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Udin G, Hoffmann L, Becce F, Borens O, Terrier A. Long vs short intramedullary nails for reverse pertrochanteric fractures: A biomechanical study. Med Eng Phys 2024; 131:104230. [PMID: 39284656 DOI: 10.1016/j.medengphy.2024.104230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 06/29/2024] [Accepted: 08/13/2024] [Indexed: 09/19/2024]
Abstract
There is currently no definitive evidence for the implant of choice for the treatment of reverse pertrochanteric fractures. Here, we aimed to compare the stability provided by two implant options: long and short intramedullary nails. We performed finite element simulations of different patterns of reverse pertrochanteric fractures with varying bone quality, and compared the short vs long nail stabilization under physiological loads. For each variable combination, the micromotions at the fracture site, bone strain, and implant stress were computed. Mean micromotions at the fracture surface and absolute and relative fracture surface with micromotions >150 µm were slightly lower with the short nail (8%, 3%, and 3%, respectively). The distal fracture extension negatively affected the stability, with increasing micromotions on the medial side. Bone strain above 1 % was not affected by the nail length. Fatigue stresses were similar for both implants, and no volume was found above the yield and ultimate stress in the tested conditions. This simulation study shows no benefit of long nails for the investigated patterns of reverse pertrochanteric fractures, with similar micromotions at the fracture site, bone strain, and implant stress.
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Affiliation(s)
- Gilles Udin
- Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker 4, 1011 Lausanne, Switzerland.
| | - Lore Hoffmann
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 09, 1015 Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Olivier Borens
- Bone and Motion Center, Clinique Bois-Cerf, Hirslanden Group, Avenue d'Ouchy 31, 1006 Lausanne, Switzerland
| | - Alexandre Terrier
- Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker 4, 1011 Lausanne, Switzerland; Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 09, 1015 Lausanne, Switzerland
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2
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Martínez-Aznar C, Mateo J, Ibarz E, Gracia L, Rosell J, Puértolas S. Biomechanical Behavior of Dynamic vs. Static Distal Locking Intramedullary Nails in Subtrochanteric Femur Fractures. Bioengineering (Basel) 2023; 10:1179. [PMID: 37892909 PMCID: PMC10604699 DOI: 10.3390/bioengineering10101179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE Hip fractures are one of the most frequent fractures presenting to the emergency department and orthopedic trauma teams. The aim of this study was to determine the best indication and therapeutic technique for subtrochanteric fractures and unifying criteria when choosing the most suitable type of nail. MATERIALS AND METHODS To analyze the influence of the material and the type of distal locking of intramedullary nails (static or dynamic), a femur model with a fracture in the subtrochanteric region stabilized with a long Gamma intramedullary nail was applied using finite element method (FEM) simulation. RESULTS The mechanical study shows that titanium nails allow for greater micromobility at the fracture site, which could act as a stimulus for the formation of callus and consolidation of the fracture. In the mechanical study, the type of distal locking mainly affects mobility at the fracture site and stress in the cortical bone around the distal screws, without in any case exceeding values that may compromise the viability of the assembly or that may result in detrimental effects (in terms of mobility at the fracture site) for the consolidation process. CONCLUSION Subtrochanteric fractures treated with titanium nail and static distal locking is safe and does not hinder consolidation.
