Yozgat Bozok University Faculty of Medicine, Department of Orthopedics and Traumatology, Yozgat, Turkey.
Yozgat Bozok University Faculty of Medicine, Department of Orthopedics and Traumatology, Yozgat, Turkey.
Orthop Traumatol Surg Res. 2021 May;107(3):102804. doi: 10.1016/j.otsr.2021.102804. Epub 2021 Jan 11.
Cephalomedullary nails are tools commonly used for surgical fixation in proximal femoral fractures. The most common complications in their use are varus collapse and screw cutout of the femoral head. The objective of this study is to examine the effects of intramedullary nail movement on varus collapse and screw cutout.
The study was conducted on 70 composite femur models treated with PFNA. We divided the femurs into 4 groups based on the differences in nail diameter, fracture type and filling of the distal intramedullary area. All femurs were exposed to axial cyclic loading. Each femur was examined in terms of intramedullary nail movement and amount of erosions in femoral medulla [amount of erosion in femoral head (FT distance), amount of erosion in femoral neck (FB distance), amount of erosion in trochanteric major (TB distance) and expansion of trochanter tip (TT distance)].
We found that degree of nail movement in the intramedullary region was inversely correlated with nail diameter and directly correlated with instability of fracture. One of the parameters used to evaluate varus development, FB distance, was affected by the degree of intramedullary nail movement and fracture type. TB distance was affected by nail diameter.
Nail diameter and fracture type are effective in intramedullary nail movement. Varus collapse progress is accelerated by the increase in nail movement in the intramedullary region. Thus, we conclude that it is important to strengthen diaphyseal adherence, which decreases intramedullary movement of the nail.
III; well-design case control study.
股骨近端髓内钉是用于股骨近端骨折手术固定的常用工具。其使用过程中最常见的并发症为内翻塌陷和股骨头螺钉切出。本研究旨在研究髓内钉运动对内翻塌陷和螺钉切出的影响。
本研究对 70 例接受 PFNA 治疗的复合股骨模型进行了研究。我们根据髓内钉直径、骨折类型和远端髓腔填充的差异将股骨分为 4 组。所有股骨均暴露于轴向循环加载下。检查每根股骨的髓内钉运动和股骨骨髓侵蚀程度[股骨头侵蚀量（FT 距离）、股骨颈侵蚀量（FB 距离）、大转子主要部侵蚀量（TB 距离）和转子尖端扩张量（TT 距离）]。
我们发现，髓内区域钉的运动程度与钉直径呈负相关，与骨折的不稳定性呈正相关。评估内翻发展程度的参数之一 FB 距离受髓内钉运动程度和骨折类型的影响。TB 距离受髓内钉直径的影响。
髓内钉直径和骨折类型对内固定钉的运动有影响。髓内钉运动增加会加速内翻塌陷的进展。因此，我们得出结论，加强骨干附着，减少髓内钉的运动，这一点很重要。
III；精心设计的病例对照研究。
