XXVI SICOT TRIENNIAL WORLD CONGRESS

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Presentation transcript:

XXVI SICOT TRIENNIAL WORLD CONGRESS BIOMECHANICAL ANALYSIS OF OSTEOSYNTHESIS IN UNSTABLE FEMORAL NECK FRACTURES Hip Surgeons: MD. Marcelo Ferrer; MD. Anderson Freitas; MD. Patrick Godinho; MD. George Neri MD. Diogo Ranier

XXVI SICOT TRIENNIAL WORLD CONGRESS BIOMECHANICAL ANALYSIS OF OSTEOSYNTHESIS IN UNSTABLE FEMORAL NECK FRACTURES Don’t have Conflict of interest

XXVI SICOT TRIENNIAL WORLD CONGRESS BIOMECHANICAL ANALYSIS OF OSTEOSYNTHESIS IN UNSTABLE FEMORAL NECK FRACTURES Acknowledgment Orthopedics fellows at the regional hospital of Gama ( HRG - DF)

BIOMECHANICAL ANALYSIS OF OSTEOSYNTHESIS IN UNSTABLE FEMORAL NECK FRACTURES Objectives To statistically analyse the results obtained in the biomechanical tests of four methods for the fixation of unstable femoral neck fractures using osteoporotic synthetic bones, and to compare these results with a control group for suggesting the most biomechanically stable method.

Results of Internal Fixation of Pauwels Type-3 Vertical Femoral Neck Fractures Frank Liporace, MD; Robert Gaines, MD; Cory Collinge, MD; George J.Haidukewych, MD J Bone Joint Surg Am, 2008 Aug 01;90(8):1654-1659. http://dx.doi.org/10.2106/JBJS.G.01353

Results of Internal Fixation of Pauwels Type-3 Vertical Femoral Neck Fractures Liporace, J Bone Joint Surg Am, 2008 Aug 01;90(8):1654-1659. 95 patients with mean age 45 19% Nounion with screws 8% Nounion with Fixed angle divece 11% Osteonecrosis

Results of Internal Fixation of Pauwels Type-3 Vertical Femoral Neck Fractures Liporace, J Bone Joint Surg Am, 2008 Aug 01;90(8):1654-1659. 95 patients with mean age 45 19% Nounion with screws 8% Nounion with Fixed angle divece 11% Osteonecrosis

Separated in 5 groups with 5 units Materials and Methods Separated in 5 groups with 5 units

Materials and Methods 1° - Step Density analysis in all synthetic bone

Materials and Methods 1° - Step Density analysis in all synthetic bone

Materials and Methods 1° - Step Density analysis in all synthetic bone

Materials and Methods 1° - Step Density analysis calculate the uncertainty Mass Volume Density

Materials and Methods 1° - Step Density analysis calculate the uncertainty Mass Volume Density

Materials and Methods 1° - Step Density analysis calculate the uncertainty Mass Volume Density

Mean density all the sintetics bones = 0.1520 g/cm³ Materials and Methods 1° - Step Density analysis Mean density all the sintetics bones = 0.1520 g/cm³

Materials and Methods 2 ° - Step ( Analysis in the control group ) Length analysis for the femoral neck fracture originate in the control group The load and extension displacement values for the femoral neck fracture originate in the control group.

Materials and Methods 2° - Step Length analysis

Materials and Methods 2° - Step Length analysis

Materials and Methods 2° - Step Length analysis

Materials and Methods 2° - Step Length analysis

Materials and Methods 2° - Step Length analysis

Materials and Methods 2° - Step Length analysis

Materials and Methods 2° - Step Length analysis

The control group length = 150 mm Materials and Methods 2° - Step Length analysis for the femoral neck fracture originate in the control group The control group length = 150 mm

The control group Load mean = 1329 N Materials and Methods 2° - Step * The load values Control Group Unit Máx. Load (N) 1 1544 2 1110 3 1359 4 1194 5 1437 Mean 1329 SD 177 The control group Load mean = 1329 N

The control group extension = 10.86 mm Materials and Methods 2° - Step * Extension displacement The control group extension = 10.86 mm

