Comparison of the Lag Screw Placements for the Treatment of Stable and Unstable Intertrochanteric Femoral Fractures regarding Trabecular Bone Failure

Çelik, Talip; Mutlu, İbrahim; Özkan, Arif; Kişioğlu, Yasin

doi:10.1155/2016/5470798

Cited by 8 publications

(3 citation statements)

References 29 publications

(61 reference statements)

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“…Good implant positioning is best determined by centre-centre and centre-inferior position of the lag screw in the femoral head in the AP and lateral radiograph4,15. A study conducted by Celik et al in 2016 (17) , reported strongest trabecular bone pattern in central and inferior region of femoral head whereby screw cut-out rate are less. The concept of TAD describes the position of lag screw within the femoral head and was shown to be highly predictive of fixation failure by screw cut out (18) .…”

Section: Discussionmentioning

confidence: 99%

Various factors influencing the outcome in DHS fixation of Intertrochanteric fractures

Singh¹,

Chandersekharan²

2020

IJOTSS

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Background: Dynamic hip screw (DHS) is a standard device for intertrochanteric fractures (ITF). Implant failure in form of screw cut out leading to varus collapse of neck shaft angle is associated with various factors like bone quality, fracture pattern, fracture reduction, lateral femoral wall thickness (LFWT), screw position and tip-apex distance (TAD). But there has been no clear consensus to the relative importance of each factor. The purpose of our study is to assess individual factors for a favorable outcome in DHS fixation of ITF. Materials and methods: 121 hips sustaining ITF treated with DHS between-June 2014 and July 2016 were reviewed in our prospective study with a mean period of 12 months. Factors under study were bone quality, fracture pattern, fracture reduction, LFWT, screw position and TAD, which were recorded and used for statistical analysis using SPSS. Chi-square test, Independent t-test and Paired t-test were used to evaluate the significance of the differences. Final analysis involved clinical and radiological assessment using Harris Hip Score (HHS) and radiographs respectively. Results and Analysis: The mean age of patient at the time of surgery was 65.27±3.21 years (range 24-85) with 80 males and 41 females. There was no statistical significant relation found between implant failure and osteoporosis even though cases of failure were found in weak osteoporotic bones. Implant failure in relation to unstable fracture pattern, non-anatomical fracture reduction, LFWT< 21.77 mm, screw placement in position apart from centre-centre or centre-inferior and TAD greater than 25mm was found to be statistically significant (p<0.05).The final functional and radiological assessment revealed 68.85% and 86.88% of hips respectively in good to excellent category. Conclusion: DHS is a well-accepted implant for ITF with lower rate of complications only if proper surgical technique is followed. Good fracture reduction, adequate LFWT, ideal screw position and TAD less than 25mm are must to prevent implant failure. Level of Evidence: Level IV

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Section: Discussionmentioning

confidence: 99%

Various factors influencing the outcome in DHS fixation of Intertrochanteric fractures

Singh¹,

Chandersekharan²

2020

IJOTSS

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“…As for the joint force of the hip and muscle, one-legged standing condition was simulated. A load of 2400 N was applied to the femoral head at an angle of 16°relative to the femoral axis, and a load of 1200 N was applied to the greater trochanter at an angle of 21° [24,25]. With regard to the prosthesis implant model, the interface state after the stable bone ingrowth was simulated, and the degrees of freedom of the prosthesis-bone interface node were coupled.…”

Section: Materials Properties and Application Of Loadmentioning

confidence: 99%

Femoral Stress Changes after Total Hip Arthroplasty with the Ribbed Prosthesis: A Finite Element Analysis

Luo

Wan

et al. 2020

BioMed Research International

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Background. A total hip reconstruction is related to the stress distribution throughout the prosthesis, cement, and femur. Researches on reducing the stress in all components to minimize the risk of failure are of great significance. The objective of our study was to determine the biomechanical variation in overall femoral stress and periprosthetic femoral stress distribution after implantation with the Ribbed anatomic prosthesis. Methods. Three-dimensional finite element models of intact femur and Ribbed prosthesis were developed according to the morphology, while the hip joint loading and the strength of related muscles were applied in the models. The overall stress changes of the intact femur before and after the implantation were analyzed, and the periprosthetic stress distribution especially in the proximal region of the femur was quantified. Results. As a result, the overall stress pattern of the femur did not change after the implantation compared with the intact femur. The region of peak stress value was located in the middle and lower segments of the full length femur, but the stress value level decreased. The final prosthesis resulted in a significant decrease in the equivalent stress level of the periprosthetic bone tissue, and the most severe area appeared at the endmost posterior quadrant. The stress shielding ratio of the Ribbed prosthesis was 71.6%. The stress value level gradually increased towards the distal part of the prosthesis and recovered to physiological level at the end of the prosthesis. Conclusions. The Ribbed prosthesis can cause significant stress shielding effect in the proximal femur. These results may help optimize prosthetic design to reduce stress shielding effect and improve clinical outcomes.

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“…Celik et al studied the importance of the position of the lag screw for the treatment of stable and unstable fractures associated with the fracture of the trabecular bone. They concluded that the position of the screw affects the fracture healing process; however, to measure the fracture's condition, the trabecular bone density was recognized as a better parameter than the position of the lag screw 15 . Tzeng et al studied the effect of the length of the lag screw, which enters the femoral head, the length of the DHS plate, and the probability of their failure 16 .…”

Section: Introductionmentioning

confidence: 99%

A comparative mechanical study of two types of femur bone implant using the finite element method

Hamidi

Khosravifard

Hematiyan

et al. 2021

Numer Methods Biomed Eng

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The femoral bone fracture is one of the most common fractures that orthopedic surgeons deal with. These fractures are associated with a significant percentage of death due to non‐orthopedic complications. For this reason, it is necessary that the surgeon be well‐aware of the condition of the patient and also of the biomechanical conditions of the bone and implant before surgery, in order to use the best surgical technique. Nowadays, the use of implants is a popular technique among the available methods for the treatment of femoral fractures. In the present study, two patients with different ages, three types of femoral bone fractures, that is, oblique, reverse oblique, and neck fracture, and two types of implants, namely, the dynamic hip screw (DHS) and the Gamma nail have been investigated. The behavior of the implants has been investigated at the two stages of treatment, that is, before and after bone union. The analysis of implants was based on the amount of stress and displacement induced in different parts of the bone and the implant. From the viewpoint of the stresses induced in the bone, all models are quite similar and in terms of the implant stresses, the Gamma nail is more reliable than the DHS. Additionally, the relative displacement of the fractured bone segments at the fracture planes was calculated. According to the obtained results, it can be concluded that the relative displacement of the fracture planes with the use of Gamma nail is somewhat less than the DHS, but this difference is not significant.

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Comparison of the Lag Screw Placements for the Treatment of Stable and Unstable Intertrochanteric Femoral Fractures regarding Trabecular Bone Failure

Cited by 8 publications

References 29 publications

Various factors influencing the outcome in DHS fixation of Intertrochanteric fractures

Various factors influencing the outcome in DHS fixation of Intertrochanteric fractures

Femoral Stress Changes after Total Hip Arthroplasty with the Ribbed Prosthesis: A Finite Element Analysis

A comparative mechanical study of two types of femur bone implant using the finite element method

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