were found in either group. Conclusion: TCS and FCS are effective for treating femoral neck fractures. For non-displaced fractures, there was no significant difference in the clinical outcomes between the two groups. However, for displaced fractures, the LFNS of the FCS is significantly lower than that of the TCS, which may reduce the occurrence of STIT and improve the Harris hip score.

The lateral femoral wall thickness on the risk of post-operative lateral wall fracture in intertrochanteric fracture after DHS fixation: A finite element analysis.

BACKGROUND: Patients with a lateral femoral wall (LFW) fracture were reported to have high rates of re-operation and complication. Although the LFW thickness was a reliable predictor of post-operative or intra-operative LFW fracture, there was a paucity of literature evaluating the critical stress distributions on the femur and screws of intertrochanteric fractures treated with dynamic hip screw (DHS). This study aimed to investigate the biomechanical performance of intertrochanteric fractures with different LFW thickness treated with DHS device. METHODS: A three-dimensional model of the proximal femur was established by computed tomography images. The intertrochanteric fracture model with three different LFW thickness (10 mm, 20.5 mm and 30 mm, respectively) was created, which was fixed by DHS. The von Mises stress on the proximal femur, lateral femoral wall, DHS and the total displacement of the device components were evaluated and compared for three different LFW thickness model. RESULTS: The maximum von Mises stress in the proximal fragment of the 10 and 20.5 mm model increased by 80.56% and 57.97% when compared with the 30 mm model. The peek von Mises stress around the blade entry point of the 10 mm and 20.5 mm model increased by 89.26% and 66.39% when compared with the 30 mm model. The peek von Mises in the DHS located near the junction of the barrel and side plate of each model and the 30 mm model had the smallest von Mises stress compared with the other two models. Furthermore, the maximum displacement in the 30 mm model was much smaller than that in the10mm model and 20 mm model. CONCLUSIONS: The intertrochanteric fracture with a thinner LFW tended to have a higher risk of LFW fracture stabilized by a DHS device. Thus, the intertrochanteric fractures with a thinner LFW should not be treated by DHS alone and the intramedullary nail or an addition of trochanteric stabilization plate(TSP) was recommended.

Evaluation of femoral head bone quality by Hounsfield units: A predictor of implant failure for intertrochanteric fractures after intramedullary nail fixation.

Purpose: The aim of present study is to evaluate the femoral head bone quality by Hounsfield units and its relationship to the occurrence of implant failure for intertrochanteric fractures after intramedullary nail fixation. Methods: This retrospective study assessed 160 intertrochanteric fractures treated with intramedullary fixation. Patients with and without implant failure were divided into failure and control groups, respectively. The demographic information, femoral head Hounsfield unit (HU) value, the reduction quality, status of posteromedial support and position of the screw/blade were collected and compared. The logistic regression analyses were performed to evaluate risk factors of implant failure in intertrochanteric fractures after intramedullary nail fixation. Results: Of the patients, 15 (9.38%) suffered from implant failure after intramedullary fixation. The mean HU value of femoral head was much lower in the failure group than the control group (133.25 ± 34.10 vs. 166.12 ± 42.68, p = 0.004). And the univariate analyses showed that A3 fracture and poor reduction quality were associated with implant failure (p < 0.05). After adjustment for confounding variables, the multivariable logistic regression analyzes showed that femoral head HU value (odds ratio [OR], 0.972; 95% CI, 0.952-0.993; p = 0.008) and poor reduction quality (OR, 7.614; 95% CI, 1.390-41.717; p = 0.019) were independent influencing factors for implant failure. Conclusion: The femoral head HU value was significantly correlated with the incidence of implant failure and can be used as an independent factor to predict implant failure for intertrochanteric fractures after intramedullary fixation.

Risk factors for implant failure of intertrochanteric fractures with lateral femoral wall fracture after intramedullary nail fixation.

