Biomechanical Evaluation of Reconstruction of Calcar Femorale Structure for Femoral Neck Fractures: A Comparative Finite Element Analysis

BackgroundThe optimum internal fixation approach for femoral neck fracture therapy is still debated, and there are few studies on calcar femorale repair following femoral neck fracture. The biomechanical properties of various internal fixation systems can be adequately studied using the finite element method. The goal of this work was to use finite element analysis to examine the biomechanical parameters of Pauwels type III femoral neck fractures under various calcar femorale repair nailing procedures.MethodThe finite element approach was used to numerically investigate the calcar femorale reconstruction method for femoral neck fracture repair. A control group with standard inverted triangle nail placement and internal fixation models with calcar femorale reconstruction nails of 150, 155, and 160 degrees, respectively, were constructed. The four groups of models' von Mises stress and displacement distributions are evaluated and compared.ResultsIn the control group and three calcar femorale reconstruction nail angle models, the maximum stress of femur was (MPa): 106.605, 87.317, 147.691, and 102.072 respectively; The peak stress of four kinds of internal fixation were (MPa): 315.121, 228.819, 198.173 and 208.798. In the control group and three calcar femorale reconstruction nail angle models, the maximum displacement of the femur was (mm): 13.19, 13.183, 12.443, and 12.896 respectively; The displacement peaks of the four internal fixations were (mm): 12.646, 12.625, 11.932 and 12.347.ConclusionsAccording to the results of finite element analysis, the biomechanical performance of calcar femorale reconstruction nail with 150 ° is excellent, which is helpful to the reconstruction of calcar femorale structure. This nail placement method can achieve better biomechanical properties. The results of this study can provide a theoretical reference for clinical practice.

Multilevel segmental femur fracture in young individuals treated by a single step - All in one intramedullary device – A prospective study

Introduction: Multilevel femur fracture is being encountered frequently than previously thought. The literature reports the incidence anywhere between 6-11%. Management of these fractures in isolation are technically demanding, and presence of other bone or organ involvement complicates the scenario in achieving the optimal functional results. The use of a single implant provides the technically better overlapping fixation. Methods: Our study represents a prospective cohort study in a 2-year period, between 2017 till 2019. Twenty-six patients with multilevel femur fractures being treated by a single step all in one interlocked cephalomedullary nail were included. Results: In our study 16 patients (88.8%) had been treated by Antegrade cephalomedullary reconstruction nail / proximal femoral nail. Healing of all the femoral fractures was without major complications or requirement of additional surgical procedures. In our study the femur fractures, on an average healed by 18 weeks. Conclusion: For multilevel segmental femur fracture in young adults, stabilization using All-in-one device such as the intramedullary nail is recommended. Closed reduction with PFNA?long / Reconstruction nail is an effective treatment for long?segment femoral fracture with good strength in fixation, high rate of fracture union, and low rate of complications.

Study of management of subtrochanteric fractures of femur with reconstruction nail

<p class="abstract"><strong>Background:</strong> Subtrochanteric fractures of femur are the fractures occurring from the inferior aspect of the lesser trochanter to 5 cm distally. They represent a challenge for surgeons due to the deforming forces acting on the region and the high rates of complications like non-union. This study evaluates the fixation of subtrochanteric fractures of femur with reconstruction nail which is a specialized antegrade intramedullary nail for femur.</p><p class="abstract"><strong>Methods:</strong> A prospective study conducted between October 2017 to May 2019 where 20 cases of subtrochanteric fractures of femur were treated with reconstruction nail and were followed up serially till 24 weeks radiologically and clinically.<strong></strong></p><p class="abstract"><strong>Results:</strong> The average time of union for patients was 5.15±1.14 months with 3 patients whose fractures didn’t unite where one went for frank non union, one had a refracture and one patient had reverse z effect. The functional outcome was excellent in 45% patients and good in 30% patients while poor in 3 (15%) patients.</p><p class="abstract"><strong>Conclusions:</strong> Reconstruction nail is a good device for subtrochanteric fractures of femur providing rigid fixation with low complication rates.</p>

