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Internal fixation of femoral neck fractures with posterior comminution

A biomechanical comparison of DHS® and Intertan nail®

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Abstract

Background and purpose

Internal fixation is a therapeutic mainstay for treatment of undisplaced femoral neck fractures and fractures without posterior comminution. The best treatment for unstable and comminuted fractures, however, remains controversial, especially in older patients. The present study was designed to assess the utility of the Intertan Nail® (IT) for stabilization of comminuted Pauwels type III fractures compared to dynamic hips screw (DHS).

Methods

Randomized on the basis of bone mineral density, 32 human femurs were assigned to four groups. Pauwels type III fractures were osteomized with a custom-made saw guide. In 16 specimens the posteromedial support was removed and all femurs were instrumented with an IT or a DHS. All constructs were tested with nondestructive axial loading to 700N, cyclical compression to 1,400N (10,000 cycles), and loading to failure. Outcome measures included number of survived cycles, mechanical stiffness, head displacement and load to failure.

Results

Postoperative mechanical stiffness and stiffness after cyclical loading were significantly reduced in all constructs regardless of the presence of a comminution defect (p = 0.02). Specimens stabilized with the IT had a lower construct displacement (IT, 8.5 ± 0.5 mm vs. DHS, 14.5 ± 2.2 mm; p = 0.007) and sustained higher failure loads (IT, 4929 ± 419 N vs. DHS, 3505 ± 453 N; p = 0.036) than the DHS constructs.

Interpretation

In comminuted Pauwels type III fractures, the fixation with the IT provided sufficient postoperative mechanical strength, comparable rate of femoral head displacement, and a similar tolerance of physiological loads compared to fractures without comminution. The absence of the posteromedial support in comminuted fractures tended to reduce the failure load regardless of the fixation method.

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Conflict of interest and funding

There is no conflict of interest and there was no funding.

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Authors and Affiliations

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

    Martin Rupprecht, Lars Grossterlinden, Michael Hoffmann, Johannes M. Rueger & Wolfgang Lehmann

  2. Biomechanics Section, Hamburg University of Technology, Denickestraße 15, 21079, Hamburg, Germany

    Kai Sellenschloh & Michael Morlock

  3. Department of Forensic Medicine, University Medical Center Hamburg–Eppendorf, Butenfeld 34, 22529, Hamburg, Germany

    Klaus Püschel

Authors
  1. Martin Rupprecht
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  2. Lars Grossterlinden
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  3. Kai Sellenschloh
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  4. Michael Hoffmann
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  5. Klaus Püschel
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  6. Michael Morlock
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  7. Johannes M. Rueger
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  8. Wolfgang Lehmann
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Correspondence to Martin Rupprecht.

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Rupprecht, M., Grossterlinden, L., Sellenschloh, K. et al. Internal fixation of femoral neck fractures with posterior comminution. International Orthopaedics (SICOT) 35, 1695–1701 (2011). https://doi.org/10.1007/s00264-010-1199-x

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  • DOI: https://doi.org/10.1007/s00264-010-1199-x

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