INTRODUCTION: Few studies have specifically evaluated the comminution extent of lateral femoral wall (LFW) fracture and risk factors of implant failure in intertrochanteric fractures with LFW fracture. The aim of present study was to evaluate the influence of comminution extent of LFW fracture on implant failure and identify risk factors of implant failure in cases with LFW fracture after intramedullary fixation. METHODS: This retrospective study included 130 intertrochanteric fracture with LFW fracture treated with intramedullary fixation at a teaching hospital over a 13-year period from January 2006 to December 2018. Demographic information, cortical thickness index, the reduction quality, status of medial support, position of the screw/blade and status of lateral femoral wall were collected and compared. The logistic regression analyzes was performed to evaluate risk factors of implant failure in intertrochanteric fractures with LFW fracture after intramedullary nail fixation. RESULTS: 10 patients (7.69%) suffered from mechanical failure after intramedullary fixation. Univariate analyzes showed that comminuted LFW fracture (OR, 7.625; 95%CI, 1.437~40.446; p = 0.017), poor reduction quality (OR, 49.375; 95%CI, 7.217~337.804; p < 0.001) and loss of medial support (OR, 17.818; 95%CI, 3.537~89.768; p < 0.001) were associated with implant failure. After adjustment for confounding variables, the multivariable logistic regression analyzes showed that poor reduction quality (OR, 11.318; 95%CI, 1.126~113.755; p = 0.039) and loss of medial support (OR, 7.734; 95%CI, 1.062~56.327; p = 0.043) were independent risk factors for implant failure. Whereas, comminuted LFW fracture was not associated with implant failure (p = 0.429). CONCLUSIONS: The comminution extent of the LFW fracture might influence the stability of intertrochanteric fractures; and intramedullary fixation might be an effective treatment method. Furthermore, poor reduction quality and loss of medial support could increaze the risk of implant failure in intertrochanteric fractures with LFW fractures after intramedullary fixation. Therefore, we should pay great emphasis on fracture reduction quality in future.

Clinical predictors for deep vein thrombosis on admission in patients with intertrochanteric fractures: a retrospective study.

BACKGROUND: Limited studies were available to investigate the prevalence of deep vein thrombosis (DVT) on admission in elderly patients with intertrochanteric fractures. The aim of present study was to evaluate risk factors and the prevalence of pre-admission DVT in elderly patients with intertrochanteric fractures. METHODS: This retrospective study included 788 elderly patients with intertrochanteric fracture who were eligible for this study from January 1, 2010, to December 31, 2019. Color doppler ultrasonography was performed for DVT detection at admission. All patients' clinical data were collected. Univariate analysis and stepwise backward multivariate logistic regression were used to identify the risk factors contributing to the occurrence of DVT. RESULTS: The overall prevalence of pre-admission DVT in patients with intertrochanteric fractures was 20.81% (164 of 788 patients). The mean time from injury to admission was 2.1 days in the total population, 2.96 and 1.87 days in patients with and without DVT. Univariate analysis showed that significantly elevated risk of DVT were found in patients with longer time from injury to admission, high energy injury, lower Hb value, higher BMI, diabetes, chronic obstructive pulmonary disease (COPD), atrial fibrillation, dementia, varicose veins, higher age-adjusted CCI, higher ASA class and A3 type intertrochanteric fractures (P < 0.05). The adjusted multivariate logistic regression analysis demonstrated that longer time from injury to admission, high energy trauma, COPD, lower Hb, diabetes and A3 type intertrochanteric fractures were independent risk factors of pre-admission DVT. CONCLUSIONS: A high prevalence of pre-admission DVT was found in elderly Chinese patients with intertrochanteric fractures. Therefore, surgeons should be aware of the high prevalence of DVT for elderly patients with intertrochanteric fractures in order to prevent intraoperative and postoperative PE and other lethal complications.

The Efficacy of Multidisciplinary Team Co-Management Program for Elderly Patients With Intertrochanteric Fractures: A Retrospective Study.

