Strategies for managing the destruction of calcar femorale

Abstract

Background The calcar femorale was identified long ago. However, our current understanding of the calcar is insufficient, and its related concepts are sometimes confused. The calcar femoral is an important anatomical structure of the proximal femur, and its function can be overlooked. In trauma, tumors, or other diseases, the calcar femorale can be destroyed or changed pathologically. As a result, the mechanical structure of the proximal femur becomes destroyed, causing pathological fractures. How to address the destruction of the calcar femorale or the damage to the calcar femorale is discussed in this article. Main text Destruction of the calcar femorale is accompanied by many conditions, including trauma, tumors, and other diseases. The types of hip fractures caused by trauma include femoral neck fractures and intertrochanteric fractures. Dynamic hip screws, proximal femoral nail anti-rotation, and multiple parallel cannulate pins can be used in different conditions. When metastatic and primary bone tumors involve the calcar femorale, endoprostheses are widely used. Other diseases, such as fibrous dysplasia and aneurysmal bone cyst are treated differently. Conclusions The calcar femorale can redistribute stresses and the destruction of the calcar femorale can lead to an increase in posterior medial stress. Many factors need to be considered when deciding whether to reconstruct the calcar femorale. Effective treatment strategies for managing the destruction of calcar femorale will need first establishing the precise mechanism of the destruction of the calcar and then designing therapies towards these mechanisms. Further investigation to the calcar needs to be carried out.

Finite Element Analysis of Biomechanical Effects of Proximal Femur Shortening After Intertrochanteric Fracture

“…The calcar femur is the internal weight-bearing system of the proximal femur, and plays an important role in the fracture of the proximal femur. By decreasing the force on the posterior and medial femur and increasing the force on the anterior and lateral femur [10,11], we found that with the gradual shortening of the proximal femur, the maximum stress on all four surfaces of the proximal femur decreased gradually. This suggests that the stability of the whole femur gradually increased with the shortening of the proximal femur.…”

Lateral wall thickness is not associated with revision risk of medially stable intertrochanteric fractures fixed with a sliding hip screw

“…Compressive stress cannot be transmitted through femur when medial calcar is disrupted, which results in loss of medial support of the fracture and subsequent screw cutout, collapse or lateral wall fracture. 22 The National Institute for Health and Care Excellence (NICE) recommends that SHS should be used in preference to an IMN in people with trochanteric fractures above and including the lesser trochanter for 31-A1 and 31-A2 fractures. 23 Therefore, for those ITF patients with effective medial calcar, SHS may be the preferred implant regardless of lateral wall thickness.…”

Hip reconstruction using a customized intercalary prosthesis with the rhino horn-designed uncemented stem for ultrashort proximal femur segments following tumor resection: a combined biomechanical and clinical study

“…There was neither significant stress shielding nor stress concentration found in the remaining femur reconstructed by Stem A, as has been found in other types of stems. A possible explanation for these results might be that the position of Stem A was closer to the inferior region of the femoral neck, which has a strong trabecular architecture and thicker cortices to resist tensile or shearing forces applied to the neck through the head [27,28]. Inserting the stem into this area with a denser structure makes the fixation system more stable and more adaptive to the physiological stress transmission.…”