PROKSİMAL FEMORAL ÇİVİ ÇIKARIMI SONRASINDA OLUŞAN VİDA DELİĞİ DEFEKTLERİNDE KIRIK RİSKİNİN ÖNLENMESİNDE MODÜLER PROTEZ ÇİVİ KOMBİNASYONUNUN ETKİNLİĞİ VE GÜVENLİĞİNİN İNCELENMESİ: KARŞILAŞTIRMALI DENEYSEL ÇALIŞMA

Yıl 2021, Cilt: 22 Sayı: 2, 88 - 92, 12.04.2021

Mehmet Nuri Konya , Recep Altın Uğur Yüzügüldü

https://doi.org/10.18229/kocatepetip.697319

Öz

seçeneğidir. Kırıkta kaynamama veya kalçada artroz durumunda implant çıkarılır ve protez ameliyatı gerçekleştirilir. Bu çalışmanın amacı PFN çıkarımı sonrasında uygulanan protezlerin distal kilit vidası delikleri üzerinde oluşturduğu stres dağılımlarını ve subtrokanterik kırık riskini, yeni geliştirilen çivi protez kombinasyonu ve revizyon kalça protezlerinde karşılaştırmalı olarak değerlendirmektir.
GEREÇ VE YÖNTEM: Altı adet yapay femur modelleri (Synbone 2162) kullanıldı. Bu femur modellerine modüler PFN-protez modeli yerleştirildi. Hepsinden boyun vidaları çıkarıldı. Femur boyun kesisi yapıldı, 3 modelden PFN çıkarıldı. Revizyon stem yerleştirildi. 3 modelde modüler PFN-protezin, protez bağlantısı yapıldı. Eksenel basma testi ile distal vida deliğindeki strese bakıldı.
BULGULAR: Altı adet yapay femur üzerinde yapılan çalışmada kontrol grubunda 200N ve üzerinde kuvvetlerde femurda kırık saptandı. Deney grubunda 300N ve üzerinde kuvvet uygulandığında femurda kırık saptandı.
SONUÇ: Yapay femurlarda PFN çıkarımı sonrasında residüel deliklerde oluşan stres dağılımı ve kırık riski değerlendirilmiştir. Yeni tasarlanan modüler çivi protez kombinasyonunun (MNP) distal deliklerinde vida bulunmasından dolayı kırık riskinin revizyon protezi uygulananlara göre daha az olduğu görülmüştür.

Anahtar Kelimeler

Modüler çivi protez, Vida deliği, Periprostetik kırık

Destekleyen Kurum

Afyon Kocatepe Üniversitesi Bilimsel Araştırma Proje Birimi

Proje Numarası

17

INVESTIGATION OF THE EFFECTIVENESS AND SAFETY OF MODULAR PROSTHETIC NAIL COMBINATION IN THE PREVENTION OF FRACTURE RISK IN SCREW HOLE DEFECTS FOLLOWING PROXIMAL FEMORAL NAIL REMOVAL: A COMPARATIVE EXPERIMENTAL STUDY

Öz

OBJECTIVE: Proximal femoral nail (PFN) is a treatment of hip fractures. In case of non-union or hip arthrosis, the implant is removed, and prosthetic surgery is performed. This study aims to evaluate the stress distributions on the distal locking screw holes of the prosthesis applied after PFN removal and subtrochanteric fracture risk in a newly developed nail-prosthesis combination and revision hip prosthesis.
MATERIAL AND METHODS: 6 (Synbone 2162) artificial femur models were used. The modular PFN-prosthesis model was placed in these femur models. Neck screws were removed from all. Femoral neck was cut. PFN was removed from 3 models and revision stem was replaced. In 3 models, the modular PFN-prosthesis was attached. The stress on the distal screw hole was examined with the axial compression test.
RESULTS: In this study, we performed on 6 artificial femurs, a fracture in the femur at 200N and above forces was detected in the control group. When 300N and above force was applied in the experimental group, a fracture in the femur was detected.
CONCLUSIONS: Stress distribution and fracture risk in residual holes were evaluated after PFN removal in artificial femurs. The newly designed modular nail prosthesis combination (MNP) was found to have a lower risk of fracture than revision prosthesis due to the presence of screws in the distal holes.

Anahtar Kelimeler

Modular nail prosthesis, Screw hole,, Periprosthetic fracture

Proje Numarası

17

Kaynakça

• Miller BJ, Lu X, Cram P. The trends in treatment of femoral neck fractures in the Medi care population from 1991 to 2008. J Bone Joint Surg Am 2013 18;95(18):e132.
• 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 impant. Proc Inst Mech. Eng H 2018;232(2):200–6.
• Huang J, Shi Y, Pan W, Zhen W, Dong Y, Bai Y. Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients. Sci Rep 2020; 16(1):1–5.
• Hao Y, Zhang Z, Zhou F, Ji H, Tian Y, Guo Y, et al. Risk factors for implant failure in reverse oblique and transverse intertrochanteric fractures treated with proximal femoral nail antirotation ( PFNA ). J Orthop Surg Res 2019;4(49):10–7.
• Weller I, Wai EK, Jaglal S, Kreder HJ. Trauma the effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Jt Br 2005; 87(3):361–6.
• Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev 2010; (9):134–5.
• Nherera L, Trueman P, Horner A, Watson T, Johnstone AJ. Comparison of a twin interlocking derotation and compression screw cephalomedullary nail ( InterTAN ) with a single screw derotation cephalomedullary nail ( proximal femoral nail antirotation ): a systematic review and meta-analysis for intertrochanteric. J Orthop Surg Res 2018; 2;13(1):46.
• Anglen JO, Weinstein JN, American Board of Orthopaedic Surgery Research Committee. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am 2008;90(4):700–7.
• Haidukewych GJ, Berry DJ. Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg Am 2003;85(5):899–904.
• Birli T, Birle A. Proksimal femur kaynamamaları. TOTBİD Derg 2017;16:562–7.
• Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. Instr Course Lect 2010;59:503–9.
• Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am 1994;76(1):15–25.
• Aksu N, Işıklar ZU. Kalça Kırıkları. TOTBID Derg 2008;7:8–19.
• Chen DW, Lin C-L, Hu C-C, Tsai M-F, Lee MS. Biomechanical consideration of total hip arthroplasty following failed fixation of femoral intertrochanteric fractures - a finite element analysis. Med Eng Phys 2013;35(5):569–75.
• Weiss RJ, Beckman MO, Enocson A, Schmalholz A, Stark A. Minimum 5-year follow-up of a cementless, modular, tapered stem in hip revision arthroplasty. J Arthroplasty 2011;26(1):16–23.
• Langenhan R, Trobisch P, Ricart P, Probst A. Aggressive surgical treatment of periprosthetic femur fractures can reduce mortality: comparison of open reduction and internal fixation versus a modular prosthesis nail. J Orthop Trauma 2012;26(2):80–5.
• Garnavos C, Lasanianos N, Kanakaris NK, Arnaoutoglou C, Papathanasopoulou V, Xenakis T. A new modular nail for the diaphyseal fractures of the humerus. Injury 2009;40(6):604–10.
• Landry PS, Marino AA, Sadasivan KK, Albright JA. Bone injury response. An animal model for testing theories of regulation. Clin Orthop Relat Res 1996;(332):260–73.
• Frankel VH, Burstein AH. The biomechanics of refracture of bone. Clin Orthop Relat Res1968;60:221–5.
• Johnson BA, Fallat LM. The effect of screw holes on bone strength. J Foot Ankle Surg 1997;36(6):446–51.