ZESBO Centre for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany.
Institute of Anatomy, Leipzig University, Leipzig, Germany.
Int Biomech. 2022 Dec;9(1):27-32. doi: 10.1080/23335432.2022.2142159.
Intraoperative proximal femoral fractures (IPFF) represent a rare but challenging complication of total hip arthroplasties. They usually occur as a longitudinal split. This pilot trial aimed to compare the biomechanical primary stability of different fixation techniques for IPFF. Standardised longitudinal medial split fractures of the proximal femur (type II, Modified Mallory Classification) were created in artificial osteoporotic and non-osteoporotic composite femora after implantation of a cementless femoral stem. Five different fixation techniques were compared: cerclage band, cerclage wiring with one or two wires, and lag screw fixation with one or two lag screws. A quasi-static loading protocol was applied and failure loads were evaluated. The observed median failure loads were 4192N (3982N - 5189N) for one cerclage band, 4450N (3577N - 4927N) for one cerclage wire, 5016N (4175N - 5685N) for two cerclage wires, 6085N (5000N - 8907N) for one lag screw, and 4774N (4509N - 8502N) for two lag screws. Due to the wide range of failure loads within the experimental groups, there were no observable differences between the groups. All fixation techniques provided sufficient primary stability in osteoporotic and non-osteoporotic composite bones. Further cadaveric studies with larger sample sizes may be needed to confirm the results presented here.
术中股骨近端骨折（IPFF）是全髋关节置换术罕见但具有挑战性的并发症。它们通常呈纵向劈裂。本试验旨在比较不同固定技术治疗 IPFF 的生物力学初始稳定性。在植入非骨水泥股骨柄后，在人工骨质疏松和非骨质疏松复合股骨中创建了标准的内侧纵向股骨近端劈裂骨折（II 型，改良 Mallory 分类）。比较了 5 种不同的固定技术：环扎带、一根或两根环扎线、一根或两根拉力螺钉固定。应用准静态加载方案评估失效载荷。观察到的中位失效载荷分别为：一根环扎带 4192N（3982N-5189N），一根环扎线 4450N（3577N-4927N），两根环扎线 5016N（4175N-5685N），一根拉力螺钉 6085N（5000N-8907N），两根拉力螺钉 4774N（4509N-8502N）。由于实验各组内失效载荷范围较宽，各组之间无明显差异。所有固定技术在骨质疏松和非骨质疏松复合骨中均提供了足够的初始稳定性。可能需要进行更大样本量的进一步尸体研究来证实这里提出的结果。