Materials and Methods 3° - Step ( Preparation the test groups ) osteotomy 70° ( Pauwels III ) Fixations ( DHS, cannulated screws type1, cannulated screws type2, DCS ) X- Ray Rotational control tag

Materials and Methods 3° - Step ( Preparation the test groups ) osteotomy 70° ( Pauwels III )

Materials and Methods 3° - Step ( Preparation the test groups ) Fixations DHS + anti-rotational screw

Materials and Methods 3° - Step ( Preparation the test groups ) Fixations Cannulated screws Type 1 ( ASNIS )

Materials and Methods 3° - Step ( Preparation the test groups ) Fixations Cannulated screws Type 2 ( No parallel )

Materials and Methods 3° - Step ( Preparation the test groups ) Fixations DCS

Materials and Methods 3° - Step ( Preparation the test groups ) X- Ray

Materials and Methods 3° - Step ( Preparation the test groups ) Rotational control tag

Materials and Methods 4° - Step (Biomechanical analysis in the test groups )

Results Control Group Max Load (N) 1544 1110 1359 1194 1437 1329 Unit Max Load (N) 1 1544 2 1110 3 1359 4 1194 5 1437 Mean 1329 Standard Desviation 177

Results DHS Group Control Max Load (N) 2064 1544 1895 1110 1682 1359 Unit Max Load (N) 1 2064 1544 2 1895 1110 3 1682 1359 4 1713 1194 5 1354 1437 Mean 1742 1329 Standard Desviation 265 177

Results DHS Group CS 1 Control Max. Load (N) 2064 860 1544 1895 607 Unit Max. Load (N) 1 2064 860 1544 2 1895 607 1110 3 1682 614 1359 4 1713 658 1194 5 1354 743 1437 Mean 1742 696 1329 Standard Desviation 265 106 177

Results DHS Group CS1 Goup CS2 Control Max. Load (N) 2064 860 640 1544 Unit Max. Load (N) 1 2064 860 640 1544 2 1895 607 555 1110 3 1682 614 801 1359 4 1713 658 593 1194 5 1354 743 655 1437 Mean 1742 696 649 1329 Standard Desviation 265 106 94 177

Results DHS Group DCS CS1 Goup CS2 Control Max. Load (N) 2064 1438 860 Unit Max. Load (N) 1 2064 1438 860 640 1544 2 1895 1409 607 555 1110 3 1682 1323 614 801 1359 4 1713 1186 658 593 1194 5 1354 1321 743 655 1437 Mean 1742 1335 696 649 1329 Standard Desviation 265 98 106 94 177

Results DHS Group DCS CS1 CS2 UNIT Rotation (mm) Rotation degrees 1 1,5 4,90 0,1 0,33 1,0 3,27 2,2 7,16 2 1.0 0,0 0,5 1,64 1,1 3,60 3 0,8 2,62 1,6 5,22 4 0,2 0,66 1,7 5,55 2,0 6,52 1,2 3,29 5 0,3 0,98 Mean 0,67 2,42 0,42 1,37 1,02 3,33 1,20 3,79 Standard Desviation 0,62 1,81 0,72 2,37 0,81 2,63 2,03

Kruskal–Wallis ANOVA analysis Dunn’s multiple comparison test ( 5%) Results Statistical analysis Kruskal–Wallis ANOVA analysis The significant difference in the maximum force for 10-mm dislocation was observed between the groups (p = 0.0006). Dunn’s multiple comparison test ( 5%) DHS > DCS ≈ control > PC1 ≈ PC2

There was no statistical difference with control group DHS DCS Conclusion There was no statistical difference with control group DHS DCS Statistical difference with control group CS1 CS2

Dunn’s multiple comparison test ( 5%) Results Statistical analysis Dunn’s multiple comparison test ( 5%) DHS > DCS ≈ control > PC1 ≈ PC2

*WAS ROTATIONAL DEVIATIONS IN ALL GROUPS Conclusion BUT *WAS ROTATIONAL DEVIATIONS IN ALL GROUPS

THANKS