Project Details
Abstract
In elderly patients, the aim of treatment of interochanteric fractures is to restore the
previous level of independence and function. To achieve this goal, stable fracture fixation
followed by early ambulation is a fundamental requirement. But it remains a considerable
challenge as these fractures are often associated with severe osteoporosis and comminution.
The standard treatment of these fractures is osteosynthesis with a dynamic hip screw (DHS).
For stable fractures, sliding of the lag screw usually facilitates bone healing by means of
impaction between fragments and controllable settling of the fracture. However, in unstable
intertrochanteric fractures, complications of cut-put and excessive sliding of the lag screw
occurred frequently. Although polymethylmethacrylate (PMMA) bone cement has been
widely as a secondary fixation to facilitate fracture stability, there has been no biomechanical
study regarding the significance of bone cement to prevent these two complications (cut-out
and excessive sliding of the lag screw) in unstable fracture patterns with osteoporotic bone.
Another device frequently used to treat these unstable intertrochanteric fractures is the use
of a second generation intramedullary nail (e.g. Russell-Taylor reconstruction nail). With two
proximal screws fixed to the femoral head, the intramedullary devices had been used in an
attempt to improve treatment results of a conventional DHS. Theoretically, the intramedullary
devices provide more effective control over screw sliding by acting as a lateral buttress.
However, most reports have shown no significant differences between the DHS and
intramedullary devices in failure of fixation. Furthermore, the intramedullary devices for
fixation of unstable intertrochanteric fractures have the disadvantages of difficult reduction,
intraoperative splintering as a result of bulky proximal part of the nails.
To prevent the common surgical complications of unstable intertrochanteric fractures in
elderly patients, this study aims to compare the biomechanical performance between a PMMA
cemented DHS and an intramedullary device using osteoporotic bone. Theoretically, PMMA
bone cement augmentation may enhance the fixation stability of a conventional DHS, and
lower the incidence of screw cutout from the femoral head in osteoporotic bone. We propose
to perform this study within two years. By using MTS hydraulic test machine, a
biomechanical study is performed to compare the fixation stability of the two currently used
fixation methods.
Twenty four (24) synthetic femora will be used and divided into two groups (cemented DHD
and intramedullary nail). By using MTS testing machine, biomechanical experiments
including: (1) Measurement of displacement of the femoral head; (2) Static compressive
failure test; and (3) Dynamic cyclic test, will be performed. The biomechanical performance
between a cemented DHS and an intramedullary device in the treatment of unstable
trochanteric fractures with osteoporotic bone will be compared accordingly.
Project IDs
Project ID:PB10007-2289
External Project ID:NSC100-2221-E182-023
External Project ID:NSC100-2221-E182-023
Status | Finished |
---|---|
Effective start/end date | 01/08/11 → 31/07/12 |
Keywords
- Unstable intertrochanteric fracture
- osteoporosis
- Dynamic Hip Screw
- reconstruction nail
- Finite element analysis
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