Intramedullary nailing of trochanteric fractures: central or caudal positioning of the load carrier? A biomechanical comparative study on cadaver bones

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• 作者：L. Konstantinidis^a ; ^{lukas.konstantinidis@uniklinik-freiburg.de} ; C. Papaioannou^b ; A. Hirschm&uuml ; ller^a ; T. Pavlidis^d ; S. Schroeter^c ; N.P. S&uuml ; dkamp^a ; P. Helwig^a
• 关键词：Biomechanics ; Cut out ; PFN-A ; Targon-PFT ; Trigen-Intertan
• 刊名：Injury
• 出版年：2013
• 出版时间：June, 2013
• 年：2013
• 卷：44
• 期：6
• 页码：784-790
• 全文大小：1311 K

文摘

<h4 class=""h4"">Backroundh4>Current recommendations with regard to central or caudal positioning of the femur head carrier in the management of trochanteric fractures are contradictory.<h4 class=""h4"">Methodsh4>

A standardised pertrochanteric osteotomy was stabilised in 15 pairs of cadaver femurs by means of intramedullary osteosynthesis (5xPFN-A-Synthes, 5xIntertan-Smith&Nephew, 5xTargon-PF-Aesculap). For each pair randomised central (group A) or caudal (group B) implantation of the femoral neck component was performed. Subsequently, the constructs were axially loaded to 2100 N. In the absence of cut out after 20,000 cycles, load was increased to a maximum force of 3100 N. Angular displacement was recorded based on ultrasound. Migration of the load carrier in the femoral head was monitored radiologically.<h4 class=""h4"">Findings displacementh4>

No significant difference between groups (p > 0.15) was found for the first 50 load cycles. A significantly greater degree of varus deformity was observed in group A (p = 0.049) after 2000 load cycles and became more apparent as the number of load cycles increased (after 6000 cycles p = 0.039, after 20,000 cycles p = 0.034, after 22,000 cycles p = 0.016). Angular displacement in the other two planes did not differ significantly across groups.<h4 class=""h4"">Cut outh4>

Migration of the load carrier in the femoral head was not significantly different for the two groups. Overall cut out occurred in 9 constructs, 3 in group A and 6 in group B. The difference in cut-out rate was not significant (p = 0.213, chi-squared test).<h4 class=""h4"">Conclusionh4>

Biomechanical superiority can be shown for caudal positioning of the femoral neck load carrier in terms of reduced varus deformity. The incidence of cut out is however unaffected by the position of the load carrier.