Srivastav Ayush, Behera Prateek, Dwivedi Ravi Kumar, Santoshi John Ashutosh
Department of Mechanical Engineering, Maulana Azad National Institute of Technology, Bhopal, India.
Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, India.
Indian J Orthop. 2024 Apr 28;58(6):785-793. doi: 10.1007/s43465-024-01156-w. eCollection 2024 Jun.
BACKGROUND AND PURPOSE: Scaphoid waist fractures are often stabilised with compression screws, Kirschner wires (K-wires), or a combination of both. While clinical and bio-mechanical studies evaluating their utility are available, the ideal configuration of implant that would provide adequate stability to permit early use of the hand is debatable. We examined configurations of a single screw, one screw along with a K-wire, and two K-wires used for a transverse scaphoid waist fracture fixation aiming to assess the stability provided by each in the immediate postoperative period. METHODS: Computer-aided design (CAD) models of the scaphoid, K-wire, and headless compression screw were created. A transverse fracture was created at the scaphoid waist, and the CAD models of the screw and K-wire were used to fix the fracture in different configurations in a distal to proximal direction. Finite Element Analysis (FEA) was used to examine the strength of configurations when they were subjected to compression and distraction forces. The total maximum deformation (TDef) and factor of safety (FoS) for each configuration were calculated and used as indirect indicators of postoperative stability. RESULTS: When a single screw was used, the configurations with the screw directed posteriorly from either centre or anterior had the best combined TDef and FoS values. For one screw and one K-wire, the configuration with screw and K-wire parallel to each other with the screw located along the long axis in the AP projection and anterior to the K-wire in the lateral projection had the best combined TDef and FoS values. When using two K-wires, configurations with the two wires diverging proximally on the lateral projection had the best combined TDef and FoS values. CONCLUSIONS: When fixing a transverse scaphoid waist fracture with a single screw, the screw directed posteriorly from either the centre or anterior aspect of the distal pole has the best stability, a parallel configuration has the best stability when fixing it using a screw and a K-wire, and divergent configuration has the best stability when fixing it with two K-wires only.
背景与目的:舟状骨腰部骨折通常采用加压螺钉、克氏针(K 针)或两者结合的方式进行固定。虽然有评估其效用的临床和生物力学研究,但能提供足够稳定性以允许早期使用手部的理想植入物配置仍存在争议。我们研究了用于横行舟状骨腰部骨折固定的单枚螺钉、一枚螺钉加一根 K 针以及两根 K 针的配置,旨在评估每种配置在术后即刻提供的稳定性。 方法:创建了舟状骨、K 针和无头加压螺钉的计算机辅助设计(CAD)模型。在舟状骨腰部制造横行骨折,然后使用螺钉和 K 针的 CAD 模型以从远到近的方向以不同配置固定骨折。使用有限元分析(FEA)来检查这些配置在承受压缩和牵张力时的强度。计算每种配置的总最大变形(TDef)和安全系数(FoS),并将其用作术后稳定性的间接指标。 结果:使用单枚螺钉时,螺钉从中心或前方朝后方的配置具有最佳的综合 TDef 和 FoS 值。对于一枚螺钉加一根 K 针,螺钉和 K 针相互平行且螺钉在前后位投影中沿长轴位于 K 针前方、在侧位投影中位于 K 针前方的配置具有最佳的综合 TDef 和 FoS 值。使用两根 K 针时,两根针在侧位投影中向近端发散的配置具有最佳的综合 TDef 和 FoS 值。 结论:用单枚螺钉固定横行舟状骨腰部骨折时,从远极中心或前方朝后方的螺钉稳定性最佳;使用螺钉和 K 针固定时,平行配置稳定性最佳;仅用两根 K 针固定时,发散配置稳定性最佳。
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