지원사업
학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
커뮤니티
연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
초록· 키워드
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Purpose: To prevent excessive sliding and subsequent fixation failures in unstable intertrochanteric fractures with posteromedial comminution, extramedullary reduction through overlapping of the anteromedial cortices of both proximal and distal fragments as a buttress has been introduced. The purpose of this study was to compare the biomechanical properties between two reduction methods–intramedullary reduction and extramedullary reduction–in treating unstable intertrochanteric fractures with posteromedial comminution (AO/OTA classification 31-A2.2). Materials and Methods: Eight pairs of frozen human cadaveric femora were used. The femora of each pair were randomly assigned to one of two groups: the intramedullary reduction group or the extramedullary reduction group. A single axial load-destruction test was conducted after cephalomedullary nailing. Axial stiffness, maximum load to failure, and energy absorbed to failure were compared between the two groups. Moreover, the pattern of mechanical failure was identified. Results: The mean axial stiffness in the extramedullary reduction group was 27.3% higher than that in the intramedullary reduction group (422.7 N/mm vs. 332.0 N/mm, p=0.017). Additionally, compared with the intramedullary reduction group, the mean maximum load to failure and mean energy absorbed to failure in the extramedullary group were 44.9% and 89.6% higher, respectively (2,848.7 N vs. 1,966.5 N, p=0.012 and 27,969.9 N·mm vs. 14,751.0 N·mm, p=0.012, respectively). In the intramedullary reduction group, the mechanical failure patterns were all sliding and varus deformities. In the extramedullary reduction group, sliding and varus deformities after external rotation were noted in 3 specimens, sliding and varus deformities after internal rotation were noted in 3 specimens, and medial slippage was noted in 2 specimens. Conclusion: In unstable intertrochanteric fractures with posteromedial comminution, the biomechanical properties of extramedullary reduction are superior to those of intramedullary reduction. Anteromedial cortex could be the proper buttress, despite a comminuted posteromedial cortex. It could help enhance the stability of the bone-nail construct.
목차
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참고문헌 (22)
참고문헌 신청
Zlowodzki M / 2007 / Shortening after femoral neck fracture fixation: is there a solution? / Clin Orthop Relat Res 461:213~218
Zlowodzki M / 2008 / The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study / J Bone Joint Surg Br 90:1487~1494
송형근 / 2014 / Presence of a Nail in the Medullary Canal; Is It Enough to Prevent Femoral Neck Shortening in Trochanteric Fracture? / Yonsei Medical Journal 55(5):1400~1405
Gilat R / 2017 / Proximal femoral shortening after cephalomedullary nail insertion for intertrochanteric fractures / J Orthop Trauma 31:311~315
Filipov O / 2011 / Biplane double-supported screw fixation (F-technique): a method of screw fixation at osteoporotic fractures of the femoral neck / Eur J Orthop Surg Traumatol 21:539~543
Zlowodzki M / 2008 / The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study / J Bone Joint Surg Br 90:1487~1494
송형근 / 2014 / Presence of a Nail in the Medullary Canal; Is It Enough to Prevent Femoral Neck Shortening in Trochanteric Fracture? / Yonsei Medical Journal 55(5):1400~1405
Gilat R / 2017 / Proximal femoral shortening after cephalomedullary nail insertion for intertrochanteric fractures / J Orthop Trauma 31:311~315
Filipov O / 2011 / Biplane double-supported screw fixation (F-technique): a method of screw fixation at osteoporotic fractures of the femoral neck / Eur J Orthop Surg Traumatol 21:539~543
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