64410 20190709135624.0 doi 10.1016/S0020-1383(17)30794-5 sideral 103583 ART-2017-103583 eng (orcid)0000-0002-2934-1525 Gabarre, S. Influence of screw combination and nail materials in the stability of anterograde reamed intramedullary nail in distal femoral fractures 2017 Access copy available to the general public Unrestricted Intramedullary nailing (IM) is a technique universally accepted to treat femoral diaphyseal fractures. The treatment of fractures located in the distal third remains a controversial issue though. A finite element model of the femur has been developed, analyzing distal fractures with several gap sizes combined with different interlocking combinations of distal screws with one oblique screw proximally to stabilize the intramedullary nail. The mechanical strength of the nail against bending and compression efforts was also studied. Beside the FE simulations, a clinical follow-up of 15 patients, 6 males and 9 females, with mean age of 53.2 years was carried out. Localizations of fractures were 10 in the right femur and 5 in the left femur, respectively. A fairly good correspondence agreement between clinical results and the simulated fractures in terms of gap size was found. Non-comminuted fractures had a mean consolidation time of 20.5 weeks (4.8 months), a tendency corresponding well to the mobility obtained in the FE simulations; Comminuted fractures on the other hand exhibited a higher mean consolidation period of 22.2 weeks (5.2 months) secondary to the excessive mobility at fracture site obtained by means of FE simulations. The best stability at fracture site was found for the system with three distal screws and the system with two distal screws placed medial lateral. The highest leverage of distal screws was obtained maximizing the distance between them and choosing the coronal plane for their orientation. The results obtained with both nail materials (stainless steel and titanium alloy) show a higher mobility when using titanium nails. Steel nails provide stiffer osteosyntheses than the titanium nails. In conclusion, the best screw combination in terms of stability to produce fracture healing and the least difficulties during treatment is the one which had one oblique proximal screw with two distal lateral screw implanted in the coronal plane. info:eu-repo/grantAgreement/ES/MINECO/DPI2016-77745-R info:eu-repo/semantics/openAccess by-nc-nd http://creativecommons.org/licenses/by-nc-nd/3.0/es/ 2.199 2017 EMERGENCY MEDICINE 8 / 26 = 0.308 2017 Q2 T1 ORTHOPEDICS 31 / 77 = 0.403 2017 Q2 T2 SURGERY 76 / 200 = 0.38 2017 Q2 T2 CRITICAL CARE MEDICINE 21 / 33 = 0.636 2017 Q3 T2 0.99 2017 Emergency Medicine 2017 Q1 Surgery 2017 Q1 Orthopedics and Sports Medicine 2017 Q1 info:eu-repo/semantics/article info:eu-repo/semantics/acceptedVersion (orcid)0000-0003-4489-3130 Albareda, J. Universidad de Zaragoza (orcid)0000-0001-7944-9625 Gracia, L. Universidad de Zaragoza (orcid)0000-0002-3613-4209 Puértolas, S. Universidad de Zaragoza (orcid)0000-0003-0785-4132 Ibarz, E. Universidad de Zaragoza (orcid)0000-0002-8643-7558 Herrera, A. Universidad de Zaragoza 1004 830 Universidad de Zaragoza Dpto. Cirugía,Ginecol.Obstetr. Área Traumatología y Ortopedia 5004 605 Universidad de Zaragoza Dpto. Ingeniería Mecánica Área Mec.Med.Cont. y Teor.Est. 48, Suppl. 6 (2017), S47-S53 Injury INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 0020-1383 389485 http://zaguan.unizar.es/record/64410/files/texto_completo.pdf Postprint 40493 http://zaguan.unizar.es/record/64410/files/texto_completo.jpg?subformat=icon icon Postprint oai:zaguan.unizar.es:64410 articulos driver 2019-07-09-12:29:57 ARTICLE