Salter Harris Tip 4 Distal Femoral Epifiz Kırıklarında Dört Farklı Konfigürasyonun Biyomekanik Etkileri

Bu çalışmada, distal femurun Salter Harris (SH) Tip 4 epifiz kırığında redüksiyon sonrası stabilizasyon için kullanılan Parallel Kirshner telleri (K teli), Parallel vidalar, Üstte K teli-Altta vida, Üstte vida-Altta K teli olmak üzere 4 farklı konfigürasyonun, aksiyel, rotasyonel ve eğme kuvvetleri altında, biyomekanik etkilerini tanımlayıp hangisinin daha avantajlı olduğu araştırıldı. 4 farklı konfigürasyon SolidWorks programı ile modellendi ve bilgisayar destekli sayısal analizler sonlu elemanlar yazılımı ile gerçekleştirildi. Herbir konfigürasyon için, ağ süreci, sınır şartları ve malzeme modeli sonlu elemanlar yazılımında uygulandı. Buna ek olarak, epifiz plağının gelişimindeki von-Mises gerilme değerleri, vidalar ve K-tellerindeki gerilme değerleri hesaplanmıştır.Frontal, sagittal ve transvers düzlemde bükme (varus-valgus açılımı, ön-arka açısal kapanma) ve burulma kuvvetleri altındaki fizis çizgi üzerinde tüm konfigürasyonlarda gerilme değerlerinde genel olarak yakın bir eğilim vardır. Eksenel kuvvetler düşünüldüğünde, en yüksek gerilme, fisizte paralel K-telleri konfigürasyonunda bulunurken, en düşük gerilme paralel vida konfigürasyonunda bulundu.Paralel vida konfigürasyonunda fiksasyon tipinin kullanılması avantajlı bulunmuştur.Ek olarak, SH tipi 4 epifiz kırıklarında, K-teli konfigürasyonunda fiksasyon tipi dezavantajlı bulunmuştur.

Biomechanical effects of four different configurations in salter harris type 4 distal femoral epiphyseal fractures

In this study, the biomechanicaleffects of four different configurations (Parallel K wires, Parallel Screw, Upper K wire-LowerScrew, Upper Screw-Lower K wire), which are used for stabilizing Salter-Harris (SH) Type 4 epiphyseal fracture of distal femurafter reduction process, on the epiphyseal plate has been investigated under axial, rotational and bendingforces in order to determinethe most advantageous configuration. The fourdifferent configurations have been modeled by using SolidWorks and computeraided numerical analyses were performed by finite element analysis software. The mesh process, boundary conditions and materialmodel have been applied in finite element analysis software for each configuration. In addition, von-Mises stress values onepiphyseal plate, screws and K wires have been calculated. There is a general near trend on stress values in all configurations onphysis line under bending (varus-valgus angulation, anterior-posterior angulation) and torsional forces in the frontal, sagittal andtransverse plane respectively. Considering the axial forces, the highest stress was found on parallel K- wires configuration in physiswhile the lowest stress was found in parallel screw configuration. It has been found particularly advantageous to use fixation typein parallel screw configuration. In addition, in SH type 4 epiphyseal fracture, fixation type is found to be disadvantageous in Kwire configuration.

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