Вiomechanical rationale for the choice of surgical tactic for treatment of distal femur fractures consolidation disturbances
Objective: to study stress-strain distribution in osteosynthesis model with non-union of distal femoral fracture and to define the most effective ways of injury fixation.
Methods: finite element model of distal femur with different length are created, which is determined by distance (3 and 10 cm) from the top edge to the fracture line of lateral condyle. To fix the fracture used: blocked intramedullary rod, LCP-plate and 95° bladed plate. The area of contact between the fragments was 50 %. To load the appropriate models applied in the natural two-limb standing and flexion of knee joint with rotatory displacement.
Results: it is revealed that for all model rotary load is critical in terms of stress in bone tissue, locking elements and structures in general and displacement of fragments of bones. In a case of fracture localization in the epiphyseal part of the femur, safer fixation of short distal fragment provides LCP-plate, so it should be used in such cases. Given the non-union location in the distal diaphyses of the femur bone stress are smallest and largest system stability «bone – fixation device» to load strains provides model with blocked intramedullar nail. Therefore, for fixation of fracture consolidation problems in the distal femur blocked nail is recommend.Conclusions:the obtained results allow to justify the method of surgical treatment of patients with impaired consolidation of the distal femur fracture, ie. to select fixation device depending on the injury level and the length of distal fragment.
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Agapov VP. The finite element method in statics, dynamics and stability of the spatial thin-slab structure: a tutorial. Moskow: АСВ, 2000. 152 p. (in Russian)
Golka GG, Bilostotskyi AI, Lytovchenko VA, Palamarchuk VV, Garjachiy YeV, Grigoruk VV, Golka TG. Analysis of surgical treatment of distal femur fractures. Vysnyk ortopedii travmatologii i hrotezuvannya. 2011;(1):36–40. (in Russian)
Gayko GV, Kalashnikov AV, Boyer VA. Analysis of structure of the primary disability and factors of its formation in trauma limbs in a big city: Proceedings of scientific and practice meeting “Medical and social expertise and rehabilitation of patients as a result of injuries and diseases of the locomotion system”. Dnipropetrovsk: Porogi, 2008: 23–4. (in Ukrainian)
Berezovsky VA, Kolotilov NN. Biophysical properties of human tissues: reference book. Kyiv: Naukova dumka, 1990. 224 p. (in Russian)
Borzunov D, Mitrofnov A, Kolchev O. Using transosseous and blocked intramedullary osteosynthesis in the treatment of patients with consequences of long bone fractures. Osteosynthesis. 2010;(1):15–7. (in Russian)
Buachidze OSh, Onoprienko GA, Zubikov VS. Stable osteosynthesis using plates in the treatment of the effects of distal femur damages. Orthopaedics, Traumatology and Prosthetics. 1986;(1):41–3. (in Russian)
Vygovskii NV. Surgical treatment of patients with distal femur fractures. The thesis abstract on a scientific degree of PhD of medical sci. Novosibirsk, 2000. 20 p. (in Russian)
Zienkiewicz OC, Morgan K. Finite elements and approximation. Courier Corporation, 2006. 338 p.
Zubikov VS. Osteosynthesis using metal plates in the treatment of the effects of juxta-articular and intraarticular fractures of femur and tibia. Khirurgia. 1986;(10):110–2. (in Russian)
Golka G, Bilostotskiy A, Subbota I, Sukhoveckiy V, Fadeyev O. Study of the strained-deformed state of a nonunion fracture model of the distal femoral metaepiphysis in different variants of its fixation. Orthopaedics, Traumatology and Prosthetics. 2011;(4):72–80. doi: 10.15674/0030-59872011472-80. (in Russian)
Golka G, Bilostotskiy A, Karpinskiy M, Karpinskaya Ie. Study of bone density in nonunion area using X-Ray method: abstracts book of scientific and practice meeting “Current researches in orthopedics and traumatology”. Kharjkiv, 2011:70–1. (in Russian)
Litvinov II, Kliuchevskii VV. Classification criteria and the results of internal fixation of closed diaphyseal femoral fractures type A and B (AO). Reporter of Traumatology and Orthopedics named Priorov. 2005;(4):14–9. (in Russian)
Melnichenko SYu. Surgical treatment of distal femur fractures. Thesis of PhD in orthopedics and traumatology. Moscow, 2008. 20 p. (in Russian)
Norrie DH, De Vries G. An introduction to finite element analysis. London: Academic Press, 1978. 301 p.
Rolik AV, Zasadniuk IA. Nonunion of long bones (analysis, risk factors, treatment tactics). Orthopaedics, Traumatology and Prosthetics. 2005;(2):61–4. (in Ukrainian)
Romanenko K. Diaphyseal nonunion of long bone (risk factors, diagnosis and treatment). The thesis abstract on a scientific degree of PhD in medical sci. Kharkiv, 2002. 19 p. (in Ukrainian)
Romanenko K, Belostotsky A, Prozorovsky D, Golka G. Functions and kinds of plates and screws in modern osteosynthesis. Orthopaedics, Traumatology and Prosthetics. 2010;(1):68–75. doi: 10.15674/0030-59872010168-75. (in Russian)
Bellabarba C, Ricci WM, Bolhofner BR. Indirect reduction and plating of distal femoral nonunions. J Orthop Trauma. 2002;16(5):287–96.
Toni A, Fabbri F, Scimeca GB, et al. Computerized morphometric analysis of the femoral diaphyseal canal. Chir Organi Mov. 1995;80(2):207–19.
Chan DB, Jeffcoat DM, Lorich DG, Helfet DL. Nonunions around the knee joint. Int. Orthop. 2010;34(2):271–81. DOI: 10.1007/s00264-009-0924-9.
Gardner MJ, Toro-Arbelaez JB, Harrison M, Hierholzer C, Lorich DG, Helfet DL. Open reduction and internal fixation of distal femoral nonunions: long-term functional outcomes following a treatment protocol. J Trauma. 2008;64(2):434–8. DOI: 10.1097/01.ta.0000245974.46709.2e.
Rosen H. Treatment of nonunions: general principles. Operative Orthopaedics. M. Chapman. 2nd ed. J. B. Lippincott Company, 1993. рр. 749–69.
Velle DL. Delayed union and nonunion of fractures. Campbelle’s Operative Orthopaedics. 1999;3:2579–83.
Wang JW, Weng LH. Treatment of distal femoral nonunion with internal fixation, cortical allograft struts, and autogenous bone-grafting. J Bone Joint Surg. Am. 2003;85-A(3):436–40.
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