Aragón Health Research Institute, Zaragoza, Spain; Department of Surgery, University of Zaragoza, Zaragoza, Spain.
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.
Injury. 2020 Apr;51 Suppl 1:S80-S88. doi: 10.1016/j.injury.2020.02.010. Epub 2020 Feb 10.
Supracondylar femoral fractures account for a noticeable percentage of the femoral shaft fractures, affecting two etiological groups: high energy trauma in young men, with good bone quality, and older women with osteoporotic femur. Surgical treatment of those kind of fractures remains controversial, with different surgical options such as plate and sliding barrel locking condylar plate, less invasive stabilization system (LISS) or intramedullary nailing, which has emerged as a new fixation choice in the treatment of that type of fractures. The present work performs a comparative study about the biomechanical behavior of anterograde and retrograde nailing in supracondylar femoral fractures type A, in order to determine the best choice of nailing and locking configuration. A three-dimensional finite element model of the femur was developed, modeling femoral supracondylar fracture and different nailing configurations, both for anterograde and retrograde nails. The study was focused on the immediately post-operative stage, verifying the appropriate stability of the osteosynthesis. The obtained results show a better biomechanical behavior for anterograde nails, providing a better stability from the point of view of global movements, lower stresses in screws, and less stress concentration in cortical bone. So, for the analyzed fractures and osteosyntheses types, anterograde nailing has demonstrated to be a better surgical option, being an excellent indication in supracondylar fractures of femur, with clear benefits compared to retrograde nailing, providing a better stabilization which enables for a more satisfactory fracture healing.
股骨干骨折占股骨骨折的相当大比例，影响两个病因学群体：年轻男性的高能创伤，骨质量良好，以及骨质疏松股骨的老年女性。这些类型骨折的手术治疗仍然存在争议，有不同的手术选择，如钢板和滑动桶锁定髁钢板、微创稳定系统（LISS）或髓内钉，髓内钉已成为治疗这类骨折的新固定选择。本工作对 A 型股骨髁上骨折顺行和逆行髓内钉的生物力学行为进行了比较研究，以确定髓内钉和锁定配置的最佳选择。建立了股骨的三维有限元模型，模拟股骨髁上骨折和不同的髓内钉配置，包括顺行和逆行钉。研究集中在术后即刻阶段，验证了骨合成的适当稳定性。得到的结果表明，顺行钉具有更好的生物力学行为，从整体运动的角度提供更好的稳定性，螺钉的应力更低，皮质骨的应力集中更小。因此，对于分析的骨折和骨合成类型，顺行髓内钉已被证明是一种更好的手术选择，是股骨髁上骨折的明确适应证，与逆行髓内钉相比具有明显优势，提供更好的稳定性，从而实现更满意的骨折愈合。
