Stabil olmayan femur proksimal kırıklarında anti rotatuar lag vidası olan proksimal femoral çivi (PFN) ile bıçaklı LAG vidası olan proksimal femoral çivinin biyomekanik kıyaslanması

Year 2022, Volume: 5 Issue: 3, 361 - 367, 31.12.2022

Burak Özturan , Tarık Sarı

https://doi.org/10.36516/jocass.1210389

Abstract

Giriş: Proksimal femur kırıkları tedavisinde kullanılan farklı lag vidalarının çivi sisteminin aksiyel yüklenmedeki dayanıklılığında değişikliğe neden olup olmadığı değerlendirildi.
Gereç ve Yöntemler: AO/OTA 31/A2 tipinde kırık oluşturulan 14 kemik modeli yedişerli olacak şekilde iki gruba randomize olarak ayrıldı. Birinci gruptaki kemik modelleri bıçaklı lag vidası olan proksimal femur çivisi ile fikse edilirken; ikinci gruptaki kemik modelleri anti-rotatuar lag vidası olan proksimal femur çivisi ile fikse edildi. Tüm kemik modellerinin femur başlarına femur mekanik aksına uygun olacak şekilde 5 mm/dk hızda siklik kuvvet aksiyel olarak uygulandı. Test implant yetmezliği gelişinceye veya model kırılıncaya kadar sürdürüldü.
Sonuç: PFN grupundaki kemikler en az 908 N en fazla 1195 N kuvvetle kırılırken ortalamaları 1050 N oldu; A-PFN grupundaki kemikler en az 847 N en fazla 1219 N kuvvetle kırılırken ortalamaları 1096 N oldu. İki gruptaki kemiklere aksiyel yüklenme sonrası kırık oluşturan kuvvetler arasında istatiksel olarak anlamlı bir fark görülmedi (p=0,95;p>0,05)
Tartışma: Stabil olmayan intertrokanterik femur kırıklarında (ITFK) proksimal femur çivilerinde doğru pozisyonda yerleştirme ve tam redüksiyon ile cut-out ve varus kollaps komplikasyonları ile karşılaşılmadı. Bu sonuçlar sonrasında her iki model çivi stabil olmayan ITFK’larda güvenle kullanılabileceği ön görülmektedir.

