Luigi La Barbera, Atsuki Tanaka, Francesca Berti, Guido Antonini, Tomaso Villa
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Biomechanical comparison between three intramedullary nails and percutaneous compression plate in stable and unstable trochanteric fractures.
Background: The best surgical treatment of trochanteric fractures remains controversial and biomechanical literature lacks a comprehensive study. The study compares the behavior of fixation implants for the treatment trochanteric fractures, namely: intramedullary gamma nail, proximal femoral nail, veronail, and extramedullary percutaneous compression plate.
Methods: The implants were virtually inserted into 3D femur digital twins characterized by stable and unstable trochanteric fractures. Loadings simulated walking condition without and with crutches, respectively, for stable and unstable fractures. Stresses below the yield point quantified implant safety. Constructs' stiffness, principal strains, and the load-sharing on the fracture rims demonstrated the biomechanical advantages of fixation implant in restoring a physiological condition by comparison with the intact femur.
Findings: All implants are safe. Extramedullary plate and proximal femoral nail allowed to better recover the stiffness of the intact femur in the unstable fracture model, and the load acting along the fracture decreased respectively between 17 % and 44 % compared to stable fracture model. The minimum and maximum strain distribution was qualitatively similar for all devices, with extramedullary plate and gamma nail showing strains in the posteromedial area getting closer to the intact condition in stable fracture model. The compressive strains in the unstable fracture model treated with extramedullary plate were closer to the intact condition.
Interpretation: All investigated devices could be safely used for stable and unstable intertrochanteric fractures. The extramedullary plate may present some biomechanical advantage with unstable fractures.
期刊介绍：
Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field.
The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management.
A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly.
Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians.
The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time.
Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.
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