Abstract
Background
A large proportion of hip fractures involve inter-trochanteric fractures which are
managed by cephalomedullary nails. There is ongoing debate about the advantages and
disadvantages of locked versus unlocked long cephalomedullary femoral nails in the
treatment of intertrochanteric fractures. The objectives of our study are to evaluate
the biomechanical effects of a distal interlocking bolt on the type of peri-implant
fractures in a healed intertrochanteric fracture with long cephalomedullary nail fixation.
Methods
20 femoral sawbone specimens were prepared with the TFN-ADVANCED Proximal Femoral
Nailing System (TFNA) and divided into 2 groups: locked and unlocked. The specimens
were subjected to axial loading force until failure. Compressive forces, strain and
fracture patterns were compared between the 2 groups.
Results
There was no significant difference in the mean load to failure of the unlocked specimens
compared to locked specimens. However, there was significant difference in the mean
compressive stress at the time of failure with the unlocked specimen (1.79±0.17 MPa)
compared to the locked group (1.92±0.05 MPa) (p < 0.05). Video review analysis showed
unlocked specimens consistently having basi-cervical type peri-implant fractures while
locked specimens showed complex, compound fractures of the head-neck region with 2
or more fracture propagation points.
Conclusion
Distal-locked long cephalomedullary nails in a healed intertrochanteric fracture model
are able to tolerate higher compressive stress at the point of failure but demonstrate
more complex peri-implant fracture patterns in the femoral head-neck region as compared
to unlocked specimens.
Keywords
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Article info
Publication history
Published online: September 28, 2022
Accepted:
September 23,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
