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Does The Screw Orientation Effects The Stability of Femoral Neck Fracture?: a Finite Element Analysis

Yıl 2018, Sayı: 3, 243 - 247, 01.09.2018

Okan Özkunt Kerim Sarıyılmaz Turgut Akgül Gökhan Polat Fatih Dikici

Öz

Objectives: The incidence of femoral neck fractures in younger-age people increases due to high-energy trauma. To avoid complications, stable internal fixation is essential. The most commonly used implants for vertically oriented femoral neck fractures are the cannulated and dynamic hip screws. In our study, we compared differently oriented cannulated screw configurations and a standard DHS for fixation of femoral neck fracture.Materials and Methods: A finite element-based collum femoris fracture was created and was fixed using four differently oriented triangular screw configurations and a dynamic hip screw. The loads were applied using a commercially available software package.Results: Centrally oriented cannulated screw configuration had the most compression and compression stress on the fracture side, and it had the highest stress values on the implant.Conclusion: We recommend the use of centrally oriented triangular cannulated screws for femoral neck fracture fixation. With this construct, more compression and compression pressure can be obtained, which can result in the early healing of the fracture. However, it must be kept in mind that this construct exerts more stress on the implant, which could be a reason for implant failure

Anahtar Kelimeler

femoral neck fractures cannulated screw dynamic hip screw screw position finite element analysis

