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Original title:
Morphologische 3D Analyse der anatomischen Lage von drei Marknagelmodellen zur Versorgung proximaler Humerusfrakturen
Translated title:
Virtual Morphological Comparison of Three Intramedullary Nailing Systems for the Treatment of Proximal Humeral Fractures
Harnoß, Tobias
Document type:
Fakultät für Medizin
Stöckle, Ulrich (Prof. Dr.)
Stöckle, Ulrich (Prof. Dr.); Burgkart, Rainer H. H. (Priv.-Doz. Dr.); Neumeier, Dieter (Prof. Dr.)
Subject group:
MED Medizin
Unfallchirurgie, Humerus, proximal, Fraktur, virtuell, Morphologie, Lage
Translated keywords:
Trauma, surgery, proximal, humerus, morphologic, intrameullary, nailing
Ziel der vorliegenden Untersuchung war es, anhand einer neuartigen Methode drei Marknägel, die zur Versorgung proximaler Humerusfrakturen verwendet werden, zu untersuchen und zu vergleichen. Mittels 3D-Software wurden 25 digitalisierte Humeri virtuell frakturiert und mit den entsprechenden Marknägeln versorgt. Die Implantation wurde vermessen und in Kategorien eingeteilt. Es zeigten sich deutliche Unterschiede zwischen den einzelnen Fabrikaten, allen gemeinsam war jedoch ein geringer Abstand der...     »
Translated abstract:
In non- or slightly displaced two or three part fractures of the proximal humerus, intramedullary nailing is the standard fixation method although problems in screw positioning are not uncommon. The objective of this study was to compare the design of three intramedullary nails used for the treatment of proximal humeral fractures in a virtual system. The focus lied on the arrangement, position and orientation of the proximal screws and how osteosynthesis is influenced by anatomical variances of the proximal humerus. Twenty-five 3D models of the proximal humerus were generated out of reconstructed CT-data. Models of three commercially available intramedullary nails used for the treatment of proximal humeral fractures were used, Targon-PHN (Aesculap, Germany), T2-PHN (Stryker, Germany), proximal bent, short TriGen-PHN, (Smith & Nephew, USA). To simulate a real situation, the humerus was divided into 4-parts according to Neer's classification. Using computer-graphical methods the Nails were inserted in the humerus. Distances between the inserted screws and the fracture lines, as well as relevant anatomical structures were measured to evaluate the quality of the implantation. According to the measurements, osteosynthesis was possible for the 4-part fracture model in 54 out of 75 cases (72%). Problems were either the lower border of the lesser tubercle (71%) or the small distance of the screws to the sulcus intertubercularis (52%). Statistical analysis of the data revealed a significant correlation between the diameter of the anatomical neck and nail implantability (p<0.05). If the diameter is more than 42,2 mm, implantation will be successful in our collective (sensitivity: 100%, specifity 80%). Using a virtual system for implant testing the different implants can be inserted in one bone without damaging it. In that way a direct comparison of the implants is possible. Converting that method into a clinical setting, preoperative planning could be enhanced. For osteosynthesis of proximal humerus fractures, the arrangement of the proximal screws differed between the three examined nails. Shortcomings of the nails were the distances between the screws and the inferior fracture line of the lesser tubercle as well as the distance between the screws and the sulcus intertubercularis.
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