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

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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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Acknowledgments

Supported by Internal Grant Agency of the Charles University in Prague GA UK 420411/2011 and Structural Funds EU OPPC CZ216/3100/24018.

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Authors and Affiliations

  1. Department of Orthopaedy and Traumatology, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic

    Radek Bartoska, Jiri Skala-Rosenbaum, Jiri Marvan & Valer Dzupa

  2. Department of Health Care Studies, Colleague of Polytechnics Jihlava, Tolsteho 16, 586 01, Jihlava, Czech Republic

    Vaclav Baca, Zdenek Horak & David Kachlik

  3. Department of Anatomy, Third Faculty of Medicine, Charles University, Prague, Czech Republic

    Vaclav Baca & David Kachlik

  4. Center for Integrated Study of Pelvis, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic

    Vaclav Baca & Valer Dzupa

  5. Department of Mechanics, Biomechanics and Mechatronics, Faculty of Mechanical Engineering, CTU in Prague, Prague, Czech Republic

    Zdenek Horak

  6. Department of Orthopaedics, Hospital Pelhrimov, Pelhrimov, Czech Republic

    Maros Hrubina

Authors
  1. Radek Bartoska
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  2. Vaclav Baca
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  3. Zdenek Horak
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  4. Maros Hrubina
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  5. Jiri Skala-Rosenbaum
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  6. Jiri Marvan
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  7. David Kachlik
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  8. Valer Dzupa
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Corresponding author

Correspondence to Vaclav Baca.

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Bartoska, R., Baca, V., Horak, Z. et al. The importance of intramedullary hip nail positioning during implantation for stable pertrochanteric fractures: biomechanical analysis. Surg Radiol Anat 38, 577–585 (2016). https://doi.org/10.1007/s00276-015-1595-4

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  • DOI: https://doi.org/10.1007/s00276-015-1595-4

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