Background: Intertrochanteric fractures increased quickly in past decades owing to the increasing number of aging population. Recently, geriatric co-management was rapidly emerging as a favored clinical care model for older patients with hip fractures. The purpose of this study was to assess the efficacy of a multidisciplinary team (MDT) co-management program in elderly patients with intertrochanteric fractures. Methods: In this retrospective study, patients were divided into MDT group and traditional orthopedic care (TOC) group according to the healthcare model applied. 249 patients were included in the TOC group from January 2014 to December 2016 and 241 patients were included in the MDT group from January 2017 to December 2019. Baseline data, peri-operative data, and postoperative complications were collected and analyzed using SPSS 21.0. Results: No significant differences were observed between the two groups in terms of patient baseline characteristics. Patients in the MDT group had significantly lower time from admission to surgery and length-of-stay (LOS) compared with those in the TOC group. Furthermore, the proportion of patients receiving surgery within 24 h (61.4 vs. 34.9%, p < 0.001) and 48 h (80.9 vs. 63.5%, p < 0.001) after admission to the ward was significantly higher in the MDT group compared with those in the TOC group. In addition, patients in the MDT group had significantly lower proportion of postoperative complications (25.3 vs. 44.2%, p < 0.001), deep vein thrombosis (7.9 vs. 12.9%, p = 0.049), pneumonia (3.8 vs. 8.0%, p = 0.045) and delirium (4.1 vs. 9.2%, p = 0.025) compared with those in the TOC group. However, no significant changes were found for in-hospital and 30-day mortality. Conclusion: The MDT co-management could significantly shorten the time from admission to surgery, LOS, and reduce the postoperative complications for elderly patients with intertrochanteric fractures. Further research was needed to evaluate the impact of this model on patient health outcomes.

Serum 25-hydroxyvitamin D, bone turnover markers and bone mineral density in postmenopausal women with hip fractures.

BACKGROUND: Vitamin D and bone turnover markers (BTMs) might have an effect on the occurrence of acute hip fracture, while the current results are conflicting. The purpose of this study is to explore the relationship between serum 25(OH)D, bone turnover markers and bone mineral density in Chinese postmenopausal women with hip fracture. METHODS: A total of 277 patients with hip fractures and 272 patients without fractures were included in this study. The serum 25(OH)D, bone formation markers, including N-terminal extension propeptide of type-I collagen (P1NP), alkaline phosphatase (ALP) and osteocalcin(OC), bone resorption markers, including C-terminal telopeptide of type-I collagen (CTX-1), and bone mineral density were collected and analyzed. RESULTS: Women with hip fractures had significantly lower concentrations of serum 25(OH)D, higher concentrations of serum CTX-1, P1NP and OC, lower concentrations of femoral neck and total hip bone mineral density (P<0.05). After adjustment for age and other confounding factors, multiple logistic regression analysis showed that serum 25(OH)D (OR=0.878, 95%CI=0.855-0.902, P<0.001), CTX-1 (OR=4.884, 95%CI=2.419-9.861, P<0.001)and total hip BMD (OR=0.141, 95%CI=0.034-0.577, P=0.006) were independent risk factors for hip fractures in postmenopausal women. The receiver operating characteristics curves showed that serum 25(OH)D had a good AUC value (0.830). CONCLUSIONS: In this study, lower concentrations of serum 25(OH)D and total hip bone mineral density were widely existed in Chinese postmenopausal women with hip fractures. Furthermore, bone resorption was more active than bone formation in senile postmenopausal women. Therefore, monitoring the alteration of serum CTX-1 in clinically might be useful for fracture prevention.

Comparison of Treatment of Acute Unstable Distal Clavicle Fractures Using Anatomical Locking Plates with Versus without Additional Suture Anchor Fixation.

