Background: Lesser trochanter avulsions are rare injuries in adolescents. Severe cases with relevant fragment displacement can be treated surgically. However, no standard approach is available in the literature. Operative techniques are presently limited to anterograde fixations. A new retrograde approach to reduce operative difficulty and postoperative morbidity has been proposed. So far, no biomechanical comparison of these techniques is available. Hypothesis: Retrograde repair of the lesser trochanter with a titanium cortical button will produce superior stability under load to failure and similar displacement under cyclic loading compared with anterograde fixation with titanium suture anchors. Study Design: Controlled laboratory study. Methods: Sixteen paired hemipelvic cadaveric specimens (mean age, 62.5 ± 10.7 years) were dissected to isolate the lesser trochanter and iliopsoas muscle. After repair of a simulated lesser trochanter avulsion, specimens were tested under cyclic loading between 10 and 125 N at 1 Hz for 1500 cycles before finally being loaded to failure at a rate of 120 mm/min in a material testing machine. Motion tracking was used to assess displacement at the superior and inferior aspects of the iliopsoas tendon under cyclic loading. Results: Load to failure was significantly greater for the retrograde repair compared with the anterograde repair (1075.24 ± 179.39 vs 321.85 ± 62.45 N; P = .012). Mean displacement at the superior repair aspect (retrograde vs anterograde: 3.29 ± 1.84 vs 4.39 ± 4.50 mm; P = .779) and mean displacement at the inferior aspect (3.54 ± 2.13 vs 4.22 ± 4.48 mm; P = .779) of the iliopsoas tendon did not significantly differ by the type of repair. Mode of failure was tendon tearing by the sutures for each retrograde repair and anchor pullout for each anterograde repair. Conclusion: Surgical repair of lesser trochanter avulsion fractures with retrograde fixation using a titanium cortical button demonstrated superior load to failure and similar displacement under cyclic loading compared with anterograde fixation using suture anchors. Clinical Relevance: The retrograde approach provides a biomechanically validated alternative to other surgical techniques for this injury.
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机译：背景：较少的Trochanter撕裂是青少年的罕见伤害。可以手术治疗相关片段位移的严重病例。但是，文献中没有任何标准方法。操作技术目前限于前后固定。提出了一种新的逆行方法，以减少手术难度和术后发病率。到目前为止，没有可获得这些技术的生物力学比较。假设：与钛皮质按钮的逆行修复较小的脱叶，在与钛缝合锚固锚固锚固锚固件相比，循环负载下的负荷和类似的位移会产生卓越的稳定性。研究设计：受控实验室研究。方法：解剖16次成对的半纤维尸体标本（平均年龄，62.5±10.7岁），分离较小的Trochanter和Iliopsoas肌肉。在修复模拟的较低的脱毛撕裂后，在1Hz的循环载荷下在10和125n的环状加载下进行试样1500个循环，然后在材料试验机中以120mm / min的速率加载到失效。运动跟踪用于评估髂腰肌肌腱在循环载荷下的上下方面的位移。结果：与逆行修复相比，对逆行修复的负荷显着大幅度（1075.24±179.39 Vs 321.85±62.45 n; p = .012）。在高级修复方面的平均位移（逆行Vs anterograde：3.29±1.84 Vs 4.39±4.50 mm; p = .779）和下方的平均位移（3.54±2.13 Vs 4.22±4.48 mm; p = .779） Iliopsoas Tenton的修复类型没有显着差异。故障模式是由每个逆行修复的缝合线撕裂，每个逆行修复和锚杆拉出。结论：使用钛皮质按钮具有逆机固定的较少拖曳者撕脱骨折的手术修复，与使用缝合锚定的前瓣固定相比，逆行固定逆行固定在循环负载下的载体和相似的位移。临床相关性：逆行方法为这种伤害的其他手术技术提供了生物力学验证的替代方案。
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