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01-07-2016 | Original Article

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

Authors: Radek Bartoska, Vaclav Baca, Zdenek Horak, Maros Hrubina, Jiri Skala-Rosenbaum, Jiri Marvan, David Kachlik, Valer Dzupa

Published in: Surgical and Radiologic Anatomy | Issue 5/2016

Abstract

Purpose

Proximal femoral fractures are among the most commonly sustained fractures. The current treatment of stable proximal femoral fractures located in trochanteric region primarily involves the use of two systems: extramedullary dynamic hip screws and intramedullary hip nails. Given that these fractures are mainly found in the elderly population, the necessity of a repeat, due to failure of the first, may jeopardize the patient’s life. Decisive factors contributing to the healing of a fracture (or the failure thereof) include fracture pattern, technical implementation of the operation (i.e., position of the implant), implant’s properties and its changes in relation to the surrounding bone tissue during loading. Each screw insertion variant results in damage to various load-bearing bone structures, which can be expected to influence healing quality and stability of newly formed bone.

Method

With the aid of a numerical model and finite element methods, the authors analyzed several different positions of IMHN/PFH-nails in the proximal femur, with the objective of determining positions with an increased risk of failure.

Results and conclusion

In model situations, it has been shown that in stable fractures results do not depend on absolutely precise positioning and small deflections in the nails and neck screws positions do not significantly increase the risk of failure for the entire fixation. Damage to load-bearing structures relative to various implant placements does not impact the resultant overall fixation stability. Therefore, it is not necessary to re-introduce implants in the ideal position, which can lead to reduced patient radiation doses during surgery.

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Title: The importance of intramedullary hip nail positioning during implantation for stable pertrochanteric fractures: biomechanical analysis
Authors: Radek Bartoska
Vaclav Baca
Zdenek Horak
Maros Hrubina
Jiri Skala-Rosenbaum
Jiri Marvan
David Kachlik
Valer Dzupa
Publication date: 01-07-2016
Publisher: Springer Paris
Published in: Surgical and Radiologic Anatomy / Issue 5/2016
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-015-1595-4

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Method

Results and conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Method

Results and conclusion

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