Zhu Jiajing, Du Zhipeng, Cao Changpeng, Gao Yang, Chen Xinxiao, Xing Haiyang, Wang Gang
Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.
Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.
Front Bioeng Biotechnol. 2025 Mar 12;13:1507774. doi: 10.3389/fbioe.2025.1507774. eCollection 2025.
Positive medial cortical support is a reliable fracture reduction pattern, but existing research on its use is mainly qualitative. We conducted this finite element analysis study to quantitatively evaluate the usefulness of positive cortical support for intertrochanteric fracture reduction.
Twenty-five models of intramedullary nail fixation for AO type 31-A1.2 intertrochanteric fractures subjected to different reduction patterns were established. The peak von Mises stress at the femoral fracture surface, proximal intersection of the intramedullary nail, and distal intersection of the intramedullary nail, as well as the maximum fracture displacement, were determined by finite element analysis under the three working conditions of standing, walking, and walking stairs.
As the head-neck fragment moved forward, the von Mises stress at the fracture surface, the proximal intersection point of the intramedullary nail, and the distal intersection point gradually decreased. This resulted in reduced fracture displacement, a significant decrease in trabecular bone volume, and a slight increase in the risk of screw cut-out. As the head-neck fragment moved medially, the fracture gained positive support from the medial cortex, leading to a gradual decrease in von Mises stress at the fracture surface and the proximal intersection point of the intramedullary nail, as well as reduced fracture displacement. However, the von Mises stress at the distal intersection point gradually increased.
The reduction pattern involving positive medial, anteromedial, and anterior cortical support may be an effective alternative to anatomical reduction for the treatment of difficult-to-reduce intertrochanteric fractures.
内侧皮质正性支撑是一种可靠的骨折复位模式，但现有关于其应用的研究主要是定性的。我们进行了这项有限元分析研究，以定量评估内侧皮质正性支撑在股骨转子间骨折复位中的作用。
建立了25个AO 31-A1.2型股骨转子间骨折不同复位模式的髓内钉固定模型。通过有限元分析确定在站立、行走和上楼梯三种工况下股骨骨折面、髓内钉近端交点和髓内钉远端交点处的峰值冯·米塞斯应力以及最大骨折位移。
随着头颈骨块向前移动，骨折面、髓内钉近端交点和远端交点处的冯·米塞斯应力逐渐降低。这导致骨折位移减小、小梁骨体积显著减少以及螺钉穿出风险略有增加。随着头颈骨块向内侧移动，骨折获得内侧皮质的正性支撑，导致骨折面和髓内钉近端交点处的冯·米塞斯应力逐渐降低，以及骨折位移减小。然而，远端交点处的冯·米塞斯应力逐渐增加。
涉及内侧、前内侧和前方皮质正性支撑的复位模式可能是治疗难以复位的股骨转子间骨折时解剖复位的有效替代方法。
