A Computational Study on the Effect of Fracture Intrusion Distance in Three- and Four-Part Trochanteric Fractures Treated With Gamma Nail and Sliding Hip Screw
A Computational Study on the Effect of Fracture Intrusion Distance in Three- and Four-Part Trochanteric Fractures Treated With Gamma Nail and Sliding Hip Screw
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DOI：
10.1002/jor.22469
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发表时间：
2014-01-01
影响因子：
2.8
通讯作者：
Simpson, A. Hamish
中科院分区：
文献类型：
--
作者：
Goffin, Jerome M.;Pankaj, Pankaj;Simpson, A. Hamish
使用有限元分析，在股骨粗隆三部分和四部分骨折（AO分类为31-A2，Evans分类为IV型和V型）固定的骨质疏松模型中，比较Gamma钉和滑动髋螺钉（SHS）的行为。根据临床数据，内侧骨折块的大小各不相同，也考虑了大转子骨折的情况。我们的研究结果表明，对于使用Gamma髓内钉稳定的Evans V型和使用SHS稳定的Evans IV型和V型，拉力螺钉周围的松质骨容易屈服，因此表明存在切出风险。易屈服的骨体积随着内侧骨折块尺寸的增加而增加。相反，使用Gamma髓内钉的Evans IV型预计不会被切断。我们的研究结果表明，未来研究近端不稳定骨折固定的临床试验应将内侧骨折块的大小和大转子的完整性作为协变量，并有把握评价髓内器械在Evans IV型骨折中是否上级SHS，在V型骨折中是否劣于/等同。（C）2013骨科研究学会。由威利期刊公司出版
Using finite element analysis, the behaviors of the Gamma nail and the sliding hip screw (SHS) were compared in an osteoporotic bone model for the fixation of three-and four-part trochanteric fractures (31-A2 in the AO classification, types IV and V in Evans' classification). The size of the medial fragment was varied based on clinical data, and the case of a fractured greater trochanter was also considered. Our results showed that for Evans' type V stabilized with a Gamma nail and for Evans' types IV and V with the SHS, cancellous bone around the lag screw is susceptible to yielding, thus indicating a risk of cut-out. The volume of bone susceptible to yielding increases with an increase in size of the medial fragment. Conversely, Evans' type IV with a Gamma nail was not predicted to cut out. Our findings suggest that future clinical trials investigating fixation of unstable proximal fractures should include the size of the medial fragment and the integrity of the greater trochanter as covariables and be powered to evaluate whether intramedullary devices are superior to SHSs for Evans' type IV fractures and inferior/equivalent for type V. (C) 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.