Nag Pratik, Borgohain Bhaskar, Chanda Souptick
Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, 781039 Assam India.
Department of Orthopaedics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, 793018 Meghalaya India.
Indian J Orthop. 2021 May 5;55(Suppl 2):385-394. doi: 10.1007/s43465-021-00408-3. eCollection 2021 Jul.
Hip fractures account for a large proportion of hospitalization among the trauma cases. Low cost, simple technique, easy removal, and high rate of the bone union makes extramedullary (EM) fixation techniques a preferred choice. A close-fit bone and plate are essential for the success of such implantation. Various studies have found femur morphometry being related to regional features and social differences. Most of the available commercial implants are developed based on the data of the Caucasian population.
In the herein study, a novel design, Double Oblique Device for Osteosynthesis of hip (DODO), is proposed while considering the regional morphometry of the Northeast (NE) population of India. This study employs finite element (FE) analysis to compare the biomechanical outcome of the new device with that of proximal femoral locking plate (PFLP) and variable angle dynamic hip screw (VA-DHS) on a femur having an Evans type-I intertrochanteric fracture.
The stress shielding was substantially high for the PFLP and VA-DHS in the distal bone fragment (lateral aspect) and for DODO in the femoral head. The difference in axial displacement between the post-implanted DODO-fixed femur and its respective intact femur was predicted to be almost the same as that of PFLP-fixed femur and its respective intact femur.
The computational results found the new device to be a viable alternative to the conventional plating techniques, especially for the NE population of India, and predicted better to comparable biomechanical characteristics.
髋部骨折在创伤病例的住院治疗中占很大比例。髓外(EM)固定技术因其成本低、技术简单、易于取出且骨愈合率高,成为首选。紧密贴合的骨骼和钢板是此类植入成功的关键。多项研究发现股骨形态测量与区域特征和社会差异有关。大多数现有的商业植入物是基于白种人群的数据开发的。
在本研究中,考虑到印度东北部(NE)人群的区域形态测量,提出了一种新颖的设计——髋部骨合成双斜装置(DODO)。本研究采用有限元(FE)分析,在具有Evans I型转子间骨折的股骨上,比较新装置与股骨近端锁定钢板(PFLP)和变角度动力髋螺钉(VA-DHS)的生物力学结果。
PFLP和VA-DHS在远端骨块(外侧)的应力遮挡显著较高,而DODO在股骨头的应力遮挡较高。植入DODO固定的股骨与其相应完整股骨之间的轴向位移差异预计与PFLP固定的股骨与其相应完整股骨之间的轴向位移差异几乎相同。
计算结果表明,新装置是传统钢板技术的可行替代方案,特别是对于印度的NE人群,并预测其生物力学特性更好或相当。