Kaynakça

  • Pauyo T, Drager J, Albers A, Harvey EJ. Management of femoral neck fractures in the young patient: A critical analysis review. World journal of orthopedics. 2014;5:204-17. [CrossRef]
  • Johansson T, Jacobsson SA, Ivarsson I, Knutsson A, Wahlstrom O. Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips. Acta orthopaedica Scandinavica. 2000;71:597-602. [CrossRef]
  • Luttrell K, Beltran M, Collinge CA. Preoperative decision making in the treatment of high-angle “vertical” femoral neck fractures in young adult patients. An expert opinion survey of the Orthopaedic Trauma Association’s (OTA) membership. Journal of orthopaedic trauma. 2014;28:e221-5. [CrossRef]
  • Dedrick DK, Mackenzie JR, Burney RE. Complications of femoral neck fracture in young adults. The Journal of trauma. 1986;26:932-7.
  • Zhang Y, Tian L, Yan Y, Sang H, Ma Z, Jie Q, et al. Biomechanical evaluation of the expansive cannulated screw for fixation of femoral neck fractures. Injury. 2011;42:1372-6. [CrossRef]
  • Kunapuli SC, Schramski MJ, Lee AS, Popovich JM, Jr., Cholewicki J, Reeves NP, et al. Biomechanical Analysis of Augmented Plate Fixation for the treatment of Vertical Shear Femoral Neck Fractures. Journal of orthopaedic trauma. 2015;29:144-50. [CrossRef]
  • Rupprecht M, Grossterlinden L, Sellenschloh K, Hoffmann M, Puschel K, Morlock M, et al. Internal fixation of femoral neck fractures with posterior comminution: a biomechanical comparison of DHS(R) and Intertan nail(R). International orthopaedics. 2011;35:1695-701. [CrossRef]
  • Rupprecht M, Grossterlinden L, Ruecker AH, de Oliveira AN, Sellenschloh K, Nuchtern J, et al. A comparative biomechanical analysis of fixation devices for unstable femoral neck fractures: the Intertan versus cannulated screws or a dynamic hip screw. The Journal of trauma. 2011;71:625-34. [CrossRef]
  • Tsouknidas A, Anagnostidis K, Maliaris G, Michailidis N. Fracture risk in the femoral hip region: A finite element analysis supported experimental approach. Journal of biomechanics. 2012;45:1959-64. [CrossRef]
  • Mei J, Liu S, Jia G, Cui X, Jiang C, Ou Y. Finite element analysis of the effect of cannulated screw placement and drilling frequency on femoral neck fracture fixation. Injury. 2014;45:2045-50. [CrossRef]
  • Clark DI, Crofts CE, Saleh M. Femoral neck fracture fixation. Comparison of a sliding screw with lag screws. The Journal of bone and joint surgery British volume. 1990;72:797-800.
  • Blair B, Koval KJ, Kummer F, Zuckerman JD. Basicervical fractures of the proximal femur. A biomechanical study of 3 internal fixation techniques. Clinical orthopaedics and related research. 1994:256-63.
  • Husby T, Alho A, Ronningen H. Stability of femoral neck osteosynthesis. Comparison of fixation methods in cadavers. Acta orthopaedica Scandinavica. 1989;60:299-302.
  • Selvan VT, Oakley MJ, Rangan A, Al-Lami MK. Optimum configuration of cannulated hip screws for the fixation of intracapsular hip fractures: a biomechanical study. Injury. 2004;35:136-41.
  • Wieding J, Souffrant R, Fritsche A, Mittelmeier W, Bader R. Finite element analysis of osteosynthesis screw fixation in the bone stock: an appropriate method for automatic screw modelling. PloS one. 2012;7:e33776. [CrossRef]
  • Abdullah A AM, Alias M, Tarhan G., editor. Finite element analysis of cemented hip arthroplasty: Influence of stem tapers. International Multiconference of Engineers and Computer Scientists; 2010; Hong Kong. https://www.researchgate.net/publication/44260959
  • Yang JJ, Lin LC, Chao KH, Chuang SY, Wu CC, Yeh TT, et al. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. The Journal of bone and joint surgery American volume. 2013;95:61-9. [CrossRef]
  • Luttrell K, Beltran M, Collinge C. Pre-operative Decision-Making in the Treatment of High-Angle “Vertical” Femoral Neck Fractures in Young Adult Patients. An Expert Opinion Survey of the Orthopaedic Trauma Association’s (OTA) Membership Journal of orthopaedic trauma. 2014;28:221-5. [CrossRef]
  • Lapidus LJ, Charalampidis A, Rundgren J, Enocson A. Internal fixation of garden I and II femoral neck fractures: posterior tilt did not influence the reoperation rate in 382 consecutive hips followed for a minimum of 5 years. Journal of orthopaedic trauma. 2013;27:386-90; discussion 90-1. [CrossRef]
  • Kakar S, Little D, Einhorn TA. Can we improve fixation and outcomes in the treatment of femoral neck fractures? The use of pharmaceuticals. Journal of orthopaedic trauma. 2009;23:413-21. [CrossRef]
  • Bhandari M, Tornetta P 3rd, Hanson B, Swiontkowski MF. Optimal internal fixation for femoral neck fractures: multiple screws or sliding hip screws? Journal of orthopaedic trauma. 2009;23:403-7. [CrossRef]
  • Swiontkowski MF, Harrington RM, Keller TS, Van Patten PK. Torsion and bending analysis of internal fixation techniques for femoral neck fractures: the role of implant design and bone density. Journal of orthopaedic research: official publication of the Orthopaedic Research Society. 1987;5:433-44. [CrossRef]
  • Aminian A, Gao F, Fedoriw WW, Zhang LQ, Kalainov DM, Merk BR. Vertically oriented femoral neck fractures: mechanical analysis of four fixation techniques. Journal of orthopaedic trauma. 2007;21:544-8. [CrossRef] .

Vİda Konfİgürasyonu Femur Boyun Kırıklarının Stabİlİzasyonuna etkİ edİyor mu: Çoklu Eleman Analİzİ

