Park Kyeong-Hyeon, Oh Chang-Wug, Kim Joon-Woo, Kim Hee-Jun, Kim Dong-Hyun, Lee Jin-Han, Hong Won-Ki, Oh Jong-Keon
Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Jung-gu, Daegu 41944, Republic of Korea.
Department of Orthopedic Surgery, School of Medicine, Korea University Guro Hospital, Seoul 10408, Republic of Korea.
J Clin Med. 2023 Jan 3;12(1):383. doi: 10.3390/jcm12010383.
Intramedullary nailing (IMN) is a popular treatment for elderly patients with femoral shaft fractures. Recently, prophylactic neck fixation has been increasingly used to prevent proximal femoral fractures during IMN. Therefore, this study aimed to investigate the biomechanical strength of prophylactic neck fixation in osteoporotic femoral fractures. An osteoporotic femur model was created to simulate the union of femoral shaft fractures with IMN. Two study groups comprising six specimens each were created for IMN with two standard proximal locking screws (SN group) and IMN with two reconstruction proximal locking screws (RN group). Axial loading was conducted to measure the stiffness, load-to-failure, and failure modes. There were no statistically significant differences in stiffness between the two groups. However, the load-to-failure in the RN group was significantly higher than that in the SN group (p < 0.05). Femoral neck fractures occurred in all specimens in the SN group. Five constructs in the RN group showed subtrochanteric fractures without femoral neck fractures. However, one construct was observed in both subtrochanteric and femoral neck fractures. Therefore, prophylactic neck fixation may be considered an alternative biomechanical solution to prevent proximal femoral fractures when performing IMN for osteoporotic femoral fractures.
髓内钉固定术（IMN）是治疗老年股骨干骨折的常用方法。近年来，预防性颈固定越来越多地用于预防IMN期间的股骨近端骨折。因此，本研究旨在探讨骨质疏松性股骨骨折中预防性颈固定的生物力学强度。建立骨质疏松性股骨模型以模拟IMN治疗股骨干骨折的愈合情况。创建了两个研究组，每组六个标本，分别为使用两颗标准近端锁定螺钉的IMN（SN组）和使用两颗重建近端锁定螺钉的IMN（RN组）。进行轴向加载以测量刚度、失效载荷和失效模式。两组之间的刚度无统计学显著差异。然而，RN组的失效载荷显著高于SN组（p < 0.05）。SN组所有标本均发生股骨颈骨折。RN组有五个结构出现转子下骨折但无股骨颈骨折。然而，有一个结构同时出现了转子下和股骨颈骨折。因此，在对骨质疏松性股骨骨折进行IMN时，预防性颈固定可被视为预防股骨近端骨折的一种生物力学替代方案。
