The importance of intramedullary hip nail positioning during implantation for stable pertrochanteric fractures: biomechanical analysis

Bartoška, Radek; Báča, Václav; Horák, Zdeněk; Hrubina, M; Skála-Rosenbaum, J; Marvan, Jiří; Kachlík, David; Džupa, Valér

doi:10.1007/s00276-015-1595-4

Cited by 11 publications

(7 citation statements)

References 27 publications

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“…While PFNA can generate bone compression around the helical blade because there are bone deficiencies in the femoral neck and femoral head after PFNA revision, which is more beneficial than DHS. This contradicts the findings of Baca et al [ 19 ]. They investigated the location of intramedullary hip screws for implantation in stabilized trochanteric fractures.…”

Section: Discussioncontrasting

confidence: 99%

A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures

Chen,

Fan,

et al. 2023

J Orthop Surg Res

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Purpose The ideal approach for revision surgery following femoral head salvage treatments for an intertrochanteric fracture is still up for debate. A novel variety of proximal femoral bionic intramedullary nail (PFBN) has been created in clinical practice. We aimed to compare the biomechanical results of the novel implant to conventional intramedullary and extramedullary fixation in the treatment of intertrochanteric fracture following primary internal fixation failure. Methods Using finite element analysis, we created a three-dimensional model of the intertrochanteric fracture's helical blade cut-out for this investigation. The PFBN 1 group, the PFBN 2 group, the PFNA group, and the DHS group were our four test groups. For each fracture group, the von Mises stress and displacements of the femur and internal fixation components were measured under 2100 N axial loads. Results The values for the femoral displacement in the PFBN1 group, PFBN2 group, PFNA group, and DHS group were 6.802 mm, 6.716 mm, 8.080 mm, and 8.679 mm, respectively. The internal implant displacement values were 6.201 mm, 6.138 mm, 7.396 mm, and 8.075 mm in the PFBN1 group, PFBN2 group, PFNA group, and DHS group, respectively. The maximum von Mises Stress in the femoral was 187.2 MPa, 85.18 MPa, 106.6 MPa, and 386.2 MPa in the PFBN1 groups, PFBN2 groups, PFNA groups, and DHS groups, respectively. In the PFBN1 groups, PFBN2 groups, PFNA groups, and DHS groups, the maximum von Mises Stress in internal fixation was 586.7 MPa, 559.8 MPa, 370.7 MPa, and 928.4.8 MPa, respectively. Conclusion Our biomechanical research demonstrates that intramedullary fixation is more stable than extramedullary fixation when salvaging failed internal fixations in intertrochanteric fracture. Compared with PFNA and DHS, PFBN showed better biomechanical stability in the treatment of patients with revised intertrochanteric fractures. In light of this, we advocate PFBN fixation as the method of choice for intertrochanteric fracture revision. This result still has to be confirmed in more clinical research.

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Section: Discussioncontrasting

confidence: 99%

A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures

Chen,

Fan,

et al. 2023

J Orthop Surg Res

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“…16 The results of the present study also showed that when the lag screw is implanted in an inferior site, the femur experiences relatively lower stress and the implant experiences less displacement, thus agreeing with the results of previous studies. 5,14,15 These findings indicate that the TAD is not a primary predictor of implant failure. This concept is similar to the results of the above-mentioned study.…”

Section: Discussionmentioning

confidence: 84%

“… 13 Researchers have also used FEA to investigate the effects of different lengths and positions of the lag screw on proximal femoral nails and found that changing the length and implant position of the lag screw caused no significant difference. 14 In addition, the results of studies using FEA for assessment of stable intertrochanteric fractures showed that a lag screw position near the inferior posterior femoral head was a relatively ideal option. 15 In contrast, another FEA study of the stress distribution on the fracture line according to different lag screw positions demonstrated that the optimal lag screw position was at the middle portion of the femoral neck in stable intertrochanteric fractures.…”

Section: Introductionmentioning

confidence: 99%

Impact of tip–apex distance and femoral head lag screw position on treatment outcomes of unstable intertrochanteric fractures using cephalomedullary nails

Lee

Chen

et al. 2018

J Int Med Res

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BackgroundCephalomedullary nails are frequently used in unstable intertrochanteric fractures. The implant position is an important factor for surgical success. Thus, in the present study, finite element analysis methods were used to investigate the biomechanical behavior of five different cephalomedullary nail positions in unstable intertrochanteric fractures.MethodsFive different cephalomedullary nail implant positions were investigated. The observed indicators were the maximum displacement of the lag screw, the stress on the intertrochanteric fracture with involvement of the posteromedial cortex, and the tip–apex distance.ResultsThe smallest lag screw displacement was achieved when the implant was closer to the inferior femoral head. Lower stress was placed on the posteromedial cortex when the implant was positioned closer to the inferior femoral head. However, the tip–apex distance increased when the lag screw was positioned more inferiorly.ConclusionsThe results of this study suggest that positioning the lag screw closer to the inferior aspect of the femoral head can reduce stress on the posteromedial cortex and deformation of the implant in unstable intertrochanteric fractures. These findings provide a biomechanical basis for selection of the cephalomedullary nail implantation site.Level of evidenceIII.

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“…Meanwhile, the ignorance of interaction between blade trajectory on the coronal and transverse planes was also a main limitation of this study [ 6 , 45 ]. However, for the lack of instant postoperative CT imaging data, the blade trajectory on the transverse plane can not be directly judged, and which should be identified in our future studies.…”

Section: Discussionmentioning

confidence: 99%

Extending the intermedullary nail will not reduce the potential risk of femoral head varus in PFNA patients biomechanically: a clinical review and corresponding numerical simulation

Cha,

Zhou,

et al. 2024

BMC Musculoskelet Disord

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Femoral head varus is an important complication in intertrochanteric fracture patients treated with proximal femoral nail anti-rotation (PFNA) fixation. Theoretically, extending the length of the intramedullary nail could optimize fixation stability by lengthening the force arm. However, whether extending the nail length can optimize patient prognosis is unclear. In this study, a review of imaging data from intertrochanteric fracture patients with PFNA fixation was performed, and the length of the intramedullary nail in the femoral trunk and the distance between the lesser trochanter and the distal locking screw were measured. The femoral neck varus status was judged at the 6-month follow-up. The correlation coefficients between nail length and femoral neck varus angle were computed, and linear regression analysis was used to determine whether a change in nail length was an independent risk factor for femoral neck varus. Moreover, the biomechanical effects of different nail lengths on PFNA fixation stability and local stress distribution have also been verified by numerical mechanical simulations. Clinical review revealed that changes in nail length were not significantly correlated with femoral head varus and were also not an independent risk factor for this complication. In addition, only slight biomechanical changes can be observed in the numerical simulation results. Therefore, commonly used intramedullary nails should be able to meet the needs of PFNA-fixed patients, and additional procedures for longer nail insertion may be unnecessary.

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The importance of intramedullary hip nail positioning during implantation for stable pertrochanteric fractures: biomechanical analysis

Cited by 11 publications

References 27 publications

A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures

A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures

Impact of tip–apex distance and femoral head lag screw position on treatment outcomes of unstable intertrochanteric fractures using cephalomedullary nails

Extending the intermedullary nail will not reduce the potential risk of femoral head varus in PFNA patients biomechanically: a clinical review and corresponding numerical simulation

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