Dong-Young Je, Ji Wan Kim, Sung-Jae Lee, Chul-Ho Kim
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Additionally, the peak von Mises stress (PVMS) in the cortical bone, cancellous bone of the femoral head, and the nail were measured, and the yielding risk for each subject was investigated.</p><p><strong>Results: </strong>Long nails were associated with less interfragmentary motion. In the cortical bone, the PVMS of short nails was observed at the distal locking screw holes of the femoral medial cortex; however, in long nails, the PVMS was observed at the lag screw holes on the lateral cortex. The mean yielding risk of long nails was 40.1% lower than that of short nails. For the cancellous bone of the femoral head, the PVMS in all 9 FE models was in the same area: at the apex of the femoral head. There was no difference in the yielding risk between short and long nails. For implants, the PVMS was at the distal locking screw hole of the nail body in the short nails and the nail body at the fracture level in the long nails. The mean yielding risk was 74.9% lower for long nails than that for short nails.</p><p><strong>Conclusions: </strong>Compared to short nails, long nails with a length of 320 mm or more showed less interfragmentary motion and lower yielding risk in low-level osteoporotic ST fractures. The FE analysis supports long nails as a safer option than short nails, especially for treating transverse-type low-level osteoporotic ST fractures.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 3","pages":"363-373"},"PeriodicalIF":1.9000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11130630/pdf/","citationCount":"0","resultStr":"{\"title\":\"What is the Optimal Nail Length to Treat Osteoporotic Subtrochanteric Fractures? 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Additionally, the peak von Mises stress (PVMS) in the cortical bone, cancellous bone of the femoral head, and the nail were measured, and the yielding risk for each subject was investigated.</p><p><strong>Results: </strong>Long nails were associated with less interfragmentary motion. In the cortical bone, the PVMS of short nails was observed at the distal locking screw holes of the femoral medial cortex; however, in long nails, the PVMS was observed at the lag screw holes on the lateral cortex. The mean yielding risk of long nails was 40.1% lower than that of short nails. For the cancellous bone of the femoral head, the PVMS in all 9 FE models was in the same area: at the apex of the femoral head. There was no difference in the yielding risk between short and long nails. For implants, the PVMS was at the distal locking screw hole of the nail body in the short nails and the nail body at the fracture level in the long nails. The mean yielding risk was 74.9% lower for long nails than that for short nails.</p><p><strong>Conclusions: </strong>Compared to short nails, long nails with a length of 320 mm or more showed less interfragmentary motion and lower yielding risk in low-level osteoporotic ST fractures. 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引用次数: 0
摘要
背景：髓内钉固定手术治疗仍是骨质疏松性转子下（ST）骨折的首选治疗方法；然而，对于合适的髓内钉长度仍未达成共识。我们旨在利用三维有限元（FE）分析确定安全固定骨质疏松性 ST 骨折的最佳钉长：使用 9 种不同长度的头髓内钉（短钉：170 毫米、180 毫米和 200 毫米；长钉：170 毫米、180 毫米和 200 毫米；短钉：170 毫米、180 毫米和 200 毫米；长钉：170 毫米、180 毫米和 200 毫米）构建了 9 种有限元模型：方法： 使用 9 种不同长度的头髓骨钉（短钉：170、180 和 200 毫米；长钉：280、300、320、330 毫米）构建了 9 种 FE 模型：280、300、320、340、360 和 380 毫米）。分析了节间运动。此外，还测量了皮质骨、股骨头松质骨和钉子的峰值 von Mises 应力（PVMS），并调查了每个受试者的屈服风险：结果：长钉与较小的骨节间运动有关。在皮质骨中，短钉的 PVMS 在股骨内侧皮质的远端锁定螺钉孔处观察到；但在长钉中，PVMS 在外侧皮质的滞后螺钉孔处观察到。长钉的平均屈服风险比短钉低 40.1%。就股骨头松质骨而言，所有 9 个 FE 模型的 PVMS 都位于相同的区域：股骨头顶点。短钉和长钉的屈服风险没有差异。就植入物而言，短钉的PVMS位于钉体远端锁定螺钉孔处，长钉的PVMS位于钉体骨折水平处。长钉的平均屈服风险比短钉低74.9%：结论：与短钉相比，长度为 320 毫米或以上的长钉在低位骨质疏松性 ST 骨折中显示出较小的节间运动和较低的屈曲风险。有限元分析支持长钉是比短钉更安全的选择，尤其是在治疗横向型低位骨质疏松性 ST 骨折时。
What is the Optimal Nail Length to Treat Osteoporotic Subtrochanteric Fractures? A Finite Element Analysis.
Background: Operative management with intramedullary nail fixation remains the definitive treatment of choice for osteoporotic subtrochanteric (ST) fractures; however, there remains no consensus regarding the proper nail length. We aimed to use 3-dimensional finite element (FE) analysis to determine the optimal nail length for the safe fixation of osteoporotic ST fractures.
Methods: Nine modes of FE models were constructed using 9 different lengths of cephalomedullary nails (short nails: 170, 180, and 200 mm; long nails: 280, 300, 320, 340, 360, and 380 mm) from the same company. The interfragmentary motion was analyzed. Additionally, the peak von Mises stress (PVMS) in the cortical bone, cancellous bone of the femoral head, and the nail were measured, and the yielding risk for each subject was investigated.
Results: Long nails were associated with less interfragmentary motion. In the cortical bone, the PVMS of short nails was observed at the distal locking screw holes of the femoral medial cortex; however, in long nails, the PVMS was observed at the lag screw holes on the lateral cortex. The mean yielding risk of long nails was 40.1% lower than that of short nails. For the cancellous bone of the femoral head, the PVMS in all 9 FE models was in the same area: at the apex of the femoral head. There was no difference in the yielding risk between short and long nails. For implants, the PVMS was at the distal locking screw hole of the nail body in the short nails and the nail body at the fracture level in the long nails. The mean yielding risk was 74.9% lower for long nails than that for short nails.
Conclusions: Compared to short nails, long nails with a length of 320 mm or more showed less interfragmentary motion and lower yielding risk in low-level osteoporotic ST fractures. The FE analysis supports long nails as a safer option than short nails, especially for treating transverse-type low-level osteoporotic ST fractures.
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