Dynamic hip screw and Gamma nail fixation repair unstable intertrochanteric fracture: a three-dimensional finite element analysis

doi:10.3969/j.issn.2095-4344.2015.53.013

Abstract

Abstract:

BACKGROUND: For unstable intertrochanteric fracture repair, there are two views: extramedullary fixation or intramedullary fixation. Theoretically, intramedullary fixation is in line with the principles of minimally invasive, more mechanical and biological advantages. However, evidence-based medicine and related studies have shown that compared with the extramedullary fixation, intramedullary fixation did not reflect the proper theoretical advantage.

OBJECTIVE: To compare the biomechanical performance of two kinds of internal fixation systems: dynamic hip screw and Gamma nail which commonly used in repair of intertrochanteric fractures by finite element method, and to evaluate the advantages and disadvantages of dynamic hip screw and Gamma nail in treatment of unstable intertrochanteric fracture.

METHODS: Three-dimensional finite element model of human femur unstable intertrochanteric fractures (31-A2; AO fracture classification), and the three-dimensional finite element models of dynamic hip screw and Gamma nail were established respectively, and were fixed according to the requirement of orthopedic surgery. The reference load which the joint bearing was at the peak time in adult step state period with the body mass of 700 N was stimulated. The stress distribution of bone, bone-internal fixation model, nail or screw, the strain and deformation of fracture location on the surface of the bone and bone-internal fixation model, the stress distribution along the femur and the loading transfer condition along the internal fixator and the like were analyzed.

RESULTS AND CONCLUSION: Dynamic hip screw and Gamma nail have good sliding compression features which could make the continuous and dynamically axial compression of the fractured section. Under the load conditions, the displacement value of dynamic hip screw was larger. In the treatment of unstable intertrochanteric fracture, Gamma nail was stronger than dynamic hip screw. Two kinds of internal fixations all make the bearing load of the proximal femur reduce. In the treatment of 31-A2 type unstable intertrochanteric fractures, we should choose dynamic hip screw for fixation if the femoral calcar was not seriously crushed, little defect or no defects and can immediately rebuild the stability of femoral calcar during operation, otherwise, stronger internal fixation, namely Gamma nail fixation should be chosen.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

CLC Number:

R318

Huang Xiao-wei, Yu Bao-qing, Li Ze-xiang, Ao Rong-guang. Dynamic hip screw and Gamma nail fixation repair unstable intertrochanteric fracture: a three-dimensional finite element analysis[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(53): 8603-8608.

Figures/Tables 5

References

[1] Kukia, Heinz T, Berger G. Gamma nail versus DHS in 120 patients over 60 years: a randomized tiral. Read at the Annual Meeting of the orthopaedic Trauma Asssociation, Vancouver, BC, Canada. 1998.

[2] Avila MA, Pereira GJ, Bocchi SC.Informal caregivers of older people recovering surgery for hip fractures caused by a fall: fall prevention. Cien Saude Colet. 2015;20(6):1901-1907.

[3] Bae KC, Cho CH, Lee KJ,et al. Bilateral medial tibial plateau fracture after arthroscopic anterior cruciate ligment reconstruction. Knee Surg Relat Res. 2015;27(2):129-132.

[4] Yoon RS, Liporace FA, Egol KA. Definitive fixation of tibial plateau fractures. Orthop Clin North Am. 2015;46(3):363-375.

[5] Cosenza G, Reif U, Martini FM.Tibial plateau levelling osteotomy in 69 small breed dogs using conically coupled 1.9/2.5 mm locking plates. A clinical and radiographic retrospective assessment. Vet Comp Orthop Traumatol. 2015.[Epub ahead of print]

[6] Çeçen GS, Gülabi D, Pehlivano?lu G, et al. The impact of obesity on teh outcomes of the patients operated on due to Schatzker type I and type II tibial plateau fractures. Ulus Travma Acil Cerrahi Derg. 2015;21(3): 209-215.

[7] Elsoe R, Larsen P, Shekhrajka N, et al.The outcome after lateral tibial plateau fracture treated with percutaneous screw fixation show a tendency towards worse functional outcome compared with a reference population. Eur J Trauma Emerg Surg.2015.[Epub ahead of print]

[8] Su L, Townsend KL, Au J, et al. Comparison of tibial plateau angles in small and large breed dogs. Can Vet J. 2015; 56(6): 610-614.

[9] Luitse J, Dunki J, Van der Hart CP. The dynamic hip screw “Goleden standard” in the treatment of pertorchanteric fractures. In: Marti RK, Dunki Jacobs, PB, editors. Proximal femoral fractures. Operative techniques and complications, vol, 2. London: ED. Medical Press; 1993: 409-422.

[10] Parker MJ, Handoll H. Extramedullary fixation implants and external fixators for estracapsular hip fractures. Cochrane Database of Systematic Reviews, 2014.

[11] Parker MJ, Tripuraneni G, McGreggor-Riley J. Osteotomy, compression and reaming techniques for internal fixation of extracapsular hip fractures. Cochrane Database Syst Rev. 2001;(3):CD000522.

[12] Aune AK, Ekeland A, Odegaard B. Gamma nail vs compression screw for trochanteric femoral fractures: 15 reoperations in a prospective, randomised study of 378 patients. Acta Orthop Scand. 1994;65: 127-130.

[13] Bridle SH, Pstel AD, Bircher M. Fixation of intertrochanteric fractures of the femur: a randomised prospective comparison of the Gamma nail and dynamic hip screw. J Bone Joint Surg Br. 1991; 73:330-334.

[14] Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the Gamma locking nail. J Bone Joint Surg Br. 1993;75: 789-793.

[15] Williams WW, Parker BC. Complications associated with the use of the Gamma nail. Injury. 1992;23:291-292.

[16] Christopher I, Adams C, Robinson M, et al. Prospective randomised controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur. J Orthop Trauma. 2001;15(6):394-400.

[17] Ahrengart L, Tornkvist H, Fornander P. A randomized study of the compressing hip screw and Gamma nail in 426 fractures. Clin Orthop. 2012; 401: 209-222.

[18] Sitthiseripratip K, Van Oosterwyck H, Vandar Sloten J. Finite element study of trochanteric Gamma nail for trochanteric fracture. Med Eng Phys. 2013;25:99-106.

[19] Taylor ME, Tanner KE, Freeman M. Stress and strain distribution within the intact femur: compression or bending? Med Eng Phys. 1997;2:122-131.

[20] Bermann G, Graichen F, Rohlmann A. Hip joint loading during walking and running, measured in two patients. J Biomech. 1993;26:969-990.

[21] Shahar R,Banks-Sills L, Eliasy R. Stress and strain distribution in the intact canine femur: finite element analysis. Med Eng Phys. 2003;25:387-395.