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Affiliation(s)
- Carmen Martínez-Aznar
- Department of Orthopaedic Surgery and Traumatology, Reina Sofía Hospital, 31500 Tudela, Spain
| | - Jesús Mateo
- Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Elena Ibarz
- Department of Mechanical Engineering, University of Zaragoza, 50018 Zaragoza, Spain
- Aragón Institute for Engineering Research, 50018 Zaragoza, Spain
| | - Luis Gracia
- Department of Mechanical Engineering, University of Zaragoza, 50018 Zaragoza, Spain
- Aragón Institute for Engineering Research, 50018 Zaragoza, Spain
| | - Jorge Rosell
- Department of Mechanical Engineering, University of Zaragoza, 50018 Zaragoza, Spain
| | - Sergio Puértolas
- Department of Mechanical Engineering, University of Zaragoza, 50018 Zaragoza, Spain
- Aragón Institute for Engineering Research, 50018 Zaragoza, Spain
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Marshall NW, Vandenbroucke D, Cockmartin L, Wanninger F, Smet M, Feng Y, Ni Y, Bosmans H. Seven general radiography x-ray detectors with pixel sizes ranging from 175 to 76 μm: technical evaluation with the focus on orthopaedic imaging. Phys Med Biol 2023; 68:195007. [PMID: 37659394 DOI: 10.1088/1361-6560/acf642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/01/2023] [Indexed: 09/04/2023]
Abstract
Aim. Flat panel detectors with small pixel sizes general can potentially improve imaging performance in radiography applications requiring fine detail resolution. This study evaluated the imaging performance of seven detectors, covering a wide range of pixel sizes, in the frame of orthopaedic applications.Material and methods. Pixel sizes ranged from 175 (detector A175) to 76μm (detector G76). Modulation transfer function (MTF) and detective quantum efficiency (DQE) were measured using International Electrotechnical Commission (IEC) RQA3 beam quality. Threshold contrast (CT) and a detectability index (d') were measured at three air kerma/image levels. Rabbit shoulder images acquired at 60 kV, over five air kerma levels, were evaluated in a visual grading study for anatomical sharpness, image noise and overall diagnostic image quality by four radiologists. The detectors were compared to detector E124.Results. The 10% point of the MTF ranged from 3.21 to 4.80 mm-1, in going from detector A175to detector G76. DQE(0.5 mm-1) measured at 2.38μGy/image was 0.50 ± 0.05 for six detectors, but was higher for F100at 0.62. High frequency DQE was superior for the smaller pixel detectors, howeverCTfor 0.25 mm discs correlated best with DQE(0.5 mm-1). Correlation betweenCTand the detectability model was good (R2= 0.964).CTfor 0.25 mm diameter discs was significantly higher for D150and F100compared to E124. The visual grading data revealed higher image quality ratings for detectors D125and F100compared to E124. An increase in air kerma was associated with improved perceived sharpness and overall quality score, independent of detector. Detectors B150, D125, F100and G76, performed well in specific tests, however only F100consistently outperformed the reference detector.Conclusion. Pixel size alone was not a reliable predictor of small detail detectability or even perceived sharpness in a visual grading analysis study.
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Affiliation(s)
- N W Marshall
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, B-3000 Leuven, Belgium
- Medical Imaging Research Center, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium
- Agfa N.V., Septestraat 27, B-2640 Mortsel, Belgium
| | | | - L Cockmartin
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, B-3000 Leuven, Belgium
| | - F Wanninger
- Agfa-Gevaert HealthCare GmbH, München, Germany
| | - M Smet
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, B-3000 Leuven, Belgium
| | - Y Feng
- Theragnostic Laboratory, Biomedical Group, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium
| | - Y Ni
- Theragnostic Laboratory, Biomedical Group, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium
| | - H Bosmans
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, B-3000 Leuven, Belgium
- Medical Imaging Research Center, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium
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ALIÇ T, GÜLER C, ÇALBIYIK M, HASSA E. Which of the three different intramedullary nail designs is superior in the treatment of femoral shaft fractures? JOURNAL OF HEALTH SCIENCES AND MEDICINE 2023. [DOI: 10.32322/jhsm.1227816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Aim: The aim of this study a retrospective comparison was the clinical and radiological results results of patients with femoral shaft fracture made oftreated with three different types of intramedullary nail (IMN).
Material and Method: The study included 54 patients operated on in our clinic because of femoral shaft fracture. The records were retrospectively examined of 18 patients applied with locked IMN (LIMN), 17 with blade expandable IMN (BEIMN), and 19 with talon distalfix IMN (TDIMN). The groups were compared statistically in respect of age, gender, BMI, affected side, operating time (mins), radiation exposure (number of shots), time to union (weeks), visual analog scale (VAS) score, soft tissue problems associated with implant irritation, amount of shortening (mm), coronal, sagittal and torsional angulation (degrees).
