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Biomechanical stability of short versus long proximal femoral nails in osteoporotic subtrochanteric A3 reverse-oblique femoral fractures: a cadaveric study

PURPOSE: Due to the demographic change towards an older society, osteoporosis-related proximal femur fractures are steadily increasing. Intramedullary nail osteosyntheses are available in different lengths, where the field of application overlaps. The aim of this study was to investigate whether sub...

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Autores principales: Linhart, Christoph, Kistler, Manuel, Kussmaul, Adrian C., Woiczinski, Matthias, Böcker, Wolfgang, Ehrnthaller, Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886623/
https://www.ncbi.nlm.nih.gov/pubmed/35061084
http://dx.doi.org/10.1007/s00402-022-04345-0
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author Linhart, Christoph
Kistler, Manuel
Kussmaul, Adrian C.
Woiczinski, Matthias
Böcker, Wolfgang
Ehrnthaller, Christian
author_facet Linhart, Christoph
Kistler, Manuel
Kussmaul, Adrian C.
Woiczinski, Matthias
Böcker, Wolfgang
Ehrnthaller, Christian
author_sort Linhart, Christoph
collection PubMed
description PURPOSE: Due to the demographic change towards an older society, osteoporosis-related proximal femur fractures are steadily increasing. Intramedullary nail osteosyntheses are available in different lengths, where the field of application overlaps. The aim of this study was to investigate whether subtrochanteric fractures can also be treated stably using a short femoral intramedullary nail in cadaveric bones. METHODS: A short PFNA and a long PFNA were implanted in both seven artificial bones and osteoporotic human specimens. A standardized AO 31-A3 (reverse-oblique) fracture was placed in the specimens with a lateral fracture spur 2 cm proximal to the distal locking screw (short PFNA) and embedded. The simulated iliotibial tract was preloaded to 50 N. The force was applied at 10 mm/min up to a force of 200–800 N (artificial bones) and 200–400 N (human specimens). The dislocation of the fracture gap, the axial bone stiffness of bone construct and the force curve of the tractus iliotibialis were measured. RESULTS: There is no difference in the use of a short versus long PFNA in terms of stiffness of the overall construct and only a slight increase in dislocation in the fracture gap results with short PFNA compared to a long intramedullary nail. CONCLUSION: In summary of the available literature, the present study supports the thesis that there is no clinical difference between long versus short nails in A3 femur fractures. Furthermore, the present study defines a safe biomechanical range of fracture extension above the locking screw of the short intramedullary nail. LEVEL OF EVIDENCE: III
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spelling pubmed-98866232023-02-01 Biomechanical stability of short versus long proximal femoral nails in osteoporotic subtrochanteric A3 reverse-oblique femoral fractures: a cadaveric study Linhart, Christoph Kistler, Manuel Kussmaul, Adrian C. Woiczinski, Matthias Böcker, Wolfgang Ehrnthaller, Christian Arch Orthop Trauma Surg Trauma Surgery PURPOSE: Due to the demographic change towards an older society, osteoporosis-related proximal femur fractures are steadily increasing. Intramedullary nail osteosyntheses are available in different lengths, where the field of application overlaps. The aim of this study was to investigate whether subtrochanteric fractures can also be treated stably using a short femoral intramedullary nail in cadaveric bones. METHODS: A short PFNA and a long PFNA were implanted in both seven artificial bones and osteoporotic human specimens. A standardized AO 31-A3 (reverse-oblique) fracture was placed in the specimens with a lateral fracture spur 2 cm proximal to the distal locking screw (short PFNA) and embedded. The simulated iliotibial tract was preloaded to 50 N. The force was applied at 10 mm/min up to a force of 200–800 N (artificial bones) and 200–400 N (human specimens). The dislocation of the fracture gap, the axial bone stiffness of bone construct and the force curve of the tractus iliotibialis were measured. RESULTS: There is no difference in the use of a short versus long PFNA in terms of stiffness of the overall construct and only a slight increase in dislocation in the fracture gap results with short PFNA compared to a long intramedullary nail. CONCLUSION: In summary of the available literature, the present study supports the thesis that there is no clinical difference between long versus short nails in A3 femur fractures. Furthermore, the present study defines a safe biomechanical range of fracture extension above the locking screw of the short intramedullary nail. LEVEL OF EVIDENCE: III Springer Berlin Heidelberg 2022-01-21 2023 /pmc/articles/PMC9886623/ /pubmed/35061084 http://dx.doi.org/10.1007/s00402-022-04345-0 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Trauma Surgery
Linhart, Christoph
Kistler, Manuel
Kussmaul, Adrian C.
Woiczinski, Matthias
Böcker, Wolfgang
Ehrnthaller, Christian
Biomechanical stability of short versus long proximal femoral nails in osteoporotic subtrochanteric A3 reverse-oblique femoral fractures: a cadaveric study
title Biomechanical stability of short versus long proximal femoral nails in osteoporotic subtrochanteric A3 reverse-oblique femoral fractures: a cadaveric study
title_full Biomechanical stability of short versus long proximal femoral nails in osteoporotic subtrochanteric A3 reverse-oblique femoral fractures: a cadaveric study
title_fullStr Biomechanical stability of short versus long proximal femoral nails in osteoporotic subtrochanteric A3 reverse-oblique femoral fractures: a cadaveric study
title_full_unstemmed Biomechanical stability of short versus long proximal femoral nails in osteoporotic subtrochanteric A3 reverse-oblique femoral fractures: a cadaveric study
title_short Biomechanical stability of short versus long proximal femoral nails in osteoporotic subtrochanteric A3 reverse-oblique femoral fractures: a cadaveric study
title_sort biomechanical stability of short versus long proximal femoral nails in osteoporotic subtrochanteric a3 reverse-oblique femoral fractures: a cadaveric study
topic Trauma Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886623/
https://www.ncbi.nlm.nih.gov/pubmed/35061084
http://dx.doi.org/10.1007/s00402-022-04345-0
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