Lorkowski Jacek, Pokorski Mieczyslaw
Department of Orthopedics, Traumatology, and Sports Medicine, Central Clinical Hospital of the Ministry of the Internal Affairs and Administration, 137 Woloska Street, 02-507 Warsaw, Poland.
Institute of Health Sciences, Opole University, 68 Katowicka Street, 45-060 Opole, Poland.
J Clin Med. 2022 Mar 28;11(7):1885. doi: 10.3390/jcm11071885.
A stabilization method of pertrochanteric femur fractures is a contentious issue. Here, we assess the feasibility of rapid in silico 2D finite element modeling (FEM) to predict the distribution of stresses arising during the two most often used stabilization methods: gamma nail fixation (GNF) and dynamic hip screw (DHS). The modeling was based on standard pre-surgery radiographs of hip joints of 15 patients with pertrochanteric fractures of type A1, A2, and A3 according to the AO/OTA classification. The FEM showed that the stresses were similar for both GNF and DHS, with the medians ranging between 53-60 MPa and consistently lower for A1 than A3 fractures. Stresses also appeared in the fixation materials being about two-fold higher for GNF. Given similar bone stresses caused by both GNF and DHS but shorter surgery time, less extensive dissection, and faster patient mobilization, we submit that the GNF stabilization appears to be the most optimal system for pertrochanteric fractures. In silico FEM appears a viable perioperative method that helps predict the distribution of compressive stresses after osteosynthesis of pertrochanteric fractures. The promptness of modeling fits well into the rigid time framework of hip fracture surgery and may help optimize the fixation procedure for the best outcome. The study extends the use of FEM in complex orthopedic management. However, further datasets are required to firmly position the FEM in the treatment of pertrochanteric fractures.
股骨转子间骨折的稳定方法是一个有争议的问题。在此，我们评估快速计算机二维有限元建模（FEM）预测两种最常用稳定方法（伽马钉固定（GNF）和动力髋螺钉（DHS））过程中产生的应力分布的可行性。建模基于15例根据AO/OTA分类为A1、A2和A3型转子间骨折患者髋关节的标准术前X光片。有限元模型显示，GNF和DHS的应力相似，中位数在53 - 60兆帕之间，A1型骨折的应力始终低于A3型骨折。固定材料中也出现应力，GNF的应力约高两倍。鉴于GNF和DHS引起的骨应力相似，但手术时间更短、解剖范围更小且患者活动更快，我们认为GNF稳定似乎是转子间骨折最理想的系统。计算机有限元建模似乎是一种可行的围手术期方法，有助于预测转子间骨折骨合成后压应力的分布。建模的及时性非常适合髋部骨折手术严格的时间框架，并可能有助于优化固定程序以获得最佳结果。该研究扩展了有限元模型在复杂骨科治疗中的应用。然而，需要更多数据集才能将有限元模型在转子间骨折治疗中准确定位。
