Tran TN, Warwas S, Haversath M, Classen T, Hohn HP, Jäger M, Kowalczyk W, Landgraeber S. Experimental and computational studies on the femoral fracture risk for advanced core decompression.
Clin Biomech (Bristol, Avon) 2014;
29:412-7. [PMID:
24629519 DOI:
10.1016/j.clinbiomech.2014.02.001]
[Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/19/2014] [Accepted: 02/07/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND
Two questions are often addressed by orthopedists relating to core decompression procedure: 1) Is the core decompression procedure associated with a considerable lack of structural support of the bone? and 2) Is there an optimal region for the surgical entrance point for which the fracture risk would be lowest? As bioresorbable bone substitutes become more and more common and core decompression has been described in combination with them, the current study takes this into account.
METHODS
Finite element model of a femur treated by core decompression with bone substitute was simulated and analyzed. In-vitro compression testing of femora was used to confirm finite element results.
FINDINGS
The results showed that for core decompression with standard drilling in combination with artificial bone substitute refilling, daily activities (normal walking and walking downstairs) are not risky for femoral fracture. The femoral fracture risk increased successively when the entrance point is located further distal. The critical value of the deviation of the entrance point to a more distal part is about 20mm.
INTERPRETATION
The study findings demonstrate that optimal entrance point should locate on the proximal subtrochanteric region in order to reduce the subtrochanteric fracture risk. Furthermore the consistent results of finite element and in-vitro testing imply that the simulations are sufficient.
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