Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 3/2019

01-06-2019 | Dynamic Hip Screw | Original Article

A biomechanical comparison of three fixation techniques in osteoporotic reverse oblique intertrochanteric femur fracture with fragmented lateral cortex

Authors: Gökhan Polat, Turgut Akgül, Mehmet Ekinci, Serkan Bayram

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2019

Login to get access

Abstract

Background

The treatment of the reverse oblique osteoporotic femur fractures is still problematic and can be complicated especially that are accompanied by a fragmented lateral cortex.

Aim

The aim of this study was to compare three different internal fixation methods in the osteosynthesis of osteoporotic reverse oblique intertrochanteric femur fracture models with a fragmented lateral cortex.

Study design

Biomechanical experiment study.

Methods

A total of 24 osteoporotic femur models were obtained and divided into three groups [Group A: Proximal femoral nail (PFN), Group B: 95° angled blade plate (ABP), and Group C: proximal femoral anatomic locking plate (PFLP)] with each group which include eight bones. A standard fracture configuration was created as a reverse oblique intertrochanteric fracture and fixed with these implants. After fixation, all femur constructs were tested with an Instron 5800R tester (Instron, Canton, MA) in the biomechanics laboratory with axial loading and bending forces to assess axial and rotational stiffness and failure load. Displacement over 10 mm and angulation greater than 10° in the fracture line were considered as failure.

Results

In all tests, ABP had statistically poorer results in comparison to the PFN and PFLP group. PFLP fixation had better biomechanical fixation results in comparison to the PFN group, although the results were not statistically significant.

