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Screw-blade fixation systems in Pauwels three femoral neck fractures: a biomechanical evaluation

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Abstract

Objectives

To reduce mechanical complications after osteosynthesis of femoral neck fractures, improved fixation techniques have been developed including blade or screw–anchor devices. This biomechanical study compares different fixation systems used for treatment of unstable femoral neck fractures with evaluation of failure mode, load to failure, stiffness, femoral head rotation, femoral neck shortening and femoral head migration.

Methods

Standardized Pauwels type 3 fractures (AO/OTA 31-B2) with comminution were created in 18 biomechanical sawbones using a custom-made sawguide. Fractures were stabilized using either SHS-Screw, SHS-Blade or Rotationally Stable Screw-Anchor (RoSA). Femurs were positioned in 25 degrees adduction and ten degrees posterior flexion and were cyclically loaded with an axial sinusoidal loading pattern of 0.5 Hz, starting with 300 N, with an increase by 300 N every 2000 cycles until bone–implant failure occurred.

Results

Mean failure load for the Screw-Anchor fixation (RoSA) was 5100 N (IQR 750 N), 3900 N (IQR 75 N) for SHS-Blade and 3000 N (IQR 675 N; p = 0.002) for SHS-Screw. For SHS-Screw and SHS-Blade we observed fracture displacement with consecutive fracture collapse as the main reason for failure, whereas RoSA mainly showed a cut-out under high loadings. Mean stiffness at 1800 N was 826 (IQR 431) N/mm for SHS-Screw, 1328 (IQR 441) N/mm for SHS-Blade and 1953 (IQR 617) N/mm for RoSA (p = 0.003). With a load of 1800 N (SHS-Screw 12° vs. SHS-Blade 7° vs. RoSA 2°; p = 0.003) and with 2700 N (24° vs. 15° vs. 3°; p = 0.002) the RoSA implants demonstrated a higher rotational stability and had the lowest femoral neck shortening (p = 0.002), compared with the SHS groups. At the 2700 N load point, RoSA systems showed a lower axial (p = 0.019) and cranial (p = 0.031) femoral head migration compared to the SHS-Screw.

Conclusions

In our study, the new Screw-Anchor fixation (RoSA) was superior to the comparable SHS implants regarding rotational stability and femoral neck shortening. Failure load, stiffness, femoral head migration, and resistance to fracture displacement were in RoSA implants higher than in SHS-Screws, but without significance in comparison to SHS-Blades.

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Acknowledgements

The authors thank carpenters Mark Altgassen and Rudi Eigelshoven for design and construction of the sawguide and their assistance with creation of the osteotomy.

Author information

Author notes

  1. Matthias Knobe and Simon Altgassen both contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedic Trauma, University of Aachen Medical Center, 30 Pauwelsstreet, 52074, Aachen, Germany

    Matthias Knobe, Simon Altgassen, Gertraud Gradl-Dietsch, Chris Kaczmarek & Klemens Horst

  2. Department of Surgery, RoMed Hospital Bad Aibling, Bad Aibling, Germany

    Klaus-Jürgen Maier

  3. Department of Radiology, University of Aachen Medical Center, Aachen, Germany

    Sven Nebelung

  4. Department of Foot and Ankle Surgery, Catholic Hospital Mainz, Mainz, Germany

    Kajetan Klos

  5. Department of Plastic Surgery, Reconstructive and Hand Surgery, University of Aachen Medical Center, Aachen, Germany

    Bong-Sung Kim

  6. AO Research Institute Davos, Davos, Switzerland

    Boyko Gueorguiev

  7. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen and Marburg GmbH, Campus Marburg, Marburg, Germany

    Benjamin Buecking

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  1. Matthias Knobe
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Corresponding author

Correspondence to Matthias Knobe.

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The authors declare that they have no conflict of interest.

Funding

Koenigsee Implants partially funded this study (student research assistant, sawbones).

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Knobe, M., Altgassen, S., Maier, KJ. et al. Screw-blade fixation systems in Pauwels three femoral neck fractures: a biomechanical evaluation. International Orthopaedics (SICOT) 42, 409–418 (2018). https://doi.org/10.1007/s00264-017-3587-y

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  • DOI: https://doi.org/10.1007/s00264-017-3587-y

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