Yıl 2018, Sayı: 3, 243 - 247, 01.09.2018

Okan Özkunt Kerim Sarıyılmaz Turgut Akgül Gökhan Polat Fatih Dikici

Öz

Amaç: Yüksek enerjili travma insidansındaki artış ile genç yaşlarda görülen femur boyun kırığı sayısında belirgin bir artma olmuştur. Komplikasyonlardan korunmak için, tedavide stabil internal fiksasyon ön koşuldur. Femur boyun kırıklarının cerrahi tedavisinde en sık kanule vidalar ve dinamik kalça çivileri kullanılmaktadır. Biz çalışmamızda değişik konfigurasyondaki kanule vida uygulamalarının ve dinamik kalça çivisinin stabilizasyonunu karşılaştırdık.Hastalar ve yöntemler : Çoklu eleman yazılımı ile femur boyun kırığı modellemesi yaratıldı. Ve kırık dört ayrı kanüle vida konfigirasyonu ya da dinamik kalça çivisi kullanılarak tespit edildi. Aksiyel yükleme yapılarak direnç ve dayanıklılık testleri uygulandı.Bulgular: Santral oryante kanüle vida konfigirasyonunun kırık hattında en iyi kompresyon sağlayan ve aksiyel yüklenme stresine en dayanıklı model olduğu ortaya kondu.Sonuç: Femur boyun kırıkları için santral konfigirasyonlu kanüle vida ile tespit yapılmasını önermekteyiz. Bu şekilde kırık hattında maksimum kompresyon sağlanarak, erken iyileşmeye de olanak sağlanmaktadır

Anahtar Kelimeler

Femur boyun kırığı kanüle vida dinamik kalça çivisi vida pozisyonu çoklu eleman analizi

