Introduction: Three different methods are described in the literature for the evaluation of carpal collapse. Measurements of carpal collapse by different people may affect the results. We aimed to investigate the inter and intraobserver reliability of three different methods used in carpal height measurement and to review the reference ranges for each method in healthy individuals. Methods: 179 wrist radiographs were evaluated by an orthopedist and a radiologist. Two observers made their evaluations independently of each other and unaware of each other's measurement results. They measured the carpal height ratio, the revised carpal height ratio, and the distance between the capitate-radius on each radiograph. One month later, all radiographs were reevaluated by two observers. Results: Results were analyzed by calculating the intraclass correlation coefficient. All methods had very high reproducibility. Interobserver reliability of the CH and RCH ratios were similar, and both had higher interobserver reliability scores than the CR index. In intraobserver reliability, the score of the CH ratio was higher in all measurements, and the lowest score was in the CR index. However, there was no statistical difference between the three methods in terms of inter- and intraobserver reliability. Conclusion: All three methods can be used in cases where the healthy extremity is desired to be used as a reference point in the evaluation of carpal height. Although the reliability scores of the CH ratio were found to be higher in this study, the practitioner can choose the desired method by evaluating the advantages and disadvantages of each method.
ÖzAmaç: Çalışmanın amacı femur üst uç kırığı olan yaşlı hastaların genel durumlarının büyük cerrahiye izin vermediği durumlarda kullanılan Modüler Aksiyel Fiksatör'ün biyomekanik özelliklerinin belirlenmesi ve çıkan sonuçlara göre yapılacak değişiklikler ile stabilizasyonunun artırılması ve standardizasyonunun sağlanmasıdır. Gereç ve Yöntemler: Bu amaçla birinci aşaması sonlu eleman analizi, ikinci aşaması laboratuvar çalışması olmak üzere iki aşamalı çalışma planlandı. Sonlu eleman analizinde, eksternal fiksatörlerde stabiliteyi etkileyen faktörler göz önüne alınarak Modüler Aksiyel Fiksatör'ün 14 değişik konfigürasyonu ve Orthofix üzerinde çalışıldı. Laboratuvar ortamında ise sanal ortamda elde edilen verilere göre Modüler Aksiyel Fiksatör'ün 4 farklı konfigürasyonu ve Orthofix üzerinde aksiyel yükleme yapılarak modellerin stabiliteleri, yük taşıma kapasiteleri, kırık hattına etkiyen yük miktarları ve rijiditeleri değerlendirildi. Bulgular: Elde edilen verilerin değerlendirilmesi; femur üst uç kırıklarında kullanılan eksternal fiksasyonun, biyomekanik açıdan alternatif bir tedavi şeklinden çok standart bir tedavi şekli olarak kullanılabileceğini ve mevcut sistemler üzerinde yapılacak modifikasyonlar ile anstabil kırıklarda da güvenilir bir yöntem olabileceğini ortaya koymaktadır. Sonuç: Normal kemikteki streslerle karşılaştırıldığında femur üst ucuna eksternal fiksatör uygulanması, fizyolojik yük dağılımını bozmaksızın femur boyunca oluşan stresleri, yükün önemli bir bölümünü distale aktararak azaltmaktadır. Yine fonksiyonel çivi boyunun kısaltılması, bar uzunluğunun azaltılması, her fragmanda daha fazla çivi bulundurulması ve distal çivilerin kırık hattına yakın yerleştirilmesi hem stresleri azaltmakta hem de stabiliteyi artırmaktadır. Anahtar Sözcükler: Eksternal fiksasyon, Kırık, Femur, Sonlu eleman analizi AbstrActObjective: In the present study, Modular Axial Fixator, which haspromising clinical outcomes, was analysed by finite element analysis to clarify and standardize its biomechanical properties. Material and Methods: During the finite element analysis carried on, 14 different Modular Axial Fixators and Orthofix were first evaluated, considering the factors influencing external fixator stability. Secondly, in the laboratory study, axial loading tests were conducted on the 4 most stable Modular Axial Fixators and Orthofix. Load carrying capacities, stabilities, amount of load affecting the fracture line and rigidity of the systems were evaluated. results: Evaluation of the obtained data showed that external fixation can be a standard method of treatment in addition to being a biomechanical alternative method in proximal femoral fractures. Besides, it can become a reliable method in unstable fracture management by modifying the presently used systems. conclusion: Compared with the stresses in normal bones, application of external fixator to the proximal femur decreases the stresses through the femur by transferring the majority of the load to 1
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