Keywords

PFN,, intertrokanterik femur kırığı,, Stabil olmayan

References

• 1.Dhanwal DK, Dennison EM, Harvey NC, et al. Epidemiology of hip fracture: Worldwide geographic variation. Indian J Orthop. 2011;45(1):15-22. https://doi.org/10.4103/0019-5413.73656
• 2. Cooper C, Campion G, Melton LJ. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2(6):285-9. https://doi.org/10.1007/BF01623184
• 3.Khan AZ, Rames RD, Miller AN. Clinical Management of Osteoporotic Fractures. Curr Osteoporos Rep. 2018;16(3):299-311. https://doi.org/10.1007/s11914-018-0443-y
• 4.Mattisson L, Bojan A, Enocson A. Epidemiology, treatment and mortality of trochanteric and subtrochanteric hip fractures: data from the Swedish fracture register. BMC Musculoskelet Disord. 2018;19(1):369. https://doi.org/10.1186/s12891-018-2276-3
• 5. Sambandam SN, Chandrasekharan J, Mounasamy V, et al. Intertrochanteric fractures: a review of fixation methods. Eur J Orthop Surg Traumatol. 2016;26(4):339-53. https://doi.org/10.1007/s00590-016-1757-z
• 6. Niu E, Yang A, Harris AHS, et al. Which Fixation Device is Preferred for Surgical Treatment of Intertrochanteric Hip Fractures in the United States? A Survey of Orthopaedic Surgeons. Clinical Orthopaedics & Related Research. 2015;473(11):3647-55. https://doi.org/10.1007/s11999-015-4469-5
• 7.Ozturan B, Erinc S, Oz TT, et al. New Generation Nail Vs. Plate In The Treatment Of Unstable Intertrochanteric Femoral Fracture. Acta ortop bras. 2020;28:311-5. https://doi.org/10.1590/1413-785220202806234631
• 8.Werner BC, Fashandi AH, Gwathmey FW, et al. Trends in the Management of Intertrochanteric Femur Fractures in the United States 2005-2011. HIP International. 2015;25(3):270-6. https://doi.org/10.5301/hipint.5000216
• 9.Broderick JM, Bruce-Brand R, Stanley E, et al. Osteoporotic Hip Fractures: The Burden of Fixation Failure. The Scientific World Journal. 2013;2013:1-7. https://doi.org/10.1155/2013/515197
• 10.Bojan AJ, Beimel C, Taglang G, et al. Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures. BMC Musculoskelet Disord. 2013;14(1):1. https://doi.org/10.1186/1471-2474-14-1
• 11.Tisherman RT, Hankins ML, Moloney GB, et al. Distal locking of short cephalomedullary nails decreases varus collapse in unstable intertrochanteric fractures – a biomechanical analysis. Injury. 2021;52(3):414-8. https://doi.org/10.1016/j.injury.2021.02.007
• 12.Andruszkow H, Frink M, Frömke C, et al. Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cut-out failure of hip screws after surgical treatment of intertrochanteric fractures. International Orthopaedics (SICOT). 2012;36(11):2347-54. https://doi.org/10.1007/s00264-012-1636-0
• 13.Horner NS, Samuelsson K, Solyom J, et al. Implant-Related Complications and Mortality After Use of Short or Long Gamma Nail for Intertrochanteric and Subtrochanteric Fractures: A Prospective Study with Minimum 13-Year Follow-up. JBJS OA. 2017;2(3):e0026. https://doi.org/10.2106/JBJS.OA.17.00026
• 14.Raghuraman R, Kam J, Chua D. Predictors of failure following fixation of intertrochanteric fractures with proximal femoral nail antirotation. smedj. 2019;60(9):463-7. https://doi.org/10.11622/smedj.2019114
• 15.Zhang W, Antony Xavier RP, Decruz J, et al. Risk factors for mechanical failure of intertrochanteric fractures after fixation with proximal femoral nail antirotation (PFNA II): a study in a Southeast Asian population. Arch Orthop Trauma Surg. 2021;141(4):569-75. https://doi.org/10.1007/s00402-020-03399-2
• 16.De Bruijn K, den Hartog D, Tuinebreijer W, et al. Reliability of Predictors for Screw Cutout in Intertrochanteric Hip Fractures. Journal of Bone and Joint Surgery. 2012;94(14):1266-72. https://doi.org/10.2106/JBJS.K.00357
• 17.Tsai SW, Lin CFJ, Tzeng YH, et al. Risk factors for cut-out failure of Gamma3 nails in treating unstable intertrochanteric fractures: An analysis of 176 patients. Journal of the Chinese Medical Association. 2017;80(9):587-94. https://doi.org/10.1016/j.jcma.2017.04.007
• 18.Lindvall E, Ghaffar S, Martirosian A, et al. Short Versus Long Intramedullary Nails in the Treatment of Pertrochanteric Hip Fractures: Incidence of Ipsilateral Fractures and Costs Associated With Each Implant. J Orthop Trauma. 2016;30(3):6.
• 19.Halonen LM, Stenroos A, Vasara H, et al. Peri-implant fracture: a rare complication after intramedullary fixation of trochanteric femoral fracture. Arch Orthop Trauma Surg. 2021;142(12):3715-20. https://doi.org/10.1007/s00402-021-04193-4
• 20.Yamamoto N, Yamakawa Y, Tomita Y, et al. Intraoperative fractures in cephalomedullary nailing for trochanteric fractures. Injury. 2022;53(2):561-8. https://doi.org/10.1016/j.injury.2021.10.017