BACKGROUND Surgical managements were recommended for unstable distal clavicle fracture owing to the high incidence of nonunion. The present study compared the efficacy of anatomical locking plate with versus without additional suture anchor fixation for the treatment of unstable Neer type II distal clavicle fractures. MATERIAL AND METHODS Between January 2013 to January 2015, 28 consecutive patients with unstable Neer type II  fractures were treated by using anatomical locking plate with or without additional suture anchor fixation. The patients were divided into anatomical locking plate group (group A) and anatomical locking plate combined with suture anchor group (group B) according to the surgical method. The operative-related parameters such as operation time, blood loss, length of hospitalization, union time, functional outcomes (Constant score, UCLA score and DASH score) and CC distance were compared. RESULTS The mean follow-up period of the 28 patients was 19.60 months (21.80 versus 18.39 months, respectively). No statistical differences in general and peri-operative parameters were found between 2 groups. The group B had significant higher Constant score than group A (P=0.004, 91.67 versus 83.10). While no statistical differences were reached in the UCLA score and DASH score between 2 groups (P=0.112 and 0.163, respectively). The group A had longer CC distance than group B (11.67 versus 8.94 mm), while no statistic difference was found (P=0.067). CONCLUSIONS For the treatment of acute unstable Neer type II distal clavicle fractures, both surgical methods could offer satisfactory outcome. However, anatomical locking plate combined with additional suture anchor fixation had a better functional and radiographic outcome than that without additional suture anchor fixation.

Clinical, morphological, and hemodynamic independent characteristic factors for rupture of posterior communicating artery aneurysms.

OBJECTIVE: To identify clinical, morphological, and hemodynamic independent characteristic factors that discriminate posterior communicating artery (PCoA) aneurysm rupture status. METHODS: 173 patients with single PCoA aneurysms (108 ruptured, 65 unruptured) between January 2012 and June 2014 were retrospectively collected. Patient-specific models based on their three-dimensional digital subtraction angiography images were constructed and analyzed by a computational fluid dynamic method. All variables were analyzed by univariate analysis and multivariate logistic regression analysis. RESULTS: Two clinical factors (younger age and atherosclerosis), three morphological factors (higher aspect ratio, bifurcation type, and irregular shape), and six hemodynamic factors (lower mean and minimum wall shear stress, higher oscillatory shear index, a greater portion of area under low wall shear stress, unstable and complex flow pattern) were significantly associated with PCoA aneurysm rupture. Independent factors characterizing the rupture status were identified as age (OR 0.956, p=0.015), irregular shape (OR 6.709, p<0.001), and minimum wall shear stress (OR 0.001, p=0.038). CONCLUSIONS: We combined clinical, morphological, and hemodynamic characteristics analysis and found the three strongest independent factors for PCoA aneurysm rupture were younger age, irregular shape, and low minimum wall shear stress. This may be useful for guiding risk assessments and subsequent treatment decisions for PCoA aneurysms.

Hemodynamic characteristics of large unruptured internal carotid artery aneurysms prior to rupture: a case control study.

OBJECTIVE: Post-ruptured intracranial aneurysm geometry models have been widely used in computational fluid dynamic studies to assess hemodynamic parameters associated with aneurysm rupture. However, their results may not be valid due to the morphological changes of the aneurysm after rupture. Our aim was to identify the hemodynamic features of aneurysms prior to rupture in comparison with unruptured aneurysms. MATERIALS AND METHODS: We retrospectively identified three large unruptured internal carotid artery (ICA) aneurysms (pre-ruptured group) with adequate image quality just before rupture. Matched with the same location and similar size, eight unruptured aneurysms (unruptured group) were selected as controls during the same time period. Flow simulations for these aneurysms were performed to compare differences in hemodynamics. RESULTS: Compared with unruptured aneurysms, pre-ruptured aneurysms had a significantly more irregular aneurysm shape, a higher aspect ratio, and lower aneurysm averaged wall shear stress (WSS) (p=0.024, p=0.048, and p=0.048, respectively). Although pre-ruptured aneurysms had a lower low WSS area and higher Oscillatory Shear Index, these were not statistically significant. CONCLUSIONS: For large unruptured ICA aneurysms, low WSS, higher aspect ratio, and irregular shape were indicators of fatal rupture. Early treatment for such lesions with flow diverter and coils may be the best therapeutic option.

