Gauthier Paul, Slullitel Pablo A, Speirs Andrew, Laude Frederic, Gofton Wade T, Beaule Paul E
University of Ottawa, Division of Orthopaedic Surgery, Ottawa, Ontario, Canada.
Hospital Italiano de Buenos Aires, Department of Orthopaedic Surgery, Buenos Aires, Argentina.
Clin Biomech (Bristol). 2023 Jan;101:105848. doi: 10.1016/j.clinbiomech.2022.105848. Epub 2022 Dec 5.
During primary total hip arthroplasty, intra-operative calcar fractures have been historically treated with cerclage wires. However, interfragmentary screw fixation technique can possibly achieve the same results with technical advantages. The aim of this biomechanical study was to assess stability of calcar fractures fixed using interfragmentary screw technique compared to a traditional cerclage system specifically in context of total hip arthroplasty.
Thirty-two periprosthetic fractures were reduced using either a single cerclage cable or an intracortical positional screw perpendicular to the fracture line. Axial and torsional load testing was terminated after experimental model failure.
No significant difference was obtained for all output parameters when comparing cerclage wires versus interfragmentary screw fixation respectively. Load at failure: 8043 ± 712 N vs 7425 ± 854 N (p = 0.115). Load at calcar fracture propagation: 6240 ± 2207 N versus 6220 ± 966 N (p = 0.668). Maximum stiffness before failure: 617 ± 115 N/mm vs 839 ± 175 N/mm (p = 0.100) and stiffness at calcar fracture propagation reached 771 ± 153 Nmm vs 886 ± 129 N/mm (p = 0.197). Torque to failure levels obtained were 59.4 ± 7.1 Nm vs 60.9 ± 12.0 Nm (p = 0.908). Torque to calcar fracture propagation, 51.6 ± 6.1 Nm vs 48.5 ± 9.8 Nm (p = 0.298). Torsional stiffness at failure, 0.38 ± 0.03 Nm\deg. vs 0.43 ± 0.13 Nm\deg. (p = 0.465). Torsional stiffness at calcar fracture propagation were 0.37 ± 0.03 Nm\deg. vs 0.45 ± 0.17 Nm\deg. (p = 0.462).
The strength of fixation and stability of the implant were similar for both techniques. In the synthetic bone model tested, using an interfragmentary screw conveyed similar stability to the constructs in the management of an intra-operative medial calcar fractures. Thus, potentially giving surgeons an alternative option for intraoperative fracture fixation during primary total hip arthroplasty.
在初次全髋关节置换术中，术中股骨距骨折历来采用环扎钢丝进行治疗。然而，骨折块间螺钉固定技术可能会取得相同的效果，且具有技术优势。本生物力学研究的目的是评估与传统环扎系统相比，使用骨折块间螺钉技术固定股骨距骨折的稳定性，尤其是在全髋关节置换的背景下。
32例假体周围骨折分别采用单根环扎缆线或垂直于骨折线的皮质内定位螺钉进行复位。在实验模型失效后终止轴向和扭转负荷测试。
分别比较环扎钢丝与骨折块间螺钉固定时，所有输出参数均无显著差异。失效负荷：8043±712N对7425±854N（p = 0.115）。股骨距骨折扩展时的负荷：6240±2207N对6220±966N（p = 0.668）。失效前的最大刚度：617±115N/mm对839±175N/mm（p = 0.100），股骨距骨折扩展时的刚度达到771±153N/mm对886±129N/mm（p = 0.197）。失效时的扭矩水平为59.4±7.1N·m对60.9±12.0N·m（p = 0.908）。股骨距骨折扩展时的扭矩：51.6±6.1N·m对48.5±9.8N·m（p = 0.298）。失效时的扭转刚度：0.38±0.03N·m/°对0.43±0.13N·m/°（p = 0.465）。股骨距骨折扩展时的扭转刚度为0.37±0.03N·m/°对0.45±0.17N·m/°（p = 0.462）。
两种技术的固定强度和植入物稳定性相似。在测试的合成骨模型中，使用骨折块间螺钉在处理术中内侧股骨距骨折时，为构建物传递了相似的稳定性。因此，这可能为初次全髋关节置换术中的术中骨折固定提供了另一种选择。
