Biomechanical analysis of peri‑implant fractures in short versus long cephalomedullary implants following pertrochanteric fracture consolidation

Breceda, Adam; Sands, Andrew K.; Schopper, Clemens; Schader, Jana Felicitas; Gehweiler, Dominic; Mischler, Dominic; Richards, R. Geoff; Gueorguiev, Boyko

doi:10.1016/j.injury.2020.09.037

Cited by 11 publications

(6 citation statements)

References 22 publications

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Section: Discussionmentioning

confidence: 99%

“…11,12 Moreover, from a biomechanical perspective, the risk of secondary periprosthetic fractures after intramedullary fixation of peritrochanteric fractures is similar when using short or long nails. 13 Postoperative cut out of the lag screw was the unsolved problem, and the occurrence was reported to be 1.0 to 6.9% in the meta-analysis. 14 No significant differences concerning changes in tip to apex distance of the lag screw and angulation of the fracture line after cyclic loading were observed among groups.…”

Section: Discussionmentioning

confidence: 99%

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Biomechanical Comparisons of Trochanteric Hip Fracture Fixation Using Short-, Mid-, and Long-Length Proximal Femoral Nails

Matsumura

Takahashi²,

et al. 2022

Geriatr Orthop Surg Rehabil

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Introduction For trochanteric hip fractures, proximal femoral nails (PFNs) have been frequently used for surgical treatment. No study has clarified whether length of the nail affected the wiper motion; the repetitive motion of the distal nail inside canal after surgery. Methods Thirty synthetic femora were used to biomechanically evaluate construct lateral angular movement of 3 different lengths of PFN [TFN-ADVANCED Proximal Femoral Nailing System (TFNA) 170 (short-length), 235 (mid-length), and 300 (long-length) mm] constructs for the fixation of stable pertrochanteric fractures. Cyclic testing and radiological evaluation were performed to investigate the loosening patterns in 3 different fixation constructs. Migration along the mechanical axis during the cyclic testing from 1-100th, 100-500th, 500-1000th, 1000-1500th, and 1500-2000th cycles was compared between TFNA lengths. Also, before and after cycling changes in tip to apex distance, angulation of fracture line, and lateral angular movement of the distal stem inside the canal were compared between TFNA lengths. Results Migration along the mechanical axis during cyclic loading, plus changes after cycling in tip to apex distance, and fracture line angulation did not differ between TFNA lengths for the fixation of stable intertrochanteric fracture model using synthetic femora. Conversely, one-way analysis of variance revealed a significant difference in lateral angular movement of the distal stem inside the canal after cyclic testing between groups (1.4 ± 1.6°, .21 ± .35°, and .26 ± .57° in 170-mm short nail, 235-mm middle nail, and 300-mm long nail, respectively; P = .026), and post-hoc analysis also revealed that middle nail yielded significantly less lateral angular movement compared with short nail ( P = .047) but did not significantly differ from the long nail. Conclusions Mid-length TFNA for the fixation of stable trochanteric hip fracture model using synthetic femora resulted in significantly smaller lateral angular movement of the distal stem after cyclic loading.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Biomechanical Comparisons of Trochanteric Hip Fracture Fixation Using Short-, Mid-, and Long-Length Proximal Femoral Nails

Matsumura

Takahashi²,

et al. 2022

Geriatr Orthop Surg Rehabil

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“…Peri-implant fractures around the tip of nail as well as diaphyseal fracture risk and anterior cortical penetration are well known risk factors of short PFN [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Management of Short Proximal Femur Nail Peri Peri-Implant Fracture of Femur Shaft with Implant Removal and Long Distal Femur Locking Plate and Bone Grafting – A Case Report

Mahajan¹,

Ghoti²,

Patil³

et al. 2022

JOCR

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Introduction:The rising demographic trend towards elderly population and increased incidence of osteosynthesis of proximal femur fractures are associated with increased recurrent falls and rise in incidence of peri- implant fractures. Case Report: Here, we present a difficult case of a peri- implant femur shaft fracture in a 55-year-old male, with stuck short proximal femur nail (PFN) removal followed by long distal femur plating with bone grafting showing good fracture union at 1 year with satisfactory functional outcome. Conclusion:Peri- implant femur fractures are quite rare and more commonly occur in elderly. Among all treatment modalities for intertrochanteric femur fracture fixation, the literature shows short PFN having highest comparative risk for peri peri-implant fractures. Implant removal followed by locking plates for long spiral fractures provides a stable, anatomical, and reliable fixation. Bone grafting augments bony union, especially in cases of bone defects. Keywords: Peri-implant, femur, fracture, proximal femur nail, distal femur locking plate.

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“…From a biomechanical perspective, investigating short and long nails following pertrochanteric fracture consolidation was reported by Breceda et al (2020) and concluded that the nail design does not have significant effects for high age groups (83.4 ± 7.7 years old). Nevertheless, it is important to point that their work neglects the effect of the demographical factors.…”

Section: Introductionmentioning

confidence: 99%

Cyclic Damage Accumulation in the Femoral Constructs Made With Cephalomedullary Nails

Hamandi

Whitney

Stouffer

et al. 2021

Front. Bioeng. Biotechnol.

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Background: The purpose of this study was to evaluate the risk of peri-prosthetic fracture of constructs made with cephalomedullary (CM) long and short nails. The nails were made with titanium alloy (Ti-6Al-4V) and stainless steel (SS 316L).Methods: Biomechanical evaluation of CM nail constructs was carried out with regard to post-primary healing to determine the risk of peri-implant/peri-prosthetic fractures. Therefore, this research comprised of, non-fractured, twenty-eight pairs of cadaveric femora that were randomized and implanted with four types of fixation CM nails resulting in four groups. These constructs were cyclically tested in bi-axial mode for up to 30,000 cycles. All the samples were then loaded to failure to measure failure loads. Three frameworks were carried out through this investigation, Michaelis–Menten, phenomenological, and probabilistic Monte Carlo simulation to model and predict damage accumulation.Findings: Damage accumulation resulting from bi-axial cyclic loading in terms of construct stiffness was represented by Michaelis–Menten equation, and the statistical analysis demonstrated that one model can explain the damage accumulation during cyclic load for all four groups of constructs (P > 0.05). A two-stage stiffness drop was observed. The short stainless steel had a significantly higher average damage (0.94) than the short titanium nails (0.90, P < 0.05). Long titanium nail group did not differ substantially from the short stainless steel nails (P > 0.05). Results showed gender had a significant effect on load to failure in both torsional and bending tests (P < 0.05 and P < 0.001, respectively).Interpretation: Kaplan–Meier survival analysis supports the use of short titanium CM nail. We recommend that clinical decisions should take age and gender into consideration in the selection of implants.

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Biomechanical analysis of peri‑implant fractures in short versus long cephalomedullary implants following pertrochanteric fracture consolidation

Cited by 11 publications

References 22 publications

Biomechanical Comparisons of Trochanteric Hip Fracture Fixation Using Short-, Mid-, and Long-Length Proximal Femoral Nails

Biomechanical Comparisons of Trochanteric Hip Fracture Fixation Using Short-, Mid-, and Long-Length Proximal Femoral Nails

Management of Short Proximal Femur Nail Peri Peri-Implant Fracture of Femur Shaft with Implant Removal and Long Distal Femur Locking Plate and Bone Grafting – A Case Report

Cyclic Damage Accumulation in the Femoral Constructs Made With Cephalomedullary Nails

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