BIOMECHANICAL COMPARATIVE STUDY ON PROXIMAL FEMORAL LOCKING PLATE AND Gamma3 FOR TREATMENT OF STABLE INTERTROCHANTERIC FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIANGWei ,  LIUYuehong , YANGLing , XUWei , LIUShuping , ZHANGDesheng , CHENXi , WANGHong

Department of Orthopaedics, Deyang People's Hospital, Deyang Sichuan, 618000, P. R. China;

Corresponding author：

LIUYuehong, Email: liuyuehong@vip.sina.com

Keywords：

Stable intertrochanteric fracture; Internal fixation; Biomechanics

DOI：

10.7507/1002-1892.20140239

Video：

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Objective To compare the biomechanical properties between the proximal femoral locking plate and Gamma3 for fixing stable intertrochanteric fracture so as to provide a theoretical basis for selecting internal fixation in the clinical application. Methods Five pairs of antiseptic femur specimens were selected. Specimens of each pair of matching were randomly divided into groups A and B (n=5). All specimens were made the intertrochanteric fracture of 31A1.1 type according to AO/Association for the Study of Internal Fixation (AO/ASIF) classification. Fracture was fixed with Gamma3 in group A and with proximal femoral locking plate in group B. The axial compression, destruction, and torsion tests were carried out on the mechanical testing machine. Results Axial compression test:The load-displacement curve of groups A and B was basically a straight line; axial stiffness of groups A and B was (621.00±36.48) N/mm and (542.55±46.94) N/mm respectively, showing significant difference (t=3.648, P=0.036). Destruction test:The maximum yield load of groups A and B was (4 394.82±450.37) N and (2 987.54±112.14) N respectively, showing significant difference (t=5.433, P=0.032). After loading maximum yield load, femoral fracture occurred again, and internal fixation and bone interface loosening were observed in group A; bending and breaking of proximal locking screw for internal fixation were found in group B, but loosening of internal fixation and bone interface was more obvious in group A than in group B. Torsion test:The torque of specimens in 2 groups increased with the increase of torsion angle (P < 0.05), the torque corresponding to the torsion angle in group B was larger than that in group A, but the difference was not significant (P > 0.05). The torsional stiffness of groups A and B was (1.78±0.16) N·mm/deg and (2.01±0.08) N·mm/deg respectively, showing no significant difference (t=-3.833, P=0.162). Conclusion Proximal femoral locking plate and Gamma3 in the treatment of stable intertrochanteric fracture have good biomechanical properties, which can meet the requirements of minimal invasion, strong internal fixation, and early activity.

Citation： JIANGWei, LIUYuehong, YANGLing, XUWei, LIUShuping, ZHANGDesheng, CHENXi, WANGHong. BIOMECHANICAL COMPARATIVE STUDY ON PROXIMAL FEMORAL LOCKING PLATE AND Gamma3 FOR TREATMENT OF STABLE INTERTROCHANTERIC FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(9): 1096-1099. doi: 10.7507/1002-1892.20140239 Copy

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2.	van Embden D, Rhemrev SJ, Meylaerts SA, et al.The comparison of two classifications for trochanteric femur fractures:the AO/ASIF classification and the Jensen classification.Injury, 2010, 41(4):377-381.
3.	Peleg E, Mosheif R, Liebergall M, et al.A short plate compression screw with diagonal bolts-a biomechanical evaluation performed experimentally and by numerical computation.Clin Biomech (Bristol, Avon), 2006, 21(9):963-968.
4.	谭三智, 黄桂填.DHS和PFN治疗股骨粗隆间骨折的疗效分析.实用医学杂志, 2010, 26(18):3395-3396.
5.	鲁英, 罗先正.203例股骨粗隆间骨折治疗分析.骨与关节损伤杂志, 1991, 6(1):7-9.
6.	S.Terry Canale, James H.Beaty, 等.坎贝尔骨科手术学.王岩, 译.11版.北京:人民军医出版社, 2009:2538-2539.
7.	Bojan AJ, Beimel C, Speitling A, et al.3066 consecutive gamma nails.12 years experience at a single centre.BMC Musculoskelet Disord, 2010, 11:133.
8.	Liu M, Yang Z, Pei F, et al.A meta-analysis of the Gamma nail and dynamic hip screw in treating peritrochanteric fractures.Int Orthop, 2010, 34(3):323-328.
9.	徐耀增, 耿德春, 王现彬, 等.防旋股骨近端髓内钉与第三代Gamma钉治疗老年股骨转子间骨折的对比研究.中华创伤杂志, 2011, 27(1):33-37.
10.	胡力.股骨转子间骨折的内固定器应用进展.中国矫形外科杂志, 2013, 21(10):989-992.
11.	Zha GC, Chen ZL, Qi XB, et al.Treatment of pertrochanteric fracture with a proximal femur locking compression plate.Injury, 2011, 42(11):1294-1299.
12.	李必奎, 陈周兵, 徐富生.股骨近端锁定钢板治疗股骨转子间骨折.中国修复重建外科杂志, 2011, 25(10):1273-1275.
13.	Seral B, García JM, Cegoñino J, et al.Finite element study of intramedullary osteosynthesis in the treatment of trochanteric fractures of the hip:Gamma and PFN.Injury, 2004, 35(2):130-135.
14.	Sitthiseripratip K, Van Oosterwyck H, Vander Sloten J, et al.Finite element study of trochanteric gamma nail for trochanteric fracture.Med Eng Physics, 2003, 25(2):99-106.
15.	刘瑞波, 白音, 孔令英, 等.力臂式外固定器治疗股骨粗隆间骨折实验研究和临床应用.中国骨伤, 1999, 12(2):20-23.
16.	Rydell N.Biomechanics of the hip-joint.Clin Orthop Relat Res, 1973, (92):6-15.
17.	Norris R, Bhattacharjee D, Parker MJ.Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures:a systematic review of 13, 568 patients.Injury, 2012, 43(6):706-711.
18.	张波, 潘显明, 权毅, 等.三种内固定器治疗股骨颈骨折的临床观察及生物力学分析.西南国防医药, 2002, 12(3):210-212.
19.	孙强, 许平安, 郑加法.三种手术方式固定不稳定性股骨转子间骨折的生物力学研究.中华创伤杂志, 2012, 28(12):1078-1082.
20.	Windolf J, Hollander DA, Hakimi M, et al.Pitfalls and complications in the use of the proximal femoral nail.Langenbecks Arch Surg, 2005, 390(1):59-65.

