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Archives of Orthopaedic and Trauma Surgery

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01-08-2015 | Trauma Surgery

Extra- vs. intramedullary treatment of pertrochanteric fractures: a biomechanical in vitro study comparing dynamic hip screw and intramedullary nail

Authors: Lukas Weiser, Andreas A. Ruppel, Jakob V. Nüchtern, Kay Sellenschloh, Johannes Zeichen, Klaus Püschel, Michael M. Morlock, Wolfgang Lehmann

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2015

Abstract

Introduction

Due to the demographic trend, pertrochanteric fractures of the femur will gain increasing importance in the future. Both extra- and intramedullary implants are used with good results in the treatment of these fractures. New, angular stable extramedullary implants promise increased postoperative stability even with unstable fractures. Additional trochanteric plates are intended to prevent secondary impaction, varisation and shortening of the fracture, as well as medialisation of the femoral shaft. The aim of this study was to perform a biomechanical comparison of both procedures regarding their postoperative stability and failure mechanisms.

Materials and methods

Twelve fresh-frozen human femurs were randomized into two groups based on the volumetric bone mineral density (vBMD). Standardized pertrochanteric fractures (AO31-A2.3) were generated and treated either with an angular stable dynamic hip screw (DHS) or an intramedullary nail (nail). Correct implant position and the tip–apex distance (TAD) were controlled postoperatively using X-ray. Specimens were mounted in a servohydraulic testing machine and an axial loading was applied according to a single-leg stance model. Both groups were biomechanically compared with regard to native and postoperative stiffness, survival during cyclic testing, load to failure, and failure mechanisms.

Results

TAD, vBMD, and native stiffness were similar for both groups. The stiffness decreased significantly from native to postoperative state in all specimens (p < 0.001). The postoperative stiffness of both groups varied non-significantly (p = 0.275). The failure loads for specimens treated with the nail were significantly higher than for those treated with the DHS (8480.8 ± 1238.9 N vs. 2778.2 ± 196.8 N; p = 0.008).

Conclusions

Extra- and intramedullary osteosynthesis showed comparable results as regards postoperative stiffness and survival during cyclic testing. Since the failure load of the nail was significantly higher in the tested AO31-A2.3 fracture model, we conclude that intramedullary implants should be preferred in these, unstable, fractures.

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Title: Extra- vs. intramedullary treatment of pertrochanteric fractures: a biomechanical in vitro study comparing dynamic hip screw and intramedullary nail
Authors: Lukas Weiser
Andreas A. Ruppel
Jakob V. Nüchtern
Kay Sellenschloh
Johannes Zeichen
Klaus Püschel
Michael M. Morlock
Wolfgang Lehmann
Publication date: 01-08-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 8/2015
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-015-2252-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Extra- vs. intramedullary treatment of pertrochanteric fractures: a biomechanical in vitro study comparing dynamic hip screw and intramedullary nail

Abstract

Introduction

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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