Özal ÖZCAN, Recep ALTIN, Gökhan MARALCAN, Feza KORKUSUZ, Teyfik DEMİR

FEMUR PERİPROSTETİK KIRIK TEDAVİSİNDE YENİ TASARLANMIŞ U ÇİVİLİ PLAĞIN ETKİNLİLİĞİ; KARŞILAŞTIRMALI BİYOMEKANİK ÇALIŞMA

AMAÇ: Osteoporozlu kemikte korteks medulla oranı azalmasına bağlı olarak vida ile tespitte yetersizlikler meydana gelmektedir. Periprostetik kırıkların tedavisinde plak-vida uygulamalarında termal nekroz, vida başında soğuk kaynak, gevşeme ve kemikte dolaşım bozukluğu görülebilir. Bu çalışmada yeni tasarladığımız U çivili plağın serklaj sistemleri ile karşılaştırılıp, periprostetik kırık tespitinde güvenle kullanılabileceğini test etmeyi amaçladık.GEREÇ VE YÖNTEM: Testler laboratuvar koşullarda numunelerin yorulma sınırlarını belirleyerek gerçekleştirilmiştir. U çivili model, kablo serklaj sistemi ve hibrit sistem olarak 3 farklı model grubu test edilmiştir.BULGULAR: Elde edilen sonuçlara göre 1. gruba yorulma direnci en düşük iken, 2. ve 3. grup arasında anlamlı fark bulunmamıştır. Elde edilen sonuçlar U çivili plak ve serklajla kombinasyonun sadece serklaj sistemine göre daha üstün olduğu görülmüştür.SONUÇ: Yeni geliştirilen U çivili plak sistemi sadece serklaj uygulanarak kırık fiksasyonundan daha etkili olduğu saptanmıştır. Periprostetik kırıklarda yeni implantın kullanımı biyomekanik olarak güvenlidir ancak uzun dönem klinik çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

U çivisi, Periprostatik femur kırığı, U çivili plak, vida

EFFICIENCY OF NEW DESIGNED U-NAIL PLATE FOR FEMUR PERIPROSTHETIC FRACTURE TREATMENT; COMPARATIVE BIOMECHANICAL STUDY

OBJECTIVE: Due to the decrease in the rate of bone cortex medulla with osteoporosis, insufficiency in screw fixation occurs. In the treatment of periprosthetic fractures, thermal necrosis, cold welding at the head of the screw, loosening and impaired bone circulation circulatory disturbance in the bone can be seen in plate-screw applications. In this study, we aimed to test the newly designed U-studded plate against cerclage systems and use it safely in the detection of periprosthetic fractures.MATERIAL AND METHODS: The tests were carried out by determining the fatigue limits of the samples in laboratory conditions. Three different model groups were tested as U-pin model, cable cerclage system and hybrid system.RESULTS: According to the results obtained, while the fatigue resistance was the lowest in the 1st group, there was no significant difference between the 2nd and 3rd groups. The results obtained have shown that the combination with U-pin plate and cerclage is superior to the cerclage system alone.CONCLUSIONS: The newly developed U-pin plate system was found to be more effective than fracture fixation by applying cerclage only. The use of the new implant is safe in periprosthetic fractures biomechanically whereas long term clinical studies should be necessary.

Keywords:

Periprostetic femur fracture, U nail, plate,

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1. Walcher MG, Giesinger K, du Sart R, Day RE, Kuster MS. Plate Positioning in Periprosthetic or Interprosthetic Femur Fractures With Stable Implants-A Biomechanical Study. J Arthroplasty. 2016;31(12):2894–9.
2. Whittaker RK, Zaghloul AM, Hothi HS, Siddiqui IA, Blunn GW, Skinner JA, et al. Clinical Cold Welding of the Modular Total Hip Arthroplasty Prosthesis. J Arthroplasty. 2017;32(2):610–5.
3. Siamos G, Winkler S, Boberick KG. Relationship between implant preload and screw loosening on implant-supported prostheses. J Oral Implantol. 2002;28(2):67–73.
4. Becker T, Weigl D, Mercado E, Katz K, Bar-On E. Fractures and refractures after femoral locking compression plate fixation in children and adolescents. J Pediatr Orthop. 32(7):e40-6.
5. Kim J-W, Park K-C, Oh J-K, Oh C-W, Yoon Y-C, Chang H-W. Percutaneous cerclage wiring followed by intramedullary nailing for subtrochanteric femoral fractures: a technical note with clinical results. Arch Orthop Trauma Surg. 2014 Sep;134(9):1227–35.
6. Parker MJ, Raghavan R, Gurusamy K. Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res. 2007 May;458:175–9.
7. Moore J, Berberian WS. Subaquatic reaming during arthrodesis of the first metatarsophalangeal joint to prevent thermal necrosis of bone. Orthopedics. 2014 Jun;37(6):389–91.
8. Shakouri E, Sadeghi MH, Karafi MR, Maerefat M, Farzin M. An in vitro study of thermal necrosis in ultrasonic-assisted drilling of bone. Proc Inst Mech Eng H. 2015 Feb;229(2):137–49.
9. Dennis MG, Simon JA, Kummer FJ, Koval KJ, DiCesare PE. Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem: a biomechanical study of 5 techniques. J Arthroplasty. 2000 Jun;15(4):523–8.
10. Zdero R, Walker R, Waddell JP, Schemitsch EH. Biomechanical evaluation of periprosthetic femoral fracture fixation. J Bone Joint Surg Am. 2008 May;90(5):1068–77.
11. Moazen M, Jones AC, Jin Z, Wilcox RK, Tsiridis E. Periprosthetic fracture fixation of the femur following total hip arthroplasty: A review of biomechanical testing. Clin Biomech. 2011;26(1):13–22.
12. Lewis GS, Caroom CT, Wee H, Jurgensmeier D, Rothermel SD, Bramer MA, et al. Tangential Bicortical Locked Fixation Improves Stability in Vancouver B1 Periprosthetic Femur Fractures: A Biomechanical Study. J Orthop Trauma. 2015 Oct;29(10):e364-70.