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Physiologically Based Treatments
Published in Verna Wright, Eric L. Radin, Mechanics of Human Joints, 2020
The socket and femoral head generally deform during the course of osteoarthrosis, with progressive subluxation or sometimes protrusio acetabuli. The articular surfaces are or tend to be congruent in full adduction only (Fig. 7). Under such conditions a valgus intertrochanteric osteotomy is the treatment of choice. The procedure takes advantage of the osteophyte that has developed medially over the femoral head. Involving the medial osteophyte in the force transmission enlarges the weight-bearing surface of the joint (Fig. 12). The overall force R is decreased by division of the psoas tendon and part of the adductor and abductor muscles (3,4).
A finite element analysis study based on valgus impacted femoral neck fracture under diverse stances
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Haowei Zhang, Xinsheng Xu, Shenghui Wu, Ying Liu, Jiong Mei
As the average life expectancy of the population has increased, the incidence of osteoporotic fractures has increased significantly. Among them, hip fractures are the most serious of osteoporotic fractures due to the high disability rate. Hip fractures account for 12% of adult fractures. Among hip fractures, about 50% are femoral neck fractures, of which valgus impacted femoral neck fractures account for 15% to 29%. Colles first reported three cases of valgus impacted femoral neck fractures in 1818, and found that this type of fracture had a better prognosis than complete fractures, and described it as an incomplete fracture. According to the Garden classification method, valgus impacted is type I. Clinically, valgus impacted femoral neck fractures are divided into non-displaced fracture types. Although valgus impacted femoral neck fractures are classified as non-displaced fractures, clinical studies have found that such fractures are sometimes unstable and may have significant displacement. There are many treatment methods for valgus impacted femoral neck fractures, including non-surgical treatment, in situ internal fixation, closed/open reduction and internal fixation, and joint replacement. Among them, internal fixation of femoral neck fractures can significantly reduce the rate of re-displacement of the fracture, as low as 0% to 3%. Biomechanical experiments have confirmed that the use of internal fixation can promote the differentiation of bone stem cells into osteoblasts after surgery, significantly promote the growth of new blood vessels, and promote fracture healing (Garden 1961). The case used in this article uses three parallel partially threaded hollow screws, which is performed in an inverted triangle configuration. Multiple parallel hollow screws are fixed at the fracture site to produce compression and promote fracture healing, but it will shorten the femoral neck, shorten the abduction arm, and affect the abduction muscle strength. Therefore, some studies have found that severe femoral neck shortening leads to weakened abductor muscle strength and poor lower limb dysfunction. Meanwhile, patients are usually point out the postoperative pain and other symptoms after a certain exercise in the postoperative follow-up visit.