Journal of Musculoskeletal Trauma

Original Articles

The Effects of Extramedullary Reduction in Unstable Intertrochanteric Fracture: A Biomechanical Study Using Cadaver Bone: Young Chang Park, Soon Phil Yoon, Kyu Hyun Yang; J Korean Fract Soc 2018;31(3):79-86. Published online July 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.3.79

PURPOSE
To prevent excessive sliding and subsequent fixation failures in unstable intertrochanteric fractures with posteromedial comminution, extramedullary reduction through overlapping of the anteromedial cortices of both proximal and distal fragments as a buttress has been introduced. The purpose of this study was to compare the biomechanical properties between two reduction methods-intramedullary reduction and extramedullary reduction-in treating unstable intertrochanteric fractures with posteromedial comminution (AO/OTA classification 31-A2.2).
MATERIALS AND METHODS
Eight pairs of frozen human cadaveric femora were used. The femora of each pair were randomly assigned to one of two groups: the intramedullary reduction group or the extramedullary reduction group. A single axial load-destruction test was conducted after cephalomedullary nailing. Axial stiffness, maximum load to failure, and energy absorbed to failure were compared between the two groups. Moreover, the pattern of mechanical failure was identified.
RESULTS
The mean axial stiffness in the extramedullary reduction group was 27.3% higher than that in the intramedullary reduction group (422.7 N/mm vs. 332.0 N/mm, p=0.017). Additionally, compared with the intramedullary reduction group, the mean maximum load to failure and mean energy absorbed to failure in the extramedullary group were 44.9% and 89.6% higher, respectively (2,848.7 N vs. 1,966.5 N, p=0.012 and 27,969.9 NÂ·mm vs. 14,751.0 NÂ·mm, p=0.012, respectively). In the intramedullary reduction group, the mechanical failure patterns were all sliding and varus deformities. In the extramedullary reduction group, sliding and varus deformities after external rotation were noted in 3 specimens, sliding and varus deformities after internal rotation were noted in 3 specimens, and medial slippage was noted in 2 specimens.
CONCLUSION
In unstable intertrochanteric fractures with posteromedial comminution, the biomechanical properties of extramedullary reduction are superior to those of intramedullary reduction. Anteromedial cortex could be the proper buttress, despite a comminuted posteromedial cortex. It could help enhance the stability of the bone-nail construct.

Citations

Citations to this article as recorded by

Which side should be taken care of when positioning a lag screw in intertrochanteric femoral fracture: right or left?
Min Uk Do, Kyeong Baek Kim, Sang-Min Lee, Hyun Tae Koo, Won Chul Shin
European Journal of Trauma and Emergency Surgery.2025;[Epub] CrossRef
Distal locking mechanism influences surgical and radiological outcomes in proximal femoral nailing using distal wedge versus distal screw designs
Aytek Hüseyin Çeliksöz, Büşra Tokmak, Ali Okan Tarlacık, Servet Igrek
Scientific Reports.2025;[Epub] CrossRef
The effect of anterior support screw (AS2) in unstable femoral trochanteric fractures: A multicenter randomized controlled trial
Takashi Maehara, Takashi Hayakawa, Shunsuke Mukoyama, Yoshihisa Anraku, Takahiro Hamada, Hiroyuki Suzuki, Takeshi Doi, Tomohiko Shimizu, Masanori Yorimitsu, Hidefumi Teramoto, Takao Mae, Yasunori Okamoto, Jun Hara, Kazushi Mihara, Koichi Kanekasu
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Anteromedial cortical support reduction of intertrochanteric fractures–A review
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Journal of Bone and Joint Surgery.2024; 106(11): 1008. CrossRef
Five states of reduction in OTA/AO A1.3 intertrochanteric fractures of the femur a biomechanical study
Shu Li, Yong-Gang Bao, Rong-Hua Tian, Chun-Yang Meng, Hai-Bin Wang, Bin Wu, Xian-Min Bu
BMC Musculoskeletal Disorders.2024;[Epub] CrossRef
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Seok Ha Hong, Kang Hun Yu, Seung Beom Han
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Clinical and Radiologic Outcome of Intertrochanteric Fracture Treatment Using TFNA (Trochanteric Fixation Nail-Advanced)
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BMC Musculoskeletal Disorders.2020;[Epub] CrossRef
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Mechanical Properties of External Fixator according to Its Arrangement and Structure: Hong Jun Han, Byung Chang Lee, Yeung Jin Kim, Byung Soo Jin, Gun Hyee Lee; J Korean Soc Fract 2000;13(1):38-45. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.38

Abstract PDF: PURPOSE
To obtain the accurate knowledge of the fundamental mechanical properties of the external fixator affected by variations in arrangements and structures. We used newly developed external fixator, Anyfix, universal testing machine and plastic padding bone model which had similar structural properties to human tibia. The measured performance for seven different configurations of external fixators was its ability to control the motion of the bone fragment at the fracture site. Based on a unit of applied load, the corresponding displacement measured at the fracture site was used to described the stiffness of the fixation device for each load. Three stiffness moduli can be determined as axial stiffness, anterior posterior bending stiffness and lateral bending stiffness.
RESULTS
In basic configuration, all three stiffnesses for unilateral two plane external fixator showed marked increase than those for unilateral one plane model. Axial compression stiffness and bending stiffness were increased when ring component were located far from the fracture site. In modified configuration, all three stiffnesses were increased when the number of pin was increased and small sized ring was used.
CONCLUSION
The stiffness of the external fixator can be substantially increased by using unilateral two plane, locating the ring at far portion from the fracture site, using a small sized ring and increasing the number of pins.

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Biomechanical study of rigidity in the domestic external fixator preliminary report about the mechanical charateristics of the domestic product comparing with the imported fixators: Joo Chul Ihn, Young Il Youm, Il Key Lee, Myeun Whan Ahn, Jong Chul Ahn, Se Dong Kim, Do Sik Choo; J Korean Soc Fract 1991;4(1):147-153. Published online May 31, 1991; DOI: https://doi.org/10.12671/jksf.1991.4.1.147

Abstract PDF: No abstract available.

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