Abstract
BackgroundCephalomedullary Nail (CMN) is seen as the mainstay of internal fixation in femoral fractures. The purpose of the study was to present an accurate calculation method by simulating diverse anterior bow femoral models with finite element software. We hypothesized that anterior cortical penetration in distal femur would occur in patients whose femoral anterior bow was identified as too large for nailing by preoperative measurement of contralateral X-ray.MethodsA 31-year healthy male was selected for building 3D bone model through computed tomography (CT) scan of right femoral femur. In Creo Parametric 2.0, the middle section of the femur was twisted gradually to simulate the different femoral anterior bow. Ratio of chord height and half chord length, belonging to the middle section arc, was defined as the tangent value of the femoral anterior bow. The value corresponding to the penetration of the CMN at the distal femur was regarded as critical value, showing the extreme curvature for CMN.ResultThree types of right femoral CMNs (ø10, 11, 12 mm × 350 mm; Smith-Nephew Co.) were involved in our study. The CMN passed through distal femur anterior cortex when the tangent value of the femoral anterior bow are 0.140185, 0.133073, 0.092415 respectively, and the corresponding central angle are 21.72°, 20.92°, 16.32°.ConclusionsThe tangent value of the femoral anterior bow would be a precise calculated method, that eliminate the deviation by description of ratio rather than length of radius. An application of this preoperative evaluation can aid surgeons during surgical planning.Trial registrationRetrospectively registered.
Highlights
Cephalomedullary Nail (CMN) is seen as the mainstay of internal fixation in femoral fractures
The tangent value of the femoral anterior bow would be a precise calculated method, that eliminate the deviation by description of ratio rather than length of radius
Cephalomedullary nailing (CMN) is a widely used technique in the management of femoral fractures; [1] including fractures located beneath the less trochanter, 9 cm above the knee joint, when the fragments are multi-section or smashed
Summary
Cephalomedullary Nail (CMN) is seen as the mainstay of internal fixation in femoral fractures. The purpose of the study was to present an accurate calculation method by simulating diverse anterior bow femoral models with finite element software. We hypothesized that anterior cortical penetration in distal femur would occur in patients whose femoral anterior bow was identified as too large for nailing by preoperative measurement of contralateral X-ray. The anterior bow of the femur can affect the insertion of CMN [3]. The purpose of this study was to investigate the influence of femur anterior bow on nail insertion by simulating different radius of the femur anterior bow with the finite element method and to device the concept of the tangent value of femoral anterior bow as a convenient evaluation method to express the curvature of the. That means plate devices or short nails were preferred rather than long CMNs when the penetration was predicted
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