DOI: https://doi.org/10.22141/1608-1706.4.18.2017.109342

Comparative analysis of the reliability of the fixation of pertrochanteric fractures using normal and elongated proximal femoral nail

I.A. Lazarev, A.V. Kalashnikov, V.D. Malik, M.V. Skiban

Abstract


Background. The problem of treating patients with periarticular fractures of the proximal femur currently can not be completely solved. According to various authors, their incidence ranges from 20 to 53.3 % of the total number of injuries in hip fractures, and they occur more often in the senile age (60 %) than in the elderly (40 %). The surgical treatment of the proximal femur fractures with minimally invasive, low-traumatic technologies using proximal fe-moral nail — Trochanteric Gamma Nail G3 (Stryker), PFN A (Synthes), ChFN (ChM) is common. Both conventional and elongated versions of the proximal femoral nail (PFN) are used. Efforts are being made to substantiate the suitability of mechanical osteoimplants based on computer modeling, reflecting some aspects of the behavior of the bone-implant system, using the finite element method (FEM). The behavior of the fixator-bone biomechanical system was studied using computer simulation. The stress-strain state was determined for models with the conventional and elongated PFN, which provides optimal biomechanical and biological conditions for the pertrochanteric fractures healing. Materials and methods. The comparative analysis of the bone fragments stability in osteosynthesis of pertrochanteric fractures types A2/A3 was done using conventional and elongated proximal femoral screw. Results. The elongated PFN provides more reliable fixation of bone fragments in both types of A2/A3 fractures. The characteristics of the stresses on the bone and the fixator are significantly reduced. The loads on the bone-fixator biomechanical system are distributed more evenly among all elements of the model, without creating local stress concentrators and not exceeding the strength limit of the material. The movements along the fracture plane are reduced approximately 10 times for all fracture/fixation combinations when fixed by an elongated PFN. Varying the number of blocking screws in the PFN osteosynthesis changes the behavior of the bone-fixator biomechanical system. The use of 1 or 2 locking screws causes a slight stresses increase in the fracture plane for type A2 fracture and a decrease in type A3 fracture. The changes in stress are insignificant, the more important point is that the addition of locking screws leads to a decrease in displacements along the fracture plane in both A2 and A3 fractures, which indicates the reliability of fragment fixation and more stable osteosynthesis. Conclusions. According to computer modeling data, both variants of PFN provide sufficient fixation of fragments and stability of osteosynthesis in the surgical treatment of pertrochanteric fractures A2/A3 types. The use of an elongated PFN provides more reliable fixation of bone fragments in comparison with the conventional PFN for pertrochanteric fractures A2/A3 types, and does not depend on the number of blocking screws used. The study allows to determine a differentiated approach to the treatment of patients with pertrochanteric fractures of the proximal femur, to improve the effectiveness of medical care for this severe category of patients.


Keywords


pertrochanteric fractures; intramedullar blocked rods; proximal femoral nail; biomechanical modeling; finite elements method

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