El fenómeno de cut-out en fractura intertrocantérica de fémur: análisis mediante modelo de elementos finitos

Abstract

Objetive: This work aimed to analyze the cut-out phenomenon, which involves oblique displacements and/or rotations of the femoral head around the cephalic component of the intramedullary nail. The analysis was carried out using finite element numerical models. This technique seeks to understand the failure of this type of fixation and establish what positioning of the system favors or prevents failure due to cut-out. Material and methods: The study was carried out on a numerical model of the proximal limb of an artificial femur and an intramedullary nail type PFNA (proximal femoral nail anti-rotation). In the numerical model, the position of the intramedullary nail was varied in the anterior/posterior and superior/inferior directions to analyze the influence of the position on the cut-out phenomenon. Stresses in critical areas and torque on the nail under normal position loading were analyzed. Results: The most critical position was the one in which the intramedullary nail is placed in the superior position, due to the high compressions that appear in the trabecular bone of the femoral head. The centered position of the nail decreased the risk of bone damage and the torque that the intramedullary nail has to support. Conclusions: This type of model allows us to simulate the influence of the nail position and obtain variables that are otherwise difficult to analyze. Although it is a simple model with static load, it confirms that a centered position of the intramedullary nail reduces the risk of cut-out.