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\nshaun t fit kids club free downloadAssessment of intramedullary nailing using the \"best\" axis of the femoral diaphysis in osteoporotic patients: a biomechanical study.\nThe objective of this study was to determine if a method could be established to assess and determine whether the use of an intramedullary nail should be considered in the treatment of femoral fractures in osteoporotic patients. A biomechanical study based on a finite element analysis was performed to compare the first and second moments of the area around the femoral midshaft in both normal and osteoporotic human femurs. Osteoporosis was simulated by introducing a decrease in bone density (30%) of the femoral cortical bone to values similar to those observed in postmenopausal patients. The objective was to assess the influence of the osteoporotic and normal bone-tissue properties on the first and second moments of the area about the femoral midshaft for all configurations of the intramedullary nail system. The intramedullary nail was placed either in a central position with a load on the axis perpendicular to the axis of the femoral bone or in an eccentric position with the axis of the nail aligned with the axis of the bone. For the central position of the nail, the forces acting on the femoral head in the femoral cortical bone were found to be greatest in osteoporotic specimens, whereas in normal specimens, the forces were greatest in the bone-tissue interstices adjacent to the nail. For eccentric configurations, the results were similar to those in normal specimens, with the exception of the conditions in which the nail was aligned with the axis of the femoral bone. With the eccentric loading, the force acting on the femoral head in osteoporotic specimens was found to be greater than in the normal specimens. The results of this study indicate that the eccentric position of an intramedullary nail system is more suitable than the central position of an intramedullary nail system for the treatment of osteoporotic femoral fractures. The eccentric loading has less risk of intrapelvic fracture, and the eccentric configuration also provides significantly lower forces acting on the femoral head when compared with forces in the central configuration.Arbiters can now recognize and distinguish shapes at the level of microns.
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