Morphologic and Hemodynamic Analysis in the Patients with Multiple Intracranial Aneurysms: Ruptured versus Unruptured.

BACKGROUND AND PURPOSE: The authors evaluated the impact of morphologic and hemodynamic factors on multiple intracranial aneurysms and aimed to identify which parameters can be reliable indexes as one aneurysm ruptured, and the others did not. METHODS: Between June 2011 and May 2014, 69 patients harboring multiple intracranial aneurysms (69 ruptured and 86 unruptured) were analyzed from 3D-digital subtraction angiography (DSA) images and computational fluid dynamics (CFD). Morphologic and hemodynamic parameters were evaluated for significance with respect to rupture. Receiver operating characteristic (ROC) analysis identified area under the curve (AUC) and optimal thresholds separating ruptured from unruptured intracranial aneurysms for each parameter. Significant parameters were examined by binary logistic regression analysis to identify independent discriminators. RESULTS: Nine morphologic (size, neck width, surface area, volume, diameter of parent arteries, aspect ratio, size ratio, lateral/bifurcation type and regular/irregular type) and 6 hemodynamic (WSSmean, WSSmin, OSI, LSA, flow stability and flow complexity) parameters achieved statistical significance (p<0.05). Six morphologic (size, surface area, volume, aspect ratio, size ratio and regular/irregular type) and five hemodynamic (WSSmean, WSSmin, LSA, flow stability and flow complexity) parameters had high AUC values (AUC>0.7). By binary logistic regression analysis, large aspect ratio and low WSSmean were the independently significant rupture factors (AUC, 0.924; 95% CI, 0.883-0.965). CONCLUSIONS: Large aspect ratio and low WSSmean were independently associated with the rupture status of multiple intracranial aneurysms.

Morphological-Hemodynamic Characteristics of Intracranial Bifurcation Mirror Aneurysms.

BACKGROUND: Many morphological and hemodynamic parameters have been proposed as promising aneurysm rupture status discriminators. Besides, a clear dichotomy between sidewall and bifurcation aneurysms was reported. In this study, we strove to evaluate the contribution of many reported morphological and hemodynamic parameters to retrospective rupture status determination in bifurcation aneurysms independent of patients' characteristics. METHODS: Computational fluid dynamics were performed on 16 patients with bifurcation mirror aneurysms (MANs). Each pair was divided into ruptured and unruptured groups. The morphological and hemodynamic factors were analyzed and compared. Receiver operating characteristics (ROC) analysis was performed, and the area under the ROC curve (AUC) was calculated for all parameters to quantify the predictability of each index and identify the optimal threshold. RESULTS: Morphological (size, aspect ratio, size ratio, and height-width ratio) and hemodynamic (time-averaged mean wall shear stress [WSSmean], low WSS area [LSA]) parameters reached statistical significance (P < 0.05). Aneurysm irregular shape, oscillatory shear index (OSI), flow stability, inflow concentration, and impingement zone did not achieve significantly statistical differences (P = 0.508, P = 0.319, P = 0.523, P = 0.227, and P = 1.000, respectively). After ROC analysis, only aspect ratio and LSA had excellent AUC values (0.840 and 0.824, respectively). Other key parameters, including size, size ratio, height-width ratio, and WSSmean, had AUC values between 0.7 and 0.8 (0.730, 0.715, 0.703, 0.727, respectively). CONCLUSIONS: Higher aspect ratio and LSA are good indicators for bifurcation aneurysm rupture. MANs with different rupture status might be a useful disease model in which many factors are balanced to investigate possible features linked to aneurysm rupture.