Results: The mean VAS score of the TDIMN group was determined to be statistically significantly higher than that of the LIMN and BEIMN groups (p=0.008, p=0.045). The operating times were similar in the BEIN and TDIMN groups (p=0.768) and significantly shorter than in the LIMN group (p
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Rosell-Pradas J, Redondo-Trasobares B, Sarasa-Roca M, Albareda-Albareda J, Puértolas-Broto S, Herrera-Rodríguez A, Gracia-Villa L. Influence of plate size and screw distribution on the biomechanical behaviour of osteosynthesis by means of lateral plates in femoral fractures. Injury 2023; 54:395-404. [PMID: 36528423 DOI: 10.1016/j.injury.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
Distal femoral fractures are fractures associated with high rates of morbidity and mortality, affecting to three different groups of individuals: younger people suffering high-energy trauma, elderly people with fragile bones and people with periprosthetic fractures around previous total knee arthroplasty. They have been classically treated with conventional plates and intramedullary nails and more recently with locked plates that have increased their indications to more types of fractures. The main objective of the present work is the biomechanical study, by means of finite element simulation, of the stability achieved in the osteosynthesis of femoral fractures in zones 4 and 5 of Wiss, by using locked plates with different plate lengths and different screw configurations, and analysing the effect of screw proximity to the fracture site. A three dimensional (3D) finite element model of the femur from 55-year-old male donor was developed, and then a stability analysis was performed for the fixation provided by Osteosynthesis System LOQTEC® Lateral Distal Femur Plate in two different fracture zones corresponding to the zones 4 and 5 according to the Wiss fracture classification. The study was focused on the immediately post-operative stage, without any biological healing process. The obtained results show that more stable osteosyntheses were obtained by using shorter plates. In the cases of longer plates, it results more convenient disposing screws in a way that the upper ones are closer to fracture site. The obtained results can support surgeons to understand the biomechanics of fracture stability, and then to guide them towards the more appropriate osteosynthesis depending on the fracture type and location.
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Affiliation(s)
- J Rosell-Pradas
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
| | - B Redondo-Trasobares
- Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Zaragoza, Spain; Aragón Health Research Institute, Zaragoza, Spain
| | - M Sarasa-Roca
- Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Zaragoza, Spain; Aragón Health Research Institute, Zaragoza, Spain
| | - J Albareda-Albareda
- Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Zaragoza, Spain; Aragón Health Research Institute, Zaragoza, Spain; Department of Surgery, University of Zaragoza, Zaragoza, Spain.
| | - S Puértolas-Broto
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain; Aragón Institute for Engineering Research, Zaragoza, Spain
| | | | - L Gracia-Villa
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain; Aragón Institute for Engineering Research, Zaragoza, Spain
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A systematic review of the use of titanium versus stainless steel implants for fracture fixation. OTA Int 2021; 4:e138. [PMID: 34746670 PMCID: PMC8568430 DOI: 10.1097/oi9.0000000000000138] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/16/2021] [Accepted: 05/14/2021] [Indexed: 11/27/2022]
Abstract
Background: Controversy exists regarding the use of titanium and stainless steel implants in fracture surgery. To our knowledge, no recent, comprehensive review on this topic has been reported. Purpose: To perform a systematic review of the evidence in the current literature comparing differences between titanium and stainless steel implants for fracture fixation. Methods: A systematic review of original research articles was performed through the PubMed database using PRISMA guidelines. Inclusion criteria were English-language studies comparing titanium and stainless steel implants in orthopaedic surgery, and outcome data were extracted. Results: The search returned 938 studies, with 37 studies meeting our criteria. There were 12 clinical research articles performed using human subjects, 11 animal studies, and 14 biomechanical studies. Clinical studies of the distal femur showed the stainless steel cohorts had significantly decreased callus formation and an increased odds radio (OR 6.3, 2.7-15.1; P < .001) of nonunion when compared with the titanium plate cohorts. In the distal radius, 3 clinical trials showed no implant failures in either group, and no difference in incidence of plate removal, or functional outcome. Three clinical studies showed a slightly increased odds ratio of locking screw breakage with stainless steel intramedullary nails compared with titanium intramedullary nails (OR 1.52, CI 1.1-2.13). Conclusion: Stainless steel implants have equal or superior biomechanical properties when compared with titanium implants. However, there is clinical evidence that titanium plates have a lower rate of failure and fewer complications than similar stainless steel implants in some situations. Although our review supports the use of titanium implants in these clinical scenarios, we emphasize that further prospective, comparative clinical studies are required before the conclusions can be made.