Kaynakça

  • Pauyo T, Drager J, Albers A, Harvey EJ. Management of femoral neck fractures in the young patient: A critical analysis review. World journal of orthopedics. 2014;5:204-17. [CrossRef]
  • Johansson T, Jacobsson SA, Ivarsson I, Knutsson A, Wahlstrom O. Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips. Acta orthopaedica Scandinavica. 2000;71:597-602. [CrossRef]
  • Luttrell K, Beltran M, Collinge CA. Preoperative decision making in the treatment of high-angle “vertical” femoral neck fractures in young adult patients. An expert opinion survey of the Orthopaedic Trauma Association’s (OTA) membership. Journal of orthopaedic trauma. 2014;28:e221-5. [CrossRef]
  • Dedrick DK, Mackenzie JR, Burney RE. Complications of femoral neck fracture in young adults. The Journal of trauma. 1986;26:932-7.
  • Zhang Y, Tian L, Yan Y, Sang H, Ma Z, Jie Q, et al. Biomechanical evaluation of the expansive cannulated screw for fixation of femoral neck fractures. Injury. 2011;42:1372-6. [CrossRef]
  • Kunapuli SC, Schramski MJ, Lee AS, Popovich JM, Jr., Cholewicki J, Reeves NP, et al. Biomechanical Analysis of Augmented Plate Fixation for the treatment of Vertical Shear Femoral Neck Fractures. Journal of orthopaedic trauma. 2015;29:144-50. [CrossRef]
  • Rupprecht M, Grossterlinden L, Sellenschloh K, Hoffmann M, Puschel K, Morlock M, et al. Internal fixation of femoral neck fractures with posterior comminution: a biomechanical comparison of DHS(R) and Intertan nail(R). International orthopaedics. 2011;35:1695-701. [CrossRef]
  • Rupprecht M, Grossterlinden L, Ruecker AH, de Oliveira AN, Sellenschloh K, Nuchtern J, et al. A comparative biomechanical analysis of fixation devices for unstable femoral neck fractures: the Intertan versus cannulated screws or a dynamic hip screw. The Journal of trauma. 2011;71:625-34. [CrossRef]
  • Tsouknidas A, Anagnostidis K, Maliaris G, Michailidis N. Fracture risk in the femoral hip region: A finite element analysis supported experimental approach. Journal of biomechanics. 2012;45:1959-64. [CrossRef]
  • Mei J, Liu S, Jia G, Cui X, Jiang C, Ou Y. Finite element analysis of the effect of cannulated screw placement and drilling frequency on femoral neck fracture fixation. Injury. 2014;45:2045-50. [CrossRef]
  • Clark DI, Crofts CE, Saleh M. Femoral neck fracture fixation. Comparison of a sliding screw with lag screws. The Journal of bone and joint surgery British volume. 1990;72:797-800.
  • Blair B, Koval KJ, Kummer F, Zuckerman JD. Basicervical fractures of the proximal femur. A biomechanical study of 3 internal fixation techniques. Clinical orthopaedics and related research. 1994:256-63.
  • Husby T, Alho A, Ronningen H. Stability of femoral neck osteosynthesis. Comparison of fixation methods in cadavers. Acta orthopaedica Scandinavica. 1989;60:299-302.
  • Selvan VT, Oakley MJ, Rangan A, Al-Lami MK. Optimum configuration of cannulated hip screws for the fixation of intracapsular hip fractures: a biomechanical study. Injury. 2004;35:136-41.
  • Wieding J, Souffrant R, Fritsche A, Mittelmeier W, Bader R. Finite element analysis of osteosynthesis screw fixation in the bone stock: an appropriate method for automatic screw modelling. PloS one. 2012;7:e33776. [CrossRef]
  • Abdullah A AM, Alias M, Tarhan G., editor. Finite element analysis of cemented hip arthroplasty: Influence of stem tapers. International Multiconference of Engineers and Computer Scientists; 2010; Hong Kong. https://www.researchgate.net/publication/44260959
  • Yang JJ, Lin LC, Chao KH, Chuang SY, Wu CC, Yeh TT, et al. Risk factors for nonunion in patients with intracapsular femoral neck fractures treated with three cannulated screws placed in either a triangle or an inverted triangle configuration. The Journal of bone and joint surgery American volume. 2013;95:61-9. [CrossRef]
  • Luttrell K, Beltran M, Collinge C. Pre-operative Decision-Making in the Treatment of High-Angle “Vertical” Femoral Neck Fractures in Young Adult Patients. An Expert Opinion Survey of the Orthopaedic Trauma Association’s (OTA) Membership Journal of orthopaedic trauma. 2014;28:221-5. [CrossRef]
  • Lapidus LJ, Charalampidis A, Rundgren J, Enocson A. Internal fixation of garden I and II femoral neck fractures: posterior tilt did not influence the reoperation rate in 382 consecutive hips followed for a minimum of 5 years. Journal of orthopaedic trauma. 2013;27:386-90; discussion 90-1. [CrossRef]
  • Kakar S, Little D, Einhorn TA. Can we improve fixation and outcomes in the treatment of femoral neck fractures? The use of pharmaceuticals. Journal of orthopaedic trauma. 2009;23:413-21. [CrossRef]
  • Bhandari M, Tornetta P 3rd, Hanson B, Swiontkowski MF. Optimal internal fixation for femoral neck fractures: multiple screws or sliding hip screws? Journal of orthopaedic trauma. 2009;23:403-7. [CrossRef]
  • Swiontkowski MF, Harrington RM, Keller TS, Van Patten PK. Torsion and bending analysis of internal fixation techniques for femoral neck fractures: the role of implant design and bone density. Journal of orthopaedic research: official publication of the Orthopaedic Research Society. 1987;5:433-44. [CrossRef]
  • Aminian A, Gao F, Fedoriw WW, Zhang LQ, Kalainov DM, Merk BR. Vertically oriented femoral neck fractures: mechanical analysis of four fixation techniques. Journal of orthopaedic trauma. 2007;21:544-8. [CrossRef] .
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Research Article
Yazarlar

Okan Özkunt

Kerim Sarıyılmaz

Turgut Akgül

Gökhan Polat

Fatih Dikici

Yayımlanma Tarihi 1 Eylül 2018
Yayımlandığı Sayı Yıl 2018Sayı: 3

Kaynak Göster

EndNote Özkunt O, Sarıyılmaz K, Akgül T, Polat G, Dikici F (01 Eylül 2018) Does The Screw Orientation Effects The Stability of Femoral Neck Fracture?: a Finite Element Analysis. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 3 243–247.