Abstract
BackgroundAlthough use of a dynamic hip screw (DHS) for stable intertrochanteric hip fracture fixation has been successfully applied in fracture healing for more than 20 years, DHS fixation on unstable intertrochanteric fractures still has a high failure rate, especially in patients with osteoporosis. Although the wire fixation is usually incorporated with orthopedic device to treat fracture, the wiring techniques are developed through experiences. Thus, this study is objective to investigate the biomechanical property of different wire fixation methods incorporated with DHS system to provide the lesser trochanter fragment stable fixation on osteoporotic TypeA2.1 fracture for enhancing stability after bone reduction.ResultsSawbone testing results demonstrated higher maximum load, stiffness, and energy in a DHS with wire fixation compared with DHS fixation only. In static biomechanical testing of a cadaver femur, we compared the stiffness of five fixation models and then tested a fatigue failure model in cycle loading with DHS fixation only. Wiring fixation can enhance stability and the cut-out failure model in the fatigue test was identical to the clinical failure model.ConclusionsLesser trochanteric fragment fixation is a crucial concern in the stability of an A2.1 unstable fracture, and the combination of a wiring technique with a DHS seems beneficial for achieving better stability. The addition of an antirotational greater trochanter is likely to enhance stability through wiring of the greater trochanter.
Highlights
Osteoporotic fractures are a major cause of morbidity in the older population
A crack appeared in the insert hole of the side plate and the head fragment had a rotational movement in the dynamic hip screw (DHS) fixation only and DHS with wire experiments
Wire fixations were purposed to restore the posteromedial buttress by restricting less trochanter fragment with wire
Summary
Osteoporotic fractures are a major cause of morbidity in the older population. Taiwan has the highest hip fracture rate in Asia, with incidence rates of 392 per 100,000 in women and 196 per 100,000 in men [1]. Hip fractures are composed of femoral neck and pertrochanteric fractures. The principal treatment for hip fracture in older patients is surgery [3]. Most femoral neck fractures are treated using arthroplasty, whereas regarding pertrochanteric fractures, injuries such as intertrochanteric fractures require internal fixation [4]. Use of a dynamic hip screw (DHS) for stable intertrochanteric hip fracture fixation has been successfully applied in fracture healing for more than 20 years, DHS fixation on unstable intertrochanteric fractures still has a high failure rate, especially in patients with osteoporosis. This study is objective to investigate the biomechanical property of different wire fixation methods incorporated with DHS system to provide the lesser trochanter fragment stable fixation on osteoporotic TypeA2.1 fracture for enhancing stability after bone reduction
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