Clinical treatment of humerus fracture using intramedullary humerus nailing system

<p class="abstract"><strong>Background:</strong> The clinical results of intramedullary humerus nailing system of humeral fracture is controversial variation in implants, and follow up factor and operative technical studies. Humerus fracture is the third long fracture after femoral and tibia bone fracture.</p><p class="abstract"><strong>Methods:</strong> In this prospective study, 45 patients (24 female and 21 male) between the age group of 18-75 years with humerus fracture were taken who did not get conservative management. Type of fracture was categorized according to AO classification. Intramedullary humeral nailing system (compression intramedullary humerus nail, reconstruction nail and reconstruction intramedullary humerus nail) manufactured at Auxein Medical Pvt. Ltd., was used to treatment of humerus fracture. Patient physical fitness was observed according to American Society of Anesthesiologist. Pain scale and outcomes was record from the patients using visual analog scale. Follow up of the patients were taken on 3-week, 8-week, 16-week, 1-year and 2-year.<strong></strong></p><p class="abstract"><strong>Results:</strong> At 2 years follow up, bone consolidation was present in 44 cases. Only one case has reported of mortality but that was not due to implant related. No clinical and biomechanical complications were reported. Proper healing of implant was achieved.</p><p class="abstract"><strong>Conclusions:</strong> Intramedullary humeral nailing system is the best treatment option to treat the humerus fracture. Compression intramedullary humerus nail can minimize the gap and increase the biomechanical stiffness.</p>

Outcome of intramedullary nailing treatment for intertrochanteric femoral fractures

Introduction The OTA/AO type 31 A3 intertrochanteric fracture has a transverse or reverse oblique fracture at the lesser trochanteric level, which accentuates the varus compressive stress in the region of the fracture and the implant. Intramedullary fixation using different types of nails is commonly preferred. The purpose of this study is to evaluate intertrochanteric femoral fractures with intramedullary nail treatment in regard to surgical procedure, complications, and clinical outcomes. Methods From one level 1 trauma center, 216 consecutive adult intertrochanteric femoral fractures (OTA/AO type 31 A3) were retrospectively identified with intramedullary nail fixation from 2004 through 2013. Of these, 193 patients (58.5% female) met the inclusion criteria. The average age was 70 years (range 19–96 years). Results Cephalomedullary nails were utilized in 176 and reconstruction nails in 17 patients. After the index procedure, 86% healed uneventfully. Nonunion development was observed in 6% and 5% had an unscheduled reoperation due to implant or fixation failure. Active smoking was reported in 16.6%. Current smokers had an increased nonunion risk compared to those who do not currently smoke (15.6% vs. 4.3%; p = 0.016). The femoral neck angle averaged 128.0° ± 5°. Fixation failure occurred in 11.1% of patients with a neck-shaft-angle < 125° compared to 2.6% (4/155) of patients with a neck-shaft angle ≥125° (p = 0.021). Patients treated with a reconstruction nail required a second surgical intervention in 23.5%, which was no different compared to 25.0% in the cephalomedullary group (p = 0.893). In the cephalomedullary group, 4.5% developed a nonunion compared to 23.5% in the reconstruction group (p = 0.002). Painful hardware led to hardware removal in 8.8%. All of them were treated with a cephalomedullary device (p = 0.180). During the last office visit, two-thirds of the patients reported no or only mild pain but most patients had reduced hip range of motion. Conclusion Intramedullary nailing is a reliable surgical technique when performed with adequate reduction. Varus reduction with a neck-shaft angle < 125° resulted in an increase in fixation failures. Patient and implant factors affected nonunion formation. Smoking increased nonunion formation. Utilization of a cephalomedullary device reduced the nonunion rate, but had higher rates of painful prominent hardware compared to reconstruction nailing.