Inal Sermet, Gok Kadir, Gok Arif, Pinar Ahmet Murat, Inal Canan
J Am Podiatr Med Assoc. 2019 Jan;109(1):13-21. doi: 10.7547/16-112.
We sought to investigate the different configurations of Kirschner wires used in distal femur Salter-Harris (SH) type 2 epiphyseal fracture for stabilization after reduction under axial, rotational, and bending forces and to define the biomechanical effects on the epiphyseal plate and the fracture line and decide which was more advantageous.
The SH type 2 fracture was modeled using design software for four different configurations: cross, cross-parallel, parallel medial, and parallel lateral with two Kirschner wires, and computer-aided numerical analyses of the different configurations after reduction were performed using the finite element method. For each configuration, the mesh process, loading condition (axial, bending, and rotational), boundary conditions, and material models were applied in finite element software, and growth cartilage and von Mises stress values occurring around the Kirschner wire groove were calculated.
In growth cartilage, the stresses were highest in the parallel lateral configuration and lowest in the cross configuration. In Kirschner wires, the stresses were highest in the cross configuration and lowest in the cross-parallel and parallel lateral configurations. In the groove between the growth cartilage and the Kirschner wire interface, the stresses were highest in the parallel lateral configuration and lowest in the cross configuration.
The results showed that the cross configuration is advantageous in fixation. In addition, in the SH type 2 epiphyseal fracture, we believe that the fixation shape should not be applied in the lateral configuration.
我们试图研究用于股骨远端Salter-Harris（SH）2型骨骺骨折复位后在轴向、旋转和弯曲力作用下稳定的克氏针不同构型，并确定其对骨骺板和骨折线的生物力学影响，以判断哪种构型更具优势。
使用设计软件对SH 2型骨折进行四种不同构型建模：两根克氏针呈交叉、交叉平行、内侧平行和外侧平行构型，并采用有限元法对复位后的不同构型进行计算机辅助数值分析。对于每种构型，在有限元软件中应用网格划分过程、加载条件（轴向、弯曲和旋转）、边界条件和材料模型，并计算克氏针凹槽周围出现的生长软骨和冯·米塞斯应力值。
在生长软骨中，外侧平行构型的应力最高，交叉构型的应力最低。在克氏针中，交叉构型的应力最高，交叉平行和外侧平行构型的应力最低。在生长软骨与克氏针界面之间的凹槽中，外侧平行构型的应力最高，交叉构型的应力最低。
结果表明交叉构型在固定方面具有优势。此外，对于SH 2型骨骺骨折，我们认为不应采用外侧构型进行固定。