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Abstract
PURPOSE OF REVIEW Fracture fixation aims to provide stability and promote healing, but remains challenging in unstable and osteoporotic fractures with increased risk of construct failure and nonunion. The first part of this article reviews the clinical motivation behind finite element analysis of fracture fixation, its strengths and weaknesses, how models are developed and validated, and how outputs are typically interpreted. The second part reviews recent modeling studies of the femur and proximal humerus, areas with particular relevance to fragility fractures. RECENT FINDINGS There is some consensus in the literature around how certain modeling aspects are pragmatically formulated, including bone and implant geometries, meshing, material properties, interactions, and loads and boundary conditions. Studies most often focus on predicted implant stress, bone strain surrounding screws, or interfragmentary displacements. However, most models are not rigorously validated. With refined modeling methods, improved validation efforts, and large-scale systematic analyses, finite element analysis is poised to advance the understanding of fracture fixation failure, enable optimization of implant designs, and improve surgical guidance.
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Affiliation(s)
- Gregory S Lewis
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, PA, USA.
| | | | - Hwabok Wee
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, PA, USA
| | - J Spence Reid
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, PA, USA
| | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
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Albareda-Albareda J, Gabarre-Raso S, Rosell-Pradas J, Puértolas-Broto S, Ibarz-Montaner E, Redondo-Trasobares B, Gómez-Vallejo J, Blanco-Rubio N, Sánchez-Gimeno M, Herrera-Rodríguez A, Gracia-Villa L. Biomechanical behavior of retrograde intramedullary nails in distal femoral fractures. Injury 2021; 52 Suppl 4:S76-S86. [PMID: 33642084 DOI: 10.1016/j.injury.2021.01.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/25/2021] [Indexed: 02/02/2023]
Abstract
Fractures of the distal femur affect three different groups of individuals: younger people suffering high-energy trauma, elderly people with fragile bones and people with periprosthetic fractures around previous total knee arthroplasty. Main indications of intramedullary nailing are for supracondylar fractures type A or type C of the AO classification. The main objective of the present work is to analyze, by means of FE simulation, the influence of retrograde nail length, considering different blocking configurations and fracture gaps, on the biomechanical behavior of supracondylar fractures of A type. A three dimensional (3D) finite element model of the femur from 55-year-old male donor was developed, and then a stability analysis was performed for the fixation provided by the retrograde nail at a distal fracture with different fracture gaps: 0.5 mm, 3 mm y 20 mm, respectively. Besides, for each gap, three nail lengths were studied with a general extent (320 mm, 280 mm and 240 mm), considering two transversal screws (M/L) at the distal part and different screw combinations above the fracture. The study was focused on the immediately post-operative stage, without any biological healing process. In view of the obtained results, it has been demonstrated new possibilities of blocking configuration in addition to the usual ones, which allows establishing recommendations for nail design and clinical practice, avoiding excessive stress concentrations both in screws, with the problem of rupture and loss of blocking, and in the contact of nail tip with cortical bone, with the problem of a new stress fracture.
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Affiliation(s)
- J Albareda-Albareda
- Department of Surgery, University of Zaragoza. Zaragoza, Spain; Aragón Health Research Institute. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Spain
| | | | - J Rosell-Pradas
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain
| | - S Puértolas-Broto
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain; Aragón Institute for Engineering Research. Zaragoza, Spain
| | - E Ibarz-Montaner
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain; Aragón Institute for Engineering Research. Zaragoza, Spain
| | - B Redondo-Trasobares
- Aragón Health Research Institute. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Spain.
| | - J Gómez-Vallejo
- Department of Surgery, University of Zaragoza. Zaragoza, Spain; Aragón Health Research Institute. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Spain
| | - N Blanco-Rubio
- Department of Surgery, University of Zaragoza. Zaragoza, Spain; Aragón Health Research Institute. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Spain
| | - M Sánchez-Gimeno
- Department of Surgery, University of Zaragoza. Zaragoza, Spain; Aragón Health Research Institute. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Spain
| | - A Herrera-Rodríguez
- Department of Surgery, University of Zaragoza. Zaragoza, Spain; Aragón Health Research Institute. Zaragoza, Spain; Aragón Institute for Engineering Research. Zaragoza, Spain
| | - L Gracia-Villa
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain; Aragón Institute for Engineering Research. Zaragoza, Spain
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Gardas BB, Ghongade NP, Jagtap AH. Application of multi‐criteria decision‐making approach in healthcare surgical management. JOURNAL OF MULTI-CRITERIA DECISION ANALYSIS 2021. [DOI: 10.1002/mcda.1753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Bhaskar B. Gardas
- Department of Mechanical Engineering M.H. Saboo Siddik College of Engineering Mumbai Maharashtra India
