How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis
Yıl: 2018 Cilt: 29 Sayı: 2 Sayfa Aralığı: 79 - 86 Metin Dili: İngilizce DOI: 10.5606/ehc.2018.58735 İndeks Tarihi: 21-11-2019
How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis
Öz: Objectives: This study aims to evaluate the effects of lesser trochanter (LT) and iliopsoas tendon on implant stability by using finite element analysis (FEA). Materials and methods: Effects of iliacus and psoas major muscles on hip joint was evaluated with inverse dynamics methods to calculate joint reaction and muscle forces. Intertrochanteric femur fracture was simulated according to AO (Arbeitsgemeinschaft für Osteosynthesefragen) 31A1 and 31A2 classifications in threedimensional modelling software. Uncemented three-dimensional model of modular nail prosthesis combination was used in FEA. All analyses were performed with Ti6Al4V’s 114 GPa elastic modulus value. Effects of LT on implant stability were evaluated with two different implant designs using the same femoral stems and four different femoral models, two of which with intact LT and two of which with fractured LT. Results: Reaction forces of the hip joint decreased by 10% in the 0-40° hip flexion range. Maximum stress distribution for proximal femoral nail (PFN) model with fractured LT was 204.68 MPa at the distal locking screw on the interconnection point of PFN, while it was 335.35 MPa for the hip prosthesis with fractured LT. The direction of stress distribution for PFN model with fractured LT varied from medial to lateral and anterior to posterior. Maximum stress distribution for the hip prosthesis model with intact LT was 357.42 MPa, with direction of stress distribution from lateral to medial and posterior to anterior. Conclusion: Hip prosthesis models with intact or fractured LT were similar in terms of stress distribution and deformation values, while there were differences between PFN models with intact or fractured LT. Thus, intact LT was significant in PFN implant stability. Further clinical and experimental analyses are necessary on this topic.
Anahtar Kelime: Konular:
Kalça protezi ve proksimal femoral çivi stabilitesi küçük trokanter kırıklarından nasıl etkilenir: Karşılaştırmalı sonlu eleman analizi
Öz: Amaç: Bu çalışmada, küçük trokanter (KT) ve iliopsoas tendonunun implant stabilitesi üzerine etkileri sonlu element analizi (SEA) kullanarak değerlendirildi. Gereç ve yöntemler: Eklem tepkisi ve kas kuvvetlerini hesaplamak için iliacus ve psoas majör kaslarının kalça eklemine etkileri ters dinamik metotları ile değerlendirildi. İntertrokanterik femur kırığı üç boyutlu modelleme yazılımı ile AO (Arbeitsgemeinschaft für Osteosynthesefragen) 31A1 ve 31A2 sınıflandırmasına göre simüle edildi. Sonlu element analizinde modüler çivi protez kombinasyonunun çimentosuz üç boyutlu modeli kullanıldı. Bütün analizler Ti6AI4V’nin 114 GPa elastik modulus değeri ile gerçekleştirildi. Küçük trokanterin implant stabilitesine etkisi aynı femoral stemi kullanan iki farklı implant tasarımıyla ve iki sağlam KT’li ve iki kırık KT’li dört farklı femoral model ile değerlendirildi. Bulgular: Kalça ekleminin reaksiyon kuvvetleri 0-40° kalça fleksiyon aralığında %10 azaldı. Maksimum stres dağılımı kırık KT’li proksimal femoral çivi (PFÇ) modelinde PFÇ’nin ara bağlantı noktasındaki distal kilitleme vidasında 204.68 MPa iken, kırık KT’li kalça protezi için 335.35 MPa idi. Kırık KT’li PFÇ modeli için stres dağılımı yönü medialden laterale ve anteriordan posteriora değişti. Sağlam KT’li kalça protezi modelinde maksimum stres dağılımı 357.42 MPa olup stres dağılımı yönü lateralden mediale ve posteriordan anteriora idi. Sonuç: Kırık veya sağlam KT’li kalça protezi modelleri stres dağılımı ve deformasyon değerleri açısından benzer iken sağlam veya kırık KT’li olmalı PFÇ modelleri arasında farklılıklar vardı. Buna bağlı olarak, PFÇ implant stabilitesi için KT önemli idi. Bu konu hakkında ileri klinik ve deneysel analizler gereklidir.
Anahtar Kelime: Konular:
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- Schipper IB, van der Werken C. Unstable trochanteric frac- tures and intramedullary treatment. The influence of fracture patterns on complications and outcome. Eur J Trauma 2004;30:29-34.
- Konya MN, Korkusuz F, Maralcan G, Demir T, Aslan A. The use of a proximal femoral nail as a hip prosthesis: A biomechanical analysis of a newly designed implant. Proc Inst Mech Eng H 2018;232:200-6.
- Esen E, Dur H, Ataoğlu MB, Ayanoğlu T, Turanlı S. Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios. Eklem Hastalik Cerrahisi 2017;28:35-40.
- Sofu H, Üçpunar H, Çamurcu Y, Duman S, Konya MN, Gürsu S. Predictive factors for early hospital readmission and 1-year mortality in elder patients following surgical treatment of a hip fracture. Ulus Travma Acil Cerrahi Derg 2017;23:245-50.
- Altay MA, Ertürk C, Işıkan UE. Bipolar hemiarthroplasty for the treatment of femoral neck fractures and the effect of surgical approach on functional results. [Article in Turkish] Eklem Hastalik Cerrahisi 2010;21:136-41.
