Biomechanical studies on the knee joint have shown that the mechanical stability of knee replacements can be improved by optimal reaming 5, 6. Nevertheless, if the endosteal diameter is reamed too forcefully, the primary reduction and retention may fail again or further fracture extensions or a new fracture morphology may be created 4.Īlso in the case of implantation of a cementless stem, especially in revision hip arthroplasties, medullary reaming of the femoral shaft section is an important part of the operation. Therefore, sufficiently extensive reaming of the intramedullary cavity to ensure a good fit of the appropriately large implant is of particular importance in order to improve the conditions for secondary fracture healing 2, 3. Torsional stiffness also improves with larger intramedullary nail size. For example, the material specifications such as stiffness and strength of a nail are proportional to its diameter. The shape and size of a nail are important factors in determining its mechanical properties. In principle, intramedullary nails create relative stability with the aim of secondary fracture healing and are now considered standard treatment for proximal and diaphyseal femoral fractures 1. In particular, classical osteosynthesis of the proximal femur requires sufficient anchoring and load-distributing properties of the inserted osteosynthesis material, especially in per-, inter- and subtrochanteric femoral fractures using gamma intramedullary nailing. Optimal preparation and reaming of the proximal femoral medullary cavity is prerequisite for certain surgical procedures in orthopedic-trauma surgery. Left-cutting reamers represent an alternative, using them in the usual clockwise-rotating technique to reduce the risk of complications during reaming. When preparing the proximal femoral medullary cavity, especially in cases with fragile bone structure, the available reamers should be introduced in opposite rotation to the cutting direction to achieve a more controllable feed of the reamer. In contrast, the mean torque during the reaming process was identical in all four groups. The feed rates of the reamers with rotation in the same direction as the cutting direction were significantly increased compared to rotation in the opposite cutting direction (CCRLC vs. In addition, the feed rate measurement was analyzed using a modified digital caliper. This was then used to determine the required torque. A specially constructed test system was used for this series of tests, with which the respective intramedullary channel were reamed step by step. Right- and left-cutting reamers with conical design were each introduced into five synthetic femurs in both clockwise and counterclockwise rotation with constant feed force. The aim of this biomechanical study is to evaluate the best combination of a right- or left-cutting reamer with a clockwise- or counterclockwise-rotating insert in terms of preparation and safety. Design and direction of rotation of the reamer are potential influencing factors. The use of reamers sometimes exerts high torsional forces on the bone. In linear algebra, a rotation matrix is a transformation matrix that is used to perform a rotation in Euclidean space.Preparation of the femoral proximal medullary cavity by reaming is essential for intramedullary nail osteosynthesis and hip revision arthroplasty.
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