Biomechanical evaluation of a central collinear entry reconstruction nail for femoral neck fracture prophylaxis
- PMID: 38823097
- DOI: 10.1016/j.injury.2024.111640
Biomechanical evaluation of a central collinear entry reconstruction nail for femoral neck fracture prophylaxis
Abstract
Introduction: Reconstruction nails are commonly used to treat proximal femur fractures, with cephalic screw placement for femoral neck "prophylaxis" becoming standard practice. These implants are traditionally introduced through piriformis fossa (PF) or greater trochanter (GT) entry portals. A third "central collinear" (CC) portal has been proposed that allows entry along the femoral anatomic axis and central placement of cephalic screws. The present study aimed to quantify and compare the CC portal femoral neck strength with the two traditional (PF and GT) entry portals.
Materials and methods: Eighteen cadaveric femur specimens (nine matched pairs) were divided into three groups using a balanced incomplete block design to control for variations in age and sex: (1) GT, (2) CC, and (3) PF entry points. Specimens and implants were cut to a standard length and instrumented with straight or valgus bend nails of appropriate laterality and two cephalic screws. Specimens were mounted on a custom jig replicating load distribution along the mechanical axis. A 100 N compressive preload was applied to the femoral head, followed by loading to failure at a rate of 10 mm/s until fracture, indicated by 30 % drop in axial force.
Results: THE THREE ENTRY POINTS DID NOT DIFFER IN LOAD-TO-FAILURE: GT (6378.7 ± 1494.9 N), P (6912.4 ± 4924.1 N) and CC (7044.2 ± 2911.4 N) (P = 0.948) or maximum displacement, stiffness, and toughness. Most PF specimens failed at the basicervical neck, whereas most GT specimens failed at the subcapital neck; these differences were not significant. CC specimens failed evenly split between subcapital and basicervical.
Conclusion: There were no significant difference in femoral neck load-to-failure after placement of a reconstruction nail through a CC entry portal when compared to both GT and PF entry. Clinically, this suggests the CC entry portal is a viable option when clinical considerations warrant its use.
Keywords: Central collinear; Femoral neck; Piriformis; Prophylactic fixation; Trochanteric.
Copyright © 2024 Elsevier Ltd. All rights reserved.
Conflict of interest statement
Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Sapan Shah reports financial support and equipment, drugs, or supplies were provided by AOTNA. Melodie Metzger reports a relationship with Arthrex Inc that includes: funding grants. Geoffrey Marecek reports a relationship with Bone Support AB that includes: consulting or advisory. Geoffrey Marecek reports a relationship with DePuy Orthopaedics Inc that includes: consulting or advisory. Geoffrey Marecek reports a relationship with Globus Medical Inc that includes: consulting or advisory, equity or stocks, and funding grants. Geoffrey Marecek reports a relationship with NuVasive Inc that includes: consulting or advisory. Geoffrey Marecek reports a relationship with Orthofix Medical Inc that includes: consulting or advisory. Geoffrey Marecek reports a relationship with restore 3D that includes: consulting or advisory and equity or stocks. Geoffrey Marecek reports a relationship with Siemens Medical Solutions USA Inc that includes: consulting or advisory. Geoffrey Marecek reports a relationship with Zimmer Inc that includes: consulting or advisory. Melodie Metzger reports a relationship with Robson Forensic Inc that includes: paid expert testimony. Geoffrey Marecek - AAOS Comprehensive Review editorial board, AOTNA committee member If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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