Mathematical Background for Different Methods of Osteosynthesis of the Proximal Femur Fracture for the Treatment of Pathological Metastatic Tumors of Long Bones

I.A. Lazarev, A.V. Ilnitskyi, V.V. Protsenko, M.V. Skyban

Abstract


Metastatic bone disease is a serious complication of cancer disease. Bone metastases occur in 17–50 % of patients with solid malignant tumors and are the third most common localization of metastatic lesions after the lungs and liver. The main clinical manifestations of metastatic bone disease are pain, pathological fractures, occurring in 8–30 % of cases, spinal cord compression, and hypercalcemia, which largely determines the severity of the patient’s condition and in some cases is the cause of mortality. Selection of osteosynthesis techniques in metastatic lesions of the long bones of the limbs is relevant due to the necessity of a reliable fixation of bone fragments, as in most cases the bone fusion occurs. A biomechanical study was held to test the strength and stiffness of the native model of the femur, with the existing hollow defect in its proximal section, using three different kinds of metal fixation apparatus: proximal femoral stem, extramedullary plate and Kostiuk external fixation apparatus. Comparing the performance of stress on fragments of the model of the femur it should be noted that in cases of Kostiuk external fixation apparatus application stress values doubled compared to the values at the proximal femoral shaft and extramedullary plate. The stress value on the bone while external fixation application exceeds the threshold strength of cortical tissue. Indicators of stress in the fixing elements grow almost 9 times with the use of Kostiuk external fixation apparatus compared to the va-lues at the application of the proximal femoral shaft and 3 times while using extramedullary plate. The value of the stress on the metal structures in cases of Kostiuk external fixation apparatus does not exceed the threshold of their strength. Comparing the movement of indicators as a whole throughout the femur model, such as the proximal area regarding its fixed distal area, almost equivalent performance in the application of the proximal fe-moral shaft and extramedullary plate is observed. Indicators of movement while using the Kostiuk external fixation apparatus are almost 2 times higher than with the proximal femoral shaft and extramedullary plate. All fixing methods are associated with the load redistribuion on the metal structures of clamps, that is a clamp has a basic function of holding, that relieves bone and fracture. As a result of the pilot study it was found that the proximal femoral shaft and extramedullary plate provide more reliable fixation of fragments. Kostiuk external fixation devices under these conditions cope with the task worse. There is observed a considerable strain of rod apparatus with crumpled bone in the fracture fragments and the increase in mobility. These pilot studies can be considered as an option to choose proper osteosynthesis technique in patients with metastatic bone
lesions.


Keywords


metastatic disease of limbs; proximal femur; patho- logical fracture; biomechanical analysis; osteosynthesis

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DOI: https://doi.org/10.22141/1608-1706.5.17.2016.83876

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