Analisis Deiksis Dialek Kedah

Abstract

OBJECTIVES:: This study compared the torsional properties of stable intertrochanteric femur fractures in a cadaveric bone model utilizing two different distal fixation strategies: unlocked long cephalomedullary nailing versus dynamically locked nailing.METHODS:: 14 matched pairs of cadaveric femora were randomly assigned to one of two distal fixation treatment groups; a single distal interlock screw placed in the dynamic orientation or no distal screw fixation. A stable two part intertrochanteric fracture was produced. Specimens were potted and mounted in a double gimbal fixture facilitating unconstrained motion in the sagittal and coronal planes. Specimens were cyclically loaded dynamically in both internal and external rotation. Range of motion, internal and external rotation stiffness, torsion stiffness, torsion yield and ultimate torsion magnitude were calculated.RESULTS:: The samples instrumented with a distal locking screw reported statistically significantly greater internal (1.54 ± 0.81Nm/° versus 1.08 ± 0.35Nm/°, p = 0.026) and external rotational stiffness (1.42 ± 0.72Nm/° versus 0.86 ± 0.36Nm/°, p = 0.009). Samples with locked distal fixation were statistically stiffer and displayed statistically less displacement at the yield and peak torque. The yield torque was statistically significantly higher in the samples without distal fixation (14.2 ± 3.3Nm versus 10.6 ± 3.8Nm, p = 0.037). The peak torque was comparable between locked an unlocked samples (15.0 ± 4.6Nm versus 16.2 ± 4.2Nm, p = 0.492).CONCLUSION:: Distal locking of femoral intramedullary nails increases the stiffness of the nail-femur construct. Unlocked samples displayed statistically significant higher yield torque while maintaining comparable peak torque as the locked samples. This study indicates that treating stable intertrochanteric fractures with unlocked, long intramedullary nails may be an acceptable option, although further clinical study will be needed to test this assertion.