Is the rotation of the femural head a potential initiation for cutting out? A theoretical and experimental approach

BMC Musculoskeletal Disorders

Research Article

Samuel Bachmeier¹  Amir Andreas Al-Munajjed¹  Jochen Hammer¹  Edgar Mayr²  Andreas Lenich³  Bernd Füchtmeier⁴  Michael Nerlich⁴  Lukas Prantl⁴ 

[1] Biomechanic Research Regensburg, University of Applied Sciences Regensburg, 93053, Regensburg, Germany;Department of Trauma Surgery, Klinikum Augsburg, 86156, Augsburg, Germany;Department of Trauma Surgery, Klinikum Augsburg, 86156, Augsburg, Germany;Biomechanic Research Regensburg, University of Applied Sciences Regensburg, 93053, Regensburg, Germany;Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675, Munich, Germany;Department of Trauma Surgery, University of Regensburg, 93053, Regensburg, Germany;

关键词: proximal femur fractures;    osteosynthesis;    center-center-position;    cutting out;   

DOI  :  10.1186/1471-2474-12-79

 received in 2010-09-19, accepted in 2011-04-22,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundSince cut-out still remains one of the major clinical challenges in the field of osteoporotic proximal femur fractures, remarkable developments have been made in improving treatment concepts. However, the mechanics of these complications have not been fully understood.We hypothesize using the experimental data and a theoretical model that a previous rotation of the femoral head due to de-central implant positioning can initiate a cut-out.MethodsIn this investigation we analysed our experimental data using two common screws (DHS/Gamma 3) and helical blades (PFN A/TFN) for the fixation of femur fractures in a simple theoretical model applying typical gait pattern on de-central positioned implants. In previous tests during a forced implant rotation by a biomechanical testing machine in a human femoral head the two screws showed failure symptoms (2-6Nm) at the same magnitude as torques acting in the hip during daily activities with de-central implant positioning, while the helical blades showed a better stability (10-20Nm).To calculate the torque of the head around the implant only the force and the leverarm is needed (N [Nm] = F [N] * × [m]). The force F is a product of the mass M [kg] multiplied by the acceleration g [m/s2]. The leverarm is the distance between the center of the head of femur and the implant center on a horizontal line.ResultsUsing 50% of 75 kg body weight a torque of 0.37Nm for the 1 mm decentralized position and 1.1Nm for the 3 mm decentralized position of the implant was calculated. At 250% BW, appropriate to a normal step, torques of 1.8Nm (1 mm) and 5.5Nm (3 mm) have been calculated.Comparing of the experimental and theoretical results shows that both screws fail in the same magnitude as torques occur in a more than 3 mm de-central positioned implant.ConclusionWe conclude the center-center position in the head of femur of any kind of lag screw or blade is to be achieved to minimize rotation of the femoral head and to prevent further mechanical complications.

【 授权许可】

CC BY   
© Lenich et al; licensee BioMed Central Ltd. 2011