ABSTRACT
BACKGROUND@#The reverse obliquity inter-trochanteric fracture is a distinct fracture pattern that is mechanically different from most inter-trochanteric fractures and the optional treatment of it is still controversial. The purpose of this study was to compare differences in the efficacy of a novel nail (medial support nail [MSN-II]) and proximal femoral nail anti-rotation (PFNA-II) in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association [AO/OTA] 31-A3.1) using finite-element analysis.@*METHODS@#Modeling software was used to establish a three-dimensional model of MSN-II and PFNA-II and an A3.1 inter-trochanteric fracture model. Abaqus software was used to implement different force loads to compare finite-element biomechanical parameters such as the maximum stress in implant and the displacement of fracture site.@*RESULTS@#The femoral stress, implant stress and fracture site displacement of MSN-II was less than that of PFNA-II. The results indicated that the maximal femoral stress was 581 MPa for PFNA-II and 443 MPa for the MSN-II. The maximum stress values in the PFNA-II and MSN-II models were 291 and 241 MPa, respectively. The maximal displacements of the fracture site were 1.47 and 1.16 mm in the PFNA-II and MSN-II models, respectively.@*CONCLUSION@#Compared with PFNA-II for inter-trochanteric fracture (AO/OTA 31-A3.1), MSN-II which was designed with a triangular stability structure can provide better biomechanical stability. The MSN-II may be a feasible option for the treatment of reverse obliquity inter-trochanteric fracture.
Subject(s)
Humans , Bone Nails , Femur , Finite Element Analysis , Fracture Fixation, Intramedullary , Hip Fractures/surgery , Treatment OutcomeABSTRACT
OBJECTIVE@#A3 intertrochanteric fracture is an extremely unstable fracture, which is often treated with intramedullary nail, but the implant failure is common due to the posterior medial fragment cannot be reconstructed. A new medial sustainable nail (MSN-Ⅱ) which can reconstruct the femoral medial support by sustainable screw was introduced in this study. The mechanical effect was verified by biomechanical experiment.@*METHODS@#The loss medial support model of intertrochanteric fracture (A3) was made by artificial Sawbones model, fixed with MSN-Ⅱ and PFNA-Ⅱ, underwent axial loading and axial failure tests. The axial stiffness, yield load, displacement of head-neck fragment and torsional angle of fracture site of these nails were recorded and compared for biomechanical differences. The effect of early reconstruction of medial support with MSN-Ⅱ was determined.@*RESULTS@#The axial stiffness, yield load, the displacement of head and neck fragment when the axial load was 1 800 N and torsional angle of the fracture site after the axial failure test of MSN-Ⅱ were (222.76 ±62.46) N /mm, (4 241.71 ±847.42) N, (11.51 ±0.62) mm, (1.71 ±0.10)° respectively, while the PFNA -Ⅱ was (184.58±40.59) N /mm, (3 058.76±379.63) N, (16.15±1.36) mm, (2.52±0.26)°respectively. The difference between the two groups was statistically significant.@*CONCLUSION@#The axial stiffness of MSN-Ⅱ is better than that of PFNA-Ⅱ. The MSN-Ⅱ can bear more loads when fixed A3.3 intertrochanteric fracture and has greater axial and rotational stability. It is an effective means to reconstruct the medial support of A3 intertrochanteric fracture.
Subject(s)
Humans , Biomechanical Phenomena , Bone Nails , Bone Screws , Femur , Fracture Fixation, Intramedullary , Hip Fractures/surgeryABSTRACT
<p><b>OBJECTIVE</b>To study the effect of Chinese drugs for supplementing qi-blood and nourishing Gan-Shen (CD) on transforming growth factor beta1 (TGF beta1) and sex hormone levels in the follicle fluid of women during in vitro fertilization-embryo transfer (IVF-ET) cycle.</p><p><b>METHODS</b>Eighty-six women undergoing IVF-ET were randomly assigned to two groups, 45 in the CD group and 41 in the control group. All received the standard regimen for promoting ovulation, but to women in the CD group, 1-week treatment of Cuhuangti Granule was administered during the period of gonadotropin releasing hormone agonist (GnRH-a) down-regulation, and Jinghou Zengzhi Granule was given from time of ovulation promoting with Gn to the day of HCG administration. On the day of oocyte retrieval, TGFbeta1 was detected using enzyme linked immunosorbent assay (ELISA), estradiol (E2), progestone (P), and luteinizing hormone (LH) detected by radioimmunoassay.</p><p><b>RESULTS</b>Follicle fluid contents of TGFbeta1 and LH in the CM group (3.25 +/- 1.11 pg/L and 0.89 +/- 0.45 IU/L) were obviously higher than those in the control group (2.21 +/- 1.08 pg/L and 0.57 +/- 0.42 IU/L, both P < 0.05).</p><p><b>CONCLUSION</b>Chinese drugs for supplementing qi-blood and nourishing Gan-Shen could significantly improve TGFbeta1 and LH levels in the follicle fluid of women, thus enhancing the embryo implantation rate.</p>