- Ehrnthaller C, Olivier AC, Gebhard F, Dürselen L. The role of lesser trochanter fragment in unstable pertrochanteric A2 proximal femur fractures - is refixation of the lesser trochanter worth the effort? Clin Biomech (Bristol, Avon) 2017;42:31-37.
- Do JH, Kim YS, Lee SJ, Jo ML, Han SK. Influence of fragment volume on stability of 3-part intertrochanteric fracture of the femur: a biomechanical study. Eur J Orthop Surg Traumatol 2013;23:371-7.
- Damsgaard M, Rasmussen J, Christensen ST, Surma E, de Zee M. Analysis of musculoskeletal systems in the AnyBody modeling system. Simul Model Pract Theory 2006;14:1100-11.
- Klein Horsman MD, Koopman HF, van der Helm FC, Prosé LP, Veeger HE. Morphological muscle and joint parameters for musculoskeletal modelling of the lower extremity. Clin Biomech (Bristol, Avon) 2007;22:239-47.
- Azboy I, Demirtaş A, Gem M, Cakır IA, Tutak Y. A comparison of proximal femoral locking plate versus 95-degree angled blade plate in the treatment of reverse intertrochanteric fractures. Eklem Hastalik Cerrahisi 2014;25:15-20.
- Konya MN, Verim Ö. Numerical Optimization of the Position in Femoral Head of Proximal Locking Screws of Proximal Femoral Nail System; Biomechanical Study. Balkan Med J 2017;34:425-31.
- Mei J, Liu S, Jia G, Cui X, Jiang C, Ou Y. Finite element analysis of the effect of cannulated screw placement and drilling frequency on femoral neck fracture fixation. Injury 2014;45:2045-50.
- Oken OF, Soydan Z, Yildirim AO, Gulcek M, Ozlu K, Ucaner A. Performance of modified anatomic plates is comparable to proximal femoral nail, dynamic hip screw and anatomic plates: finite element and biomechanical testing. Injury 2011;42:1077-83.
- Staszkiewicz R, Chwała W, Forczek W, Laska J. Influence of surface on kinematic gait parameters and lower extremity joints mobility. Acta Bioeng Biomech 2012;14:75-82.
- Aprato A, Lo Baido R, Crosio A, Matteotti R, Grosso E, Massè A. Does lesser trochanter implication affect hip flexion strength in proximal femur fracture? Eur J Trauma Emerg Surg 2015;41:523-9. 16.
- Kim SY, Kim YG, Hwang JK. Cementless calcar replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. A prospective, randomized study. J Bone Joint Surg [Am] 2005;87:2186-92.
- Bao NR, Zhao JN, Zhou LW, Zeng XF, Guo T. Complications of bipolar hemiarthroplasty for the treatment of unstable intertrochanteric fractures in the elderly. Zhongguo Gu Shang 2010;23:329-31. [Abstract]
- ISO 7206-4:2010, Implants for surgery - Partial and total hip joint prostheses - Part 4: Determination of endurance properties and performance of stemmed femoral components. Available from: https://www.iso.org/ standard/42769.html.
APA | KONYA M, Aslan A, BAKBAK S (2018). How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis. , 79 - 86. 10.5606/ehc.2018.58735 |
Chicago | KONYA Mehmet Nuri,Aslan Ahmet,BAKBAK Sibel How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis. (2018): 79 - 86. 10.5606/ehc.2018.58735 |
MLA | KONYA Mehmet Nuri,Aslan Ahmet,BAKBAK Sibel How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis. , 2018, ss.79 - 86. 10.5606/ehc.2018.58735 |
AMA | KONYA M,Aslan A,BAKBAK S How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis. . 2018; 79 - 86. 10.5606/ehc.2018.58735 |
Vancouver | KONYA M,Aslan A,BAKBAK S How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis. . 2018; 79 - 86. 10.5606/ehc.2018.58735 |
IEEE | KONYA M,Aslan A,BAKBAK S "How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis." , ss.79 - 86, 2018. 10.5606/ehc.2018.58735 |
ISNAD | KONYA, Mehmet Nuri vd. "How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis". (2018), 79-86. https://doi.org/10.5606/ehc.2018.58735 |
APA | KONYA M, Aslan A, BAKBAK S (2018). How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), 29(2), 79 - 86. 10.5606/ehc.2018.58735 |
Chicago | KONYA Mehmet Nuri,Aslan Ahmet,BAKBAK Sibel How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.) 29, no.2 (2018): 79 - 86. 10.5606/ehc.2018.58735 |
MLA | KONYA Mehmet Nuri,Aslan Ahmet,BAKBAK Sibel How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), vol.29, no.2, 2018, ss.79 - 86. 10.5606/ehc.2018.58735 |
AMA | KONYA M,Aslan A,BAKBAK S How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.). 2018; 29(2): 79 - 86. 10.5606/ehc.2018.58735 |
Vancouver | KONYA M,Aslan A,BAKBAK S How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.). 2018; 29(2): 79 - 86. 10.5606/ehc.2018.58735 |
IEEE | KONYA M,Aslan A,BAKBAK S "How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis." Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), 29, ss.79 - 86, 2018. 10.5606/ehc.2018.58735 |
ISNAD | KONYA, Mehmet Nuri vd. "How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis". Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.) 29/2 (2018), 79-86. https://doi.org/10.5606/ehc.2018.58735 |