1. 王亦璁, 姜保国.骨与关节损伤.5版.北京:人民卫生出版社, 2012:1160-1163.
2. van Embden D, Rhemrev SJ, Meylaerts SA, et al.The comparison of two classifications for trochanteric femur fractures:the AO/ASIF classification and the Jensen classification.Injury, 2010, 41(4):377-381.
3. Peleg E, Mosheif R, Liebergall M, et al.A short plate compression screw with diagonal bolts-a biomechanical evaluation performed experimentally and by numerical computation.Clin Biomech (Bristol, Avon), 2006, 21(9):963-968.
4. 谭三智, 黄桂填.DHS和PFN治疗股骨粗隆间骨折的疗效分析.实用医学杂志, 2010, 26(18):3395-3396.
5. 鲁英, 罗先正.203例股骨粗隆间骨折治疗分析.骨与关节损伤杂志, 1991, 6(1):7-9.
6. S.Terry Canale, James H.Beaty, 等.坎贝尔骨科手术学.王岩, 译.11版.北京:人民军医出版社, 2009:2538-2539.
7. Bojan AJ, Beimel C, Speitling A, et al.3066 consecutive gamma nails.12 years experience at a single centre.BMC Musculoskelet Disord, 2010, 11:133.
8. Liu M, Yang Z, Pei F, et al.A meta-analysis of the Gamma nail and dynamic hip screw in treating peritrochanteric fractures.Int Orthop, 2010, 34(3):323-328.
9. 徐耀增, 耿德春, 王现彬, 等.防旋股骨近端髓内钉与第三代Gamma钉治疗老年股骨转子间骨折的对比研究.中华创伤杂志, 2011, 27(1):33-37.
10. 胡力.股骨转子间骨折的内固定器应用进展.中国矫形外科杂志, 2013, 21(10):989-992.
11. Zha GC, Chen ZL, Qi XB, et al.Treatment of pertrochanteric fracture with a proximal femur locking compression plate.Injury, 2011, 42(11):1294-1299.
12. 李必奎, 陈周兵, 徐富生.股骨近端锁定钢板治疗股骨转子间骨折.中国修复重建外科杂志, 2011, 25(10):1273-1275.
13. Seral B, García JM, Cegoñino J, et al.Finite element study of intramedullary osteosynthesis in the treatment of trochanteric fractures of the hip:Gamma and PFN.Injury, 2004, 35(2):130-135.
14. Sitthiseripratip K, Van Oosterwyck H, Vander Sloten J, et al.Finite element study of trochanteric gamma nail for trochanteric fracture.Med Eng Physics, 2003, 25(2):99-106.
15. 刘瑞波, 白音, 孔令英, 等.力臂式外固定器治疗股骨粗隆间骨折实验研究和临床应用.中国骨伤, 1999, 12(2):20-23.
16. Rydell N.Biomechanics of the hip-joint.Clin Orthop Relat Res, 1973, (92):6-15.
17. Norris R, Bhattacharjee D, Parker MJ.Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures:a systematic review of 13, 568 patients.Injury, 2012, 43(6):706-711.
18. 张波, 潘显明, 权毅, 等.三种内固定器治疗股骨颈骨折的临床观察及生物力学分析.西南国防医药, 2002, 12(3):210-212.
19. 孙强, 许平安, 郑加法.三种手术方式固定不稳定性股骨转子间骨折的生物力学研究.中华创伤杂志, 2012, 28(12):1078-1082.
20. Windolf J, Hollander DA, Hakimi M, et al.Pitfalls and complications in the use of the proximal femoral nail.Langenbecks Arch Surg, 2005, 390(1):59-65.

Chinese Journal of Reparative and Reconstructive Surgery

BIOMECHANICAL COMPARATIVE STUDY ON PROXIMAL FEMORAL LOCKING PLATE AND Gamma3 FOR TREATMENT OF STABLE INTERTROCHANTERIC FRACTURE

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