Abstract
OBJETIVO: Estudo experimental idealizado com o objetivo de se avaliar a estabilização primária das fraturas da diáfise umeral com três diferentes métodos de osteossíntese, representados por uma placa tipo DCP aplicada com técnica em ponte, uma síntese incomum, denominada SPS®, ainda sem similar na literatura, aplicada pela técnica em ponte, e um terceiro método constituído de uma haste intramedular com um método de bloqueio também incomum proporcionado por um parafuso cortical distalmente e por um fio do tipo Ender proximalmente. MATERIAL E MÉTODO: Vinte e um pares de úmeros humanos foram divididos em três grupos, utilizando-se um tipo de material para cada grupo, os quais foram submetidos a osteotomias, aos procedimentos de fixação e a ensaios não destrutivos de flexo-compressão e de torção, com limites de carga de 200N e de 100N, respectivamente e, num mecanismo de "crossing", foram submetidos secundariamente a novos ensaios de torção e de flexo-compressão, amparados por análise estatística. RESULTADOS: O grupo da placa DCP em ponte mostrou boa resistência às cargas aplicadas, o que também ocorreu no grupo do SPS®, que apesar de mostrar maiores índices de deflexão, apresentou grande capacidade elástica. O grupo da haste intramedular mostrou bons resultados nos ensaios de flexo-compressão, devido ao seu mecanismo de tutor, mas não demonstrou resistência às cargas de torção.
Highlights
Surgical treatments have been notably evolving since 1917, when Hoglund[1] described a method for autogenous bone transplantation providing intramedullary fixation in a femoral fracture by using a bone graft removed from his own femur
The search for an optimal fixation method still remains, both for lower and upper limbs’ bones. Both the intramedullary fixation with nails and osteosynthesis with plates evolved its designs and assemblies, giving rise to blocked nails, as described by many authors[5,6] proximally and distally blocked nails, and plates[7,8] changing the concepts of rigid fixation into “biological” fixation, giving priority to alignment without absolute stability and promoting union by stimulating bone callus formation, trying to minimize injuries on soft parts[9]. Based on this new concept of biological fixation, this study was aimed to test the relative stability of three different kinds of osteosyntheses in unstable humeral shaft fractures by means of mechanical flexion-compression and torsion assays
In biomechanical flexion-compression assays where the assemblies were submitted to forces of up to 200Nm the DCP bridge plate group showed deflexions ranging from 0.15588 mm to 0.4457 mm on primary experiment, and from 0.21914 mm to 0.34688 mm on secondary experiment
Summary
Surgical treatments have been notably evolving since 1917, when Hoglund[1] described a method for autogenous bone transplantation providing intramedullary fixation in a femoral fracture by using a bone graft removed from his own femur. The search for an optimal fixation method still remains, both for lower and upper limbs’ bones Both the intramedullary fixation with nails and osteosynthesis with plates evolved its designs and assemblies, giving rise to blocked nails, as described by many authors[5,6] proximally and distally blocked nails, and plates[7,8] changing the concepts of rigid fixation into “biological” fixation, giving priority to alignment without absolute stability and promoting union by stimulating bone callus formation, trying to minimize injuries on soft parts[9]. Based on this new concept of biological fixation, this study was aimed to test the relative stability of three different kinds of osteosyntheses in unstable humeral shaft fractures by means of mechanical flexion-compression and torsion assays
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