| | - Nilesh P. Ghongade
- Department of Mechanical Engineering M.H. Saboo Siddik College of Engineering Mumbai Maharashtra India
| | - Annasaheb H. Jagtap
- Department of Mechanical Engineering M.H. Saboo Siddik College of Engineering Mumbai Maharashtra India
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Bauwens PH, Malatray M, Fournier G, Rongieras F, Bertani A. Risk factors for complications after primary intramedullary nailing to treat tibial shaft fractures: A cohort study of 184 consecutive patients. Orthop Traumatol Surg Res 2021; 107:102877. [PMID: 33652149 DOI: 10.1016/j.otsr.2021.102877] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/30/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Intramedullary nailing is the standard of care for tibial shaft fractures. The risk factors for infectious and/or mechanical complications, notably non-union, remain incompletely understood. The objective of this study was to evaluate risk factors for complications, notably non-union. HYPOTHESIS Active smoking and an initial open wound are independent risk factors for complications. MATERIALS AND METHODS We retrospectively included consecutive patients managed for open or closed tibial shaft fractures by primary intramedullary nailing between 2013 and 2018. We collected data on preoperative factors related to the patient and to the mechanism of injury (age, sex, smoking history, energy of the trauma, open wound), on intraoperative factors (residual interfragmentary gap), and on postoperative factors (early or delayed weight-bearing). We evaluated the associations between these factors and the occurrence of complications, notably non-union, by performing a univariate analysis followed by a multivariate analysis. RESULTS We included 184 patients [mean age, 38.5±17.6 (range, 15-91), 72.2% of males]. One or more complications developed in 28 (15.2%) patients and non-union occurred in 15 (8.1%) patients. There were three significant risk factors for complications: active smoking (OR, 7.93; 95%CI, 2.76-22.7), a residual interfragmentary gap >5mm (OR, 4.92; 95%CI, 1.72-14.02), and an initial open wound (OR,5.16; 95%CI, 1.62-16.43) (p<0.05). The same three factors were significant risk factors for non-union. Energy of the trauma, age, sex, and early or delayed weight bearing were not significantly associated with an excess risk of complications. DISCUSSION Active smoking, a residual interfragmentary gap >5mm, and an initial open wound are risk factors for postoperative complications after intramedullary nailing to treat a tibial shaft fracture. Preventive strategies and specific information could be implemented for these patients. LEVEL OF EVIDENCE IV; single-centre retrospective cohort study.
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Affiliation(s)
- Paul-Henri Bauwens
- Service de chirurgie orthopédique et traumatologique, Pavillons E et H, Hôpital Édouard-Herriot, Hospices civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France.
| | - Matthieu Malatray
- Service de chirurgie orthopédique et traumatologique, Pavillons E et H, Hôpital Édouard-Herriot, Hospices civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France; Service de chirurgie orthopédique, Hôpital de la Croix-Rousse, Hospices civils de Lyon, Lyon, France
| | - Gaspard Fournier
- Service de chirurgie orthopédique, Hôpital de la Croix-Rousse, Hospices civils de Lyon, Lyon, France
| | - Frédéric Rongieras
- Service de chirurgie orthopédique et traumatologique, Pavillons E et H, Hôpital Édouard-Herriot, Hospices civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France
| | - Antoine Bertani
- Service de chirurgie orthopédique et traumatologique, Pavillons E et H, Hôpital Édouard-Herriot, Hospices civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France
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Herrera A, Rosell J, Ibarz E, Albareda J, Gabarre S, Mateo J, Gracia L. Biomechanical analysis of the stability of anterograde reamed intramedullary nails in femoral spiral fractures. Injury 2020; 51 Suppl 1:S74-S79. [PMID: 32081396 DOI: 10.1016/j.injury.2020.02.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
Femoral shaft fractures present high morbidity and important complications and consequences, being spiral fractures the most complicated from a biomechanical point of view, being unstable and without possibility of getting a good contact between nail and femoral endosteum. Femoral diaphyseal fractures are treated, usually, by means of intramedullary nailing. So, it is necessary to know the osteosynthesis stability and which locking screws combination is optimal. This work studies the use of reamed locked intramedullary nails in spiral femoral fractures located along zones 2 and 4 of wiss, depending on the spire length, corresponding to 32-A spiral type in AO/OTA classification, which represent a percentage of 23% within the total of diaphyseal fractures. A three-dimensional finite element model of the femur was developed, modeling a spiral fracture with different spiral lengths and gaps. A femoral nail was used, considering two transversal screws both at the proximal and the distal parts. The study was focused on the immediately post-operative stage, verifying the appropriate stability of the osteosynthesis. Reamed intramedullary blocked nails provide appropriate stability of femoral spiral fractures, considering global mobility of femoral head with respect to femoral condyles, relative displacements between fragments at fracture site, stresses at nail and locking screws, and stresses at cortical bone. The obtained results show that the use of blocked reamed nails in spiral femoral fractures can be considered as an appropriate surgical technique, providing sufficient stability in order to obtain an adequate fracture healing.
