Mechanical Complications after Limb Osteosynthesis: Analysis of Etiologic Factors in 42 Cases

Traore, Moctar; Gogoua, R. D.; Kouame, Maurice; Yepie, Armand; Anoumou, M.; Varango, G.

doi:10.4236/ojo.2017.72006

Cited by 2 publications

(4 citation statements)

References 8 publications

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“…This was also the case in our study. On the other hand, an association between the disassembly of fixation material and the age of the patients was found in Traore et al study [42]. This association was also found with the CSM in Hsueh et al study [30].…”

Section: Discussionmentioning

confidence: 77%

Predictors of Failure Following Fixation of Trochanteric Fractures

Abdennadher

Hjaiej

Ayari

et al. 2023

Open Access Maced J Med Sci

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BACKGROUND: Trochanteric fractures are frequent and mainly affect the elderly causing autonomy loss. Their incidence is increasing, and they are associated with substantial morbidity and high cost. AIM: The aim of our study was to identify epidemiological, radiological, and technical predictors of failure of trochanteric fracture fixation in the elderly. METHODS: We conducted a retrospective study including 188 patients aged over 65 years, who underwent surgery for trochanteric fractures, in the period between 2015 and 2020 at the orthopedics department of the Military Hospital of Tunis. The minimum follow-up was 12 months. RESULTS: Thirty-four patients had a mechanical failure (18.1% of cases), including 12 cases of cephalic screw migration (CSM) (6.4%), 12 cases of disassembly (6.4%), eight cases of malunion (4.3%), and four cases of non-union (2.1%). Bone fragility with a Singh index ≤III was associated with CSM, disassembly of fixation material, and malunion (respectively, p < 0.001; p = 0.01 and p = 0.044). Reduction quality was associated with disassembly (p < 0.001) and CSM (p = 0.004). Eccentric screw positioning on anteroposterior (p < 0.001) and lateral views (p = 0.018), high tip-apex distance (TAD) (p < 0.001), and calcar-referenced TAD (p < 0.001) were predictive of CSM. Logistic regression analysis showed that poor reduction quality was an independent factor associated with the occurrence of mechanical complications. Functional outcomes were assessed using Parker and Postel Merle d’Aubigné scores. CONCLUSION: To minimize the risk of mechanical complications, the surgeon must pay close attention to the fracture reduction and to the correct positioning of the cervical screw.

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Section: Discussionmentioning

confidence: 77%

Predictors of Failure Following Fixation of Trochanteric Fractures

Abdennadher

Hjaiej

Ayari

et al. 2023

Open Access Maced J Med Sci

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“…Разом з тим лікування пацієнтів із переломами довгих кісток гомілки та супутньою надмірною вагою створює певні особливості в перебігу захворювання, дещо обмежує вибір імплантата для якісного остеосинтезу, оскільки зростає навантаження на біомеханічну конструкцію [2,3]. Наразі добре вивчені особливості роботи різних засобів остеосинтезу довгих кісток за стискання та згинання [4], але на кістки гомілки випробовують навантаження на кручення. Вони найнебезпечніші, бо є складною комбінацією навантажень на згин, розтягнення та стискання.…”

Section: вступunclassified

“…Лікування пацієнтів з переломами кісток гомілки та супутньою надмірною вагою чи ожирінням має певні особливості: обмежений вибір імплантата для якісного остеосинтезу, оскільки зростає навантаження на біомеханічну конструкцію [3,4].…”

Section: вступunclassified

“…Результати. Найбільші показники рівня напружень в зоні перелому (6,(3)(4)(5)(6)(7)(8)(9)(10)8 МПа) та на металевій конструкції (251,0-430,2 МПа) визначено в моделі з накістковою пластиною. У моделі з остеосинтезом за допомогою АЗФ установлений досить низький рівень напружень (0,2-0,3 МПа) у зоні перелому, але високий -у проксимальному відділі великогомілкової кістки (6,7-11,5 МПа).…”

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The effectiveness of resistance to torsional loads of various options for osteosynthesis of bone fragments of the tibia for fractures in the upper third of the diaphysis (mathematical modeling)

Karpinsky¹,

Stroiev²,

Berezka³

et al. 2023

OTP

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The treatment of patients with tibial fractures and overweight has certain peculiarities due to the increased load on the osteosynthesis device. Objective. To compare the stress-strain state of models of the lower leg with a fracture of the tibia in the upper third of the diaphysis under the influence of torsional load under different options of osteosynthesis depending on the patient's weight. Methods. Using the finite element method, a fracture in the upper third of the tibia and three types of osteosynthesis were modeled: using an external fixation device (EFD), a bone plate, and an intramedullary rod. A torque of 7 Nm and 12 Nm was applied to the tibial plateau. The results. The highest indicators of the stress level in the fracture zone (6.3‒10.8 MPa) and on the metal structure (251.0‒430.2 MPa) were determined in the model with a bony plate. In the model with osteosynthesis with the help of EFD, a fairly low stress level (0.2‒0.3 MPa) was established in the fracture zone, but a high one in the proximal part of the tibia (6.7‒11.5 MPa). The lowest values of stresses in the fracture zone (0.1‒0.2 MPa) and the proximal fragment of the tibia (0.6‒1.0 MPa) were determined under the conditions of reproduction of osteosynthesis using an intramedullary rod, but in the distal part of the tibia the stresses remained quite high — 11.1‒19.0 MPa. Conclusions. The values of stresses in the fracture zone in the models with EFD and intramedullary rod were significantly lower than the values of the intact bone, with the periosteal plate - only at a load of 7 Nm. In the distal fragment of the tibia, the highest stress level was determined in the model with osteosynthesis with an intramedullary rod, in the proximal one — with EFD. Among the metal structures, the greatest stresses were found in the periosteal plate and around the fixing screws and rods under the conditions of its use. The function of the dependence of the amount of stress on the weight of the patient in the elements of the model turned out to be linear and directly proportional.

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Mechanical Complications after Limb Osteosynthesis: Analysis of Etiologic Factors in 42 Cases

Cited by 2 publications

References 8 publications

Predictors of Failure Following Fixation of Trochanteric Fractures

Predictors of Failure Following Fixation of Trochanteric Fractures

The effectiveness of resistance to torsional loads of various options for osteosynthesis of bone fragments of the tibia for fractures in the upper third of the diaphysis (mathematical modeling)

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