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Extra- vs. intramedullary treatment of pertrochanteric fractures: a biomechanical in vitro study comparing dynamic hip screw and intramedullary nail

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Due to the demographic trend, pertrochanteric fractures of the femur will gain increasing importance in the future. Both extra- and intramedullary implants are used with good results in the treatment of these fractures. New, angular stable extramedullary implants promise increased postoperative stability even with unstable fractures. Additional trochanteric plates are intended to prevent secondary impaction, varisation and shortening of the fracture, as well as medialisation of the femoral shaft. The aim of this study was to perform a biomechanical comparison of both procedures regarding their postoperative stability and failure mechanisms.

Materials and methods

Twelve fresh-frozen human femurs were randomized into two groups based on the volumetric bone mineral density (vBMD). Standardized pertrochanteric fractures (AO31-A2.3) were generated and treated either with an angular stable dynamic hip screw (DHS) or an intramedullary nail (nail). Correct implant position and the tip–apex distance (TAD) were controlled postoperatively using X-ray. Specimens were mounted in a servohydraulic testing machine and an axial loading was applied according to a single-leg stance model. Both groups were biomechanically compared with regard to native and postoperative stiffness, survival during cyclic testing, load to failure, and failure mechanisms.

Results

TAD, vBMD, and native stiffness were similar for both groups. The stiffness decreased significantly from native to postoperative state in all specimens (p < 0.001). The postoperative stiffness of both groups varied non-significantly (p = 0.275). The failure loads for specimens treated with the nail were significantly higher than for those treated with the DHS (8480.8 ± 1238.9 N vs. 2778.2 ± 196.8 N; p = 0.008).

Conclusions

Extra- and intramedullary osteosynthesis showed comparable results as regards postoperative stiffness and survival during cyclic testing. Since the failure load of the nail was significantly higher in the tested AO31-A2.3 fracture model, we conclude that intramedullary implants should be preferred in these, unstable, fractures.

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Acknowledgments

Funding from the state of Hamburg is kindly acknowledged.

Conflict of interest

No potential conflict of interest is declared by all authors.

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Author notes

    Authors and Affiliations

    1. Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

      Lukas Weiser, Jakob V. Nüchtern & Wolfgang Lehmann

    2. Trauma and Orthopedic Department, Johannes Wesling Klinikum Minden, Minden, Germany

      Andreas A. Ruppel & Johannes Zeichen

    3. Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany

      Kay Sellenschloh & Michael M. Morlock

    4. Institute of Forensic Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

      Klaus Püschel

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    1. Lukas Weiser
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    Correspondence to Lukas Weiser.

    Additional information

    L. Weiser and A. A. Ruppel contributed equally and therefore share first authorship.

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    Weiser, L., Ruppel, A.A., Nüchtern, J.V. et al. Extra- vs. intramedullary treatment of pertrochanteric fractures: a biomechanical in vitro study comparing dynamic hip screw and intramedullary nail. Arch Orthop Trauma Surg 135, 1101–1106 (2015). https://doi.org/10.1007/s00402-015-2252-4

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    • DOI: https://doi.org/10.1007/s00402-015-2252-4

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