Biomechanical Consequences of Nail Insertion Point and Anterior Cortical Perforation for Antegrade Femoral Nailing

Ching, Michael; Gee, Aaron; Balso, Christopher Del; Lawendy, Abdel; Schemitsch, Emil H.; Zdero, Radovan; Sanders, David

doi:10.1155/2020/5878607

Cited by 4 publications

(6 citation statements)

References 40 publications

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“…Historically, anterior inline entry portals were discouraged because of a risk of femoral neck fracture and increased hoop stresses. 17,18 However, this concern was most prevalent with large diameter nails and has not been reported with modern nail design. Indeed, although this technique has not been reported in the medical literature, it has been described in manufacturers' technique guides for antegrade nailing.…”

Section: Discussionmentioning

confidence: 99%

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A Central Collinear Start Point for Reconstruction Nailing of Femur Fractures: A Technical Trick and Case Series

Robles

DeSanto

Earhart³

et al. 2023

Journal of Orthopaedic Trauma

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Summary:Selecting the optimal entry point for reconstruction nailing is critical to avoid iatrogenic malalignment and optimize mechanical stability. In-line nailing is familiar to surgeons and desirable for its on-axis position. However, there are several potential drawbacks. We describe a modified entry point and present an accompanying clinical series emphasizing an entry point in line with the medullary canal and central on the femoral neck. This central collinear start point is anterior to the traditional piriformis start point and may obviate some of the potential drawbacks with traditional piriformis nailing.

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Section: Discussionmentioning

confidence: 99%

“…An additional benefit in the elderly is that the more anterior start point may minimize the chance of anterior cortical perforation in the distal femur. 17,18…”

Section: Discussionmentioning

confidence: 99%

A Central Collinear Start Point for Reconstruction Nailing of Femur Fractures: A Technical Trick and Case Series

Robles

DeSanto

Earhart³

et al. 2023

Journal of Orthopaedic Trauma

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“…In a similar radiographic review of 214 patients, Bazylewicz et al found 40% of distal nail tips seated “far anterior”, with 16% within 3 mm of the anterior cortex 15. This propensity for anterior positioning or impingement may be problematic, as biomechanical models have shown bone stress to rise as the distal nail tip moves closer to the anterior cortex, highlighting an ensuing risk for periprosthetic fracture due to a stress riser 16. Many surgeons therefore elect to minimize the risk of anterior distal nail placement during femoral medullary nailing.…”

Section: Discussionmentioning

confidence: 99%

“…15 This propensity for anterior positioning or impingement may be problematic, as biomechanical models have shown bone stress to rise as the distal nail tip moves closer to the anterior cortex, highlighting an ensuing risk for periprosthetic fracture due to a stress riser. 16 Many surgeons therefore elect to minimize the risk of anterior distal nail placement during femoral medullary nailing. Options to achieve this include the use of bent guide wires and blocking implants.…”

Section: Discussionmentioning

confidence: 99%

Influence of greater trochanteric starting point on distal anterior cortical perforation during antegrade femoral nailing

Megerian

Schimizzi

Uppstrom

et al. 2023

Current Orthopaedic Practice

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Background:Distal anterior cortical perforation is 1 complication of antegrade femoral nailing. The effect of greater trochanteric (GT) starting points on cortical perforation risk has not been described in human femoral models. This study assessed the influence of sagittal plane starting point on rate of anterior cortical perforation using 3D CT-reconstructions of human femora. Secondarily, patient age and nail radius of curvature (ROC) were assessed as risk factors. Methods:CT scans of 53 patients (18 non-geriatric (< 65 yr), 35 geriatric ( > 65 yr)) with non-fractured femora were converted into dynamic 3D-reconstructed renderings. Medullary nails from two manufacturers that differed in ROC were digitally templated in each femur from an anterior, central, and posterior ⅓ GT starting point. The rate of anterior cortical perforation and distance from the inner anterior cortex to the nail tip were recorded. Results:Perforation rate increased significantly as starting point moved from anterior (6%), to central (43%), to posterior (79%) regardless of patient age or implant manufacturer (P < 0.001). On average, an anterior starting point positioned the nail tip furthest from the inner anterior cortex (5. mm), safely within the canal (P < 0.001). Perforation rate was significantly increased in the geriatric versus non-geriatric population (47% vs. 34%) (P = 0.028), and when using the nail with the larger versus smaller ROC (50% vs. 36%) (P = 0.03). Conclusion:Distal nail sagittal alignment is sensitive to both patient and treatment factors. A posterior starting point, increased age ( > 65 yr), and increased implant ROC significantly increase risk for anterior cortical perforation of the distal femur.

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“…Cortical bone was tied with cancellous bone ( Fu et al, 2022 ). A constant load of 250N was applied straight down on the femoral head with the bottom of the metal jig fixed ( Ching et al, 2020 ).…”

Section: Methodsmentioning

confidence: 99%

Biomechanical comparison of the undercut thread design versus conventional buttress thread for the lag screw of the dynamic hip screw system

Liu

Feng²,

Zheng³

et al. 2022

Front. Bioeng. Biotechnol.

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Objective: To compare the fixation stability of the lag screw with a undercut thread design for the dynamic hip screw (DHS) system versus the lag screw with the conventional buttress thread.Methods: The lag screws with the undercut thread (a flat crest feature, a tip-facing undercut feature) and buttress thread were both manufactured. Fixation stability was investigated using cyclic compressive biomechanical testing on custom osteoporotic femoral head sawbone. The forces required for the same vertical displacement in the two types of lag screw were collected to evaluate the resistance to migration. Varus angle was measured on X-ray images to assess the ability in preventing varus collapse. Finite element analysis (FEA) was performed to analyze the stress and strain distribution at the bone-screw interface of the two types of lag screws.Results: The biomechanical test demonstrated that the force required to achieve the same vertical displacement of the lag screw with the undercut thread was significantly larger than the lag screw with conventional buttress thread (p < 0.05). The average varus angles generated by the undercut and buttress threads were 3.38 ± 0.51° and 5.76 ± 0.38°, respectively (p < 0.05). The FEA revealed that the region of high-stress concentration in the bone surrounding the undercut thread was smaller than that surrounding the buttress thread.Conclusion: The proposed DHS system lag screw with the undercut thread had higher migration resistance and superior fixation stability than the lag screw with the conventional buttress thread.

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Biomechanical Consequences of Nail Insertion Point and Anterior Cortical Perforation for Antegrade Femoral Nailing

Cited by 4 publications

References 40 publications

A Central Collinear Start Point for Reconstruction Nailing of Femur Fractures: A Technical Trick and Case Series

A Central Collinear Start Point for Reconstruction Nailing of Femur Fractures: A Technical Trick and Case Series

Influence of greater trochanteric starting point on distal anterior cortical perforation during antegrade femoral nailing

Biomechanical comparison of the undercut thread design versus conventional buttress thread for the lag screw of the dynamic hip screw system

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