DOI: https://doi.org/10.22141/1608-1706.6.17.2016.88622

Mathematical Modeling оf Osteosynthesis for Transtrochanteric Fractures Type A1 Using Different Metal Fixation Devices

A.V. Kalashnikov, V.D. Malyk, I.A. Lazarev, O.V. Kalashnikov

Abstract


Background. In most cases, fractures of the proximal femur are associated with osteoporosis. The choice of treatment for fractures of the proximal femur is one of the most important, because it affects not only the time of fracture union, but also the restoration of limb function and rehabilitation of the victim. Today, in the developed world in the treatment of fractures of the proximal femur, a minimally invasive, less traumatic technology using proximal femoral rods have been widely introduced (troсhanteric gamma nail 3 G — STRYKER, PFN A — SYNTHES, ChFN — ChM). This technique of operative treatment for fractures of the long bones is used in 60–70 % of patients. Materials and Methods. We applied computer simulation and finite element methods (FEM) for solving problems of continuum mechanics in application to biological objects with the use of software and computer systems. For comparative analysis of reliability of fixation of bone fragments in transtrochanteric fractures type A1, we have used a model of the femur, in which fixing elements are implanted in. For fixation of fragments, there were used 2 types of fixators: DHS plate (1st one) and the proximal femoral rod (2nd one), which provides optimal biomechanical and biological conditions for healing the fractures. Based on axial scans of computed tomography (CT) in models of the femur with different versions of fixation obtained on CT scanner Toshiba Asteion Super 4 (Japan) using the software package mimics, in automatic and semi-automatic modes, the spatial geometry of the proximal femur has been reproduced. Models in polylines were imported in Solid Works environment, where with the help of appropriate simulation tools we have created 3D models of the proximal femur with transtrochanteric fractures of type A1 and their fixation with a DHS plate and PFN rod. Calculation of the stress-strain state using FEM was performed for the intact model with both fixation devices, and then with nails in transtrochanteric fractures of type A1 and distal nailing (without locking, with 1 screw, 2 screws). Results. It was determined that the minimum stress on metal fixators in their proximal was noted during the use of DHS plate and PFN rod without using screws for distal locking. These data are statistically significantly (p ≤ 0.05) differed from data in the application of PFN rod with distal locking by means of 1 or 2 screws. On the distal part of metal fixation devices, the stress was absent when using PFN rod without the use of screws for distal locking, in contrast to this, during the use of DHS plates the stress increased to maximum values and was 57.19 MPa. Maximum but adequate micromotion was observed when using model of PFN rod without the use of screws for distal locking. These micromovements will contribute to the improvement of reparative osteogenesis in patients with transtrochanteric fractures of type A1. Too strong fixation when using DHS plates (1.95 mm) can lead to the violation of reparative osteogenesis in the application of this method of metal fixation. Conclusions. The study will determine a differentiated approach in the treatment of patients with transtrochanteric femoral neck fractures, will improve the efficiency of medical care for this severe category of patients.


Keywords


computer modeling; transtrochanteric fractures type A1; tension; metal fixation devices

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