Nurgeldi Manap

Background: Acetabular fractures are complex injuries of the hip joint. Careful design of fixation plates is crucial for achieving stable osteosynthesis, especially in patients with poor bone quality. Finite element analysis (FEA) is widely used for biomechanical evaluation of orthopedic implants. Objective: The aim of this study was to perform a comparative finite element analysis of three acetabular plate designs differing in bridge geometry and to identify the configuration with the most favourable biomechanical performance. We hypothesized that a plate with two parallel bridges would provide more favourable stress distribution and a higher safety factor compared to single-bridge and non-parallel-bridge designs. Methods: A three-dimensional model of the pelvic bone was reconstructed from CT data. Three titanium alloy (Ti-6Al-4V, thickness 2.5 mm) plates with different bridge configurations (single bridge, two parallel bridges, two non-parallel bridges) were virtually implanted using CAD software (KOMPAS-3D, Autodesk Inventor). The FEA model included cortical and cancellous bone with mechanical properties taken from the literature. A load of 250 N applied at 15° to the inner plate surface simulated partial weight-bearing in the early postoperative period. Von Mises equivalent stress, linear displacement, and safety factor were evaluated. Results: Maximum von Mises equivalent stresses were 207 MPa for the single-bridge plate, 170 MPa for the two-parallel-bridge plate, and 344 MPa for the two-non-parallel-bridge plate. The corresponding minimum safety factors were 1.33, 1.62, and 0.8. The obtained stress values are consistent with findings from similar studies. Conclusion: The plate with two parallel bridges exhibited the highest safety factor and appears to be the most promising candidate for further experimental evaluation based on the present computational findings. The single-bridge and two-non-parallel-bridge designs require further design modification, particularly in the bridge cross-sections, because of their lower static safety margins. FEA is a useful tool for comparative biomechanical assessment of implant designs.

Aims. To evaluate the efficacy of the modified Stoppa approach for surgical treatment of pelvic bone injuries based on clinical (sex distribution, fracture type), surgical (duration of operation, intraoperative blood loss, incision length, quality of reduction), and functional outcome (hip joint function). Materials and methods. A total of 31 patient were included in a retrospective cohort study from 2019 until March 2022 with various injuries of acetabulum in the N.D. Batpenov National Scientific Center of Traumatology and Orthopaedics (NSCTO).The inclusion criteria for this study were: patients with acetabulum injuries, and who underwent surgical interventions using one of two surgical approaches (modified Stoppa, ilioinguinal approaches), patients over 18 years old. Exclusion criteria: other operative approaches to pelvic bones and patients under 18 years of age. 21 patients underwent surgery with the use of modified Stoppa approach (group A) and 10 surgeries were performed using the ilioinguinal approach (group B). Efficiency was evaluated by comparison of duration of surgical procedures, amount of blood lossbetween groups, size of skin incision, quality of reduction and functional outcomes. Results. There are males – 18(58.1%), females – 13(41.9%) in the study. The clinical study results showed that average volume of intraoperative blood loss and size of skin incision were significantly less during Stoppa approach then ilioinguinal approach though average duration of surgical procedures did not reveal significant differences between two groups. Average duration of surgical procedures did not reveal significant differences between two groups – 109.5 min (±54.7) among group A and 126 min (±58.9) in group B. The volume of intraoperative blood loss averaged 338±254.5 ml of blood for the total sample. The volume of intraoperative blood loss was 525.0 ±322.5 ml of blood in group B, which is more than twice the estimated blood loss for group A (250 ±157.3 ml). When using a Stoppa approach, the length of the cutaneous surgical incision averaged at 8.8 ± 1.5 cm, while with an ilioinguinal approach, this value was estimated at 20.6 ± 8.5 cm, which suggests a favorable cosmetic effect of Stoppa approach. Conclusion. The positive results obtained with the modified Stoppa approach, which are reflected in a reduction in the length of the skin incision and the amount of intraoperative blood loss, suggest that the use of this approach in clinical practice provides an opportunity to improve the surgical treatment of acetabular fractures by obtaining variability in the study of surgical approach. Nevertheless, the frequency and complexity of the occurring pelvic bone injuries dictate the need for further search and improvement of more optimal access options for surgical treatment.

Ұршық ойығының сынықтары өте күрделі сынықтардың бірі болып табылады және оны емдеу травматолог-ортопед дәрігерлер үшін қиын мәселе болып табылады. Ұршық ойығы сынықтарын хирургиялық емдеу туралы алғашқы деректер 1943 жылы жазылған болатын. 1964 жылы R.Judet, J.Judet және E.Letournel ұршық ойығы сынықтарын емдеуге арналған хирургиялық кескіндер мен классификация жүйесін сипаттайтын белгілі мақаласы жарық көрген. Аталмыш ілімі ұршық ойығы сынықтарын хирургиялық бекітуден кейінгі клиникалық нәтижелерге айтарлықтай ықпал етті. Letournel 1980 жылы 80% жақсы және үздік нәтижелер көрсетсе, Matta 2012 жылы хирургиялық емнен кейін 79% жақсы нәтижелерге қол жеткізген. Letournel ақыры дәлелдегендей, сынықтың анатомиялық репозициясы клиникалық нәтижені болжауға мүмкіндік беретін ең ықпалды фактор болып табылады. Соңғы жылдары жамбас және ұршық ойығы хирургиясында көптеген жетістіктерге қол жеткізілді. Дегенмен, бұл жетістіктерге қарамастан, мамандар әлі де ұршық ойығы сынықтарын хирургиялық емдеудегі нәтижелерді жақсарту үшін аянбай еңбек етуде.

This study aimed to share our experience of a self-developed plate for acetabular fracture fixation through the presentation of clinical cases. Eight