Conclusion

Orthopaedic surgeons should keep in mind that lateral cortex comminution brings further instability to these reverse oblique intertrochanteric osteoporotic fractures and high rates of failure may be encountered due to this instability. PFLP fixation may be an alternative fixation method biomechanically for these instable fractures.
Literature
1.
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007;22:465–75.CrossRefPubMed
2.
Radford PJ, Needoff M, Webb JK. Aprospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Jt Surg Br. 1993;75(5):789–93.CrossRef
3.
Nuber S, Schönweiss T, Rüter A. Stabilisation of unstable trochanteric femoral fractures. Dynamic hip screw (DHS) with trochanteric stabilisation plate vs. proximal femur nail (PFN). Unfallchirurg. 2003;106(1):39–47.CrossRefPubMed
4.
5.
Zha GC, Chen ZL, Qi XB, Sun JY. Treatment of pertrochanteric fractures with a proximal femur locking compression plate. Injury. 2011;42(11):1294–9.CrossRefPubMed
6.
Kokoroghiannis C, Aktselis I, Deligeorgis A, Fragkomichalos E, Papadimas D, Pappadas I. Evolving concepts of stability and intramedullary fixation of intertrochanteric fractures—a review. Injury. 2012 Jun;43(6):686–93.CrossRefPubMed
7.
Lamb JN, Panteli M, Pneumaticos SG, Giannoudis PV. Epidemiology of pertrochanteric fractures: our institutional experience. Eur J Trauma Emerg Surg. 2014;40(3):225–32.CrossRefPubMed
8.
Yao C, Zhang CQ, Jin DX, Chen YF. Early results of reverse less invasive stabilization system plating in treating elderly intertrochanteric fractures: a prospective study compared to proximal femoral nail. Chin Med J (Engl). 2011;124:2150–7.
9.
Loizou C, Mcnamara I, Ahmed K, Pryor G, Parker M. Classification of subtrochanteric femoral fractures. Injury. 2010;41:739–45.CrossRefPubMed
10.
Palm H, Jacobsen S, Sonne-Holm S, Gebuhr P. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Jt Surg Am. 2007;89:470–47.CrossRef
11.
van Meeteren MC, van Rief YE, Roukema JA, et al. Condylar plate fixation of subtrochanteric femoral fractures. Injury. 1996;27:715–7.CrossRefPubMed
12.
Yoo MC, Cho YJ, Kim KI, et al. Treatment of unstable peritrochanteric femoral fractures using a 95 degrees angled blade plate. J Orthop Trauma. 2005;19:687–92.CrossRefPubMed
13.
Sadowski C, Lübbeke A, Saudan M, Riand N, Stern R, Hoffmeyer P. Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate: a prospective, randomized study. J Bone Jt Surg Am. 2002;84-A(3):372–81.CrossRef
14.
Kumar N, Kataria H, Yadav CS, Gadagoli BS, Raj R. Evaluation of proximal femoral locking plate in unstable extracapsular proximal femoral fractures: surgical technique and mid term follow up results. J Clin Orthop Trauma. 2014;5(3):137–45.CrossRefPubMedPubMedCentral
15.
Kraus J, Volf V, Burget F, Jindrová B. PCCP versus standard proximal femoral nail in the treatment of pertrochanteric femoral fractures. Rozhl Chir. 2009;88(8):469–74.PubMed
16.
Streubel PN, Moustoukas M, Obremskey WT. Locked plating versus cephalomedullary nailing of unstable intertrochanteric femur fractures. Eur J Orthop Surg Traumatol. 2016;26(4):385–90.CrossRefPubMed
17.
Johnson B, Stevenson J, Chamma R, Patel A, Rhee SJ, Lever C, Starks I, Roberts PJ. Short-term follow-up of pertrochanteric fractures treated using the proximal femoral locking plate. J Orthop Trauma. 2014;28(5):283–7.CrossRefPubMed
18.
Collinge CA, Hymes R, Archdeacon M, Streubel P, Obremskey W, Weber T, Watson JT, Lowenberg D, Members of the Proximal Femur Working Group of the Southeast Trauma Consortium. Unstable proximal femur fractures treated with proximal femoral locking plates: a retrospective, multicenter study of 111 cases. J Orthop Trauma. 2016;30(9):489–95.CrossRefPubMed
19.
Zderic I, Oh JK, Stoffel K, Sommer C, Helfen T, Camino G, Richards G, Nork SE, Gueorguiev B. Biomechanical analysis of the proximal femoral locking compression plate: do quality of reduction and screw orientation influence construct stability? J Orthop Trauma. 2018;32(2):67–74.CrossRefPubMed
20.
Ma JX, Wang J, Xu WG, Yu JT, Yang Y, Ma XL. Biomechanical outcome of proximal femoral nail antirotation is superior to proximal femoral locking compression plate for reverse oblique intertrochanteric fractures: a biomechanical study of intertrochanteric fractures. Acta Orthop Traumatol Turc. 2015;49(4):426–32.PubMed
21.
Singh AK, Narsaria N, Gupta RK. A biomechanical study comparing proximal femur nail and proximal femur locking compression plate in fixation of reverse oblique proximal femur fractures. Injury. 2017;48(10):2050–3.CrossRefPubMed
22.
Ozkan K, Türkmen İ, Sahin A, Yildiz Y, Erturk S, Soylemez MS. A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation: a study on synthetic bones. Indian J Orthop. 2015;49(3):347–51.CrossRefPubMedPubMedCentral
23.
Floyd MW, France JC, Hubbard DF. Early experience with the proximal femoral locking plate. Orthopedics. 2013;36(12):1488–94.CrossRef
Metadata
Title
A biomechanical comparison of three fixation techniques in osteoporotic reverse oblique intertrochanteric femur fracture with fragmented lateral cortex
Authors
Gökhan Polat
Turgut Akgül
Mehmet Ekinci
Serkan Bayram
Publication date
01-06-2019
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2019
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-018-1061-1

Other articles of this Issue 3/2019

European Journal of Trauma and Emergency Surgery 3/2019 Go to the issue

Original Article

Blunt traumatic injury during pregnancy: a descriptive analysis from a level 1 trauma center

Correction

Correction to: A biomechanical comparison of three fixation techniques in osteoporotic reverse oblique intertrochanteric femur fracture with fragmented lateral cortex

Editorial

Consequences and treatment aspects of trauma in female patients

Original Article

The influence of an injury prevention program on young road users: a German experience

Original Article

Reduction of relative centrifugal forces increases growth factor release within solid platelet-rich-fibrin (PRF)-based matrices: a proof of concept of LSCC (low speed centrifugation concept)

Original Article

Outcome of penetrating chest injuries in an urban level I trauma center in the Netherlands