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Affiliation(s)
- A Herrera
- Aragón Health Research Institute. Zaragoza, Spain; Department of Surgery, University of Zaragoza. Zaragoza, Spain
| | - J Rosell
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain
| | - E Ibarz
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain; Aragón Institute for Engineering Research. Zaragoza, Spain
| | - J Albareda
- Aragón Health Research Institute. Zaragoza, Spain; Department of Surgery, University of Zaragoza. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital. Zaragoza, Spain
| | - S Gabarre
- Vlaams Instituut voor Biotechnologie, Leuven, Belgium
| | - J Mateo
- Aragón Health Research Institute. Zaragoza, Spain; Department of Surgery, University of Zaragoza. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital. Zaragoza, Spain
| | - L Gracia
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain; Aragón Institute for Engineering Research. Zaragoza, Spain.
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12
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Tucker SM, Wee H, Fox E, Reid JS, Lewis GS. Parametric Finite Element Analysis of Intramedullary Nail Fixation of Proximal Femur Fractures. J Orthop Res 2019; 37:2358-2366. [PMID: 31254411 DOI: 10.1002/jor.24401] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/06/2019] [Indexed: 02/04/2023]
Abstract
Proximal femur fracture fixation with intramedullary nailing relies on stability at the fracture site and integrity of the fixation construct to achieve union. The biomechanics that dictate fracture site stability and implant stress depend on fracture type as well as implant features such as nail length, nail diameter, presence of distal fixation screws, and material composition of the implant. When deciding how to fix a fracture, surgeons have choices in these implant-related design variables. This study models all combinations of a range of implant variables for nine standard AO/OTA proximal femur fractures using finite element analysis. Under simulated maximum load during gait, the maximum stress in the implant and screws as well as interfragmentary motions at the fracture site in the axial and shear directions were computed. The results were separated by fracture type to show the influence of each design variable on measured biomechanical outcomes. Filling the reamed canal with the largest fitting nail diameter reduced axial and shear interfragmentary motion for all fracture types. Nail length was less predictive of shear interfragmentary motion for most simulated fracture types than other construct variables. Furthermore, gapping at the fracture site predisposed the construct to higher implant stresses and larger interfragmentary motions. Clinical significance: Biomechanical outcomes from this computational study can aid in surgical decision-making for optimizing hip fracture fixation with IM nailing. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2358-2366, 2019.
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Affiliation(s)
- Scott M Tucker
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Hwabok Wee
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Edward Fox
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - J Spence Reid
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Gregory S Lewis
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
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Pre-planning of intramedullary nailing procedures: A methodology for predicting the position of the distal hole. Med Eng Phys 2019; 74:172-179. [PMID: 31543440 DOI: 10.1016/j.medengphy.2019.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/28/2019] [Accepted: 09/08/2019] [Indexed: 11/23/2022]
Abstract
Inserting the distal locking screws is a challenging step of the intramedullary nailing procedures due to the nail deformation that makes the proximally mounted targeting systems ineffective. A pre-planning methodology is proposed, based on an analytical model of the nail-bone construct, to predict the nail deformation during surgery using orthogonal preoperative radiographs. Each of the femoral shaft and the nail was modeled as a curved tubular Euler-Bernoulli beam. The unknown positions and forces of the nail-bone interaction were found using a systematic trial and error approach, which minimized the total strain energy of the system while satisfying the force and geometrical constraints. The predictions of the model for the nail deformation were compared with the experimental results of five cadaver specimens in 15 test conditions. Relatively large displacements (up to 13 mm) were found for the distal hole in sagittal plane only. The model predictions were in close agreement with the experimental results, with a root mean square error of 1.2 mm. It was concluded that the proposed pre-planning methodology is promising for practical clinical use in intramedullary nailing operations, in order to provide the compensatory information that is required for tuning of proximally mounted targeting systems.
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