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Biomechanical study on the stability and strain conduction of intertrochanteric fracture fixed with proximal femoral nail antirotation versus triangular supporting intramedullary nail

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A Correction to this article was published on 19 January 2022

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Abstract

Objectives

Based on the features of the three-dimensional spatial structure of the proximal femoral trabeculae, we developed a bionic triangular supporting intramedullary nail (TSIN) for the treatment of the femoral intertrochanteric fracture. The current study aimed to compare the mechanical stability and restoration of mechanical conduction between proximal femoral nail antirotation (PFNA) and TSIN to fix the intertrochanteric fractures.

Methods

Firstly, five sets of PFNA and TSIN with the same size were selected and fixed on a biomechanical testing machine, and strain gauges were pasted on the main nail, lag screw, and supporting screw to load to the vertical load to 600 N, and the displacement and strain values were recorded. Secondly, formalin-preserved femurs were selected, and the left and right femurs of the same cadaver were randomly divided into two groups to prepare intertrochanteric femur fractures (AO classification 31–A1), which were fixed with PFNA (n = 15) and TSIN (n = 15), respectively. Sixteen sites around the fracture line were chosen to paste strain gauges and loaded vertically to 600 N, and then, the fracture fragment displacement and strain values were recorded. Finally, a 10,000-cycle test ranging from 10 to 600 N was conducted, and the cycle number and displacement value were recorded.

Results

The overall displacement of PFNA was 2.17 ± 0.18 mm, which was significantly greater than the displacement of the TSIN group (1.66 ± 0.05 mm, P < 0.05) under a vertical load of 600 N. The strain below the PFNA lag screw was 868.29 ± 147.85, which was significantly greater than that of the TSIN (456.02 ± 35.06, P < 0.05); the strain value at the medial side of the PFNA nail was 444.00 ± 34.23, which was significantly less than that of the TSIN (613.57 ± 108.00, P < 0.05). Under the vertical load of 600 N, the displacement of the fracture fragments of the PFNA group was 0.95 ± 0.25 mm, which was significantly greater than that of the TSIN group (0.41 ± 0.09 mm, P < 0.05). The femoral specimens in the PFNA group showed significantly greater strains at the anterior (1, 2, and 4), lateral (7, 9, and 10), posterior (11), and medial (15 and 16) sites than those in the TSIN group (all P < 0.05). In the cyclic compression experiment, the displacements of the PFNA group at 2000, 4000, 6000, 8000, and 10,000 cycles were 1.38 mm, 1.81 mm, 2.07 mm, 2.64 mm, and 3.58 mm, respectively, which were greater than the corresponding displacements of the TSIN group: 1.01 mm, 1.48 mm, 1.82 mm, 2.05 mm, and 2.66 mm (P8000 = 0.012, P10000 = 0.006).

Conclusions

The current study showed that TSIN had apparent advantages in stability and stress conduction. TSIN enhanced the stability of intertrochanteric fractures, particularly in superior fracture fragments, improved stress conduction, reduced the stress in the anterior and medial femur, and restored the biomechanical properties of the femur.

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Funding

National Natural Science Foundation of China (82072447); Hebei Province fund for Distinguished Young Scholars (H2021206329).

This study conforms to the provisions of the Declaration of Helsinki and has been reviewed and approved by the Institutional Review Board of The Third Hospital of Hebei Medical University.

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Author notes

  1. Qi Zhang, Wei Chen and Yingze Zhang contributed equally to this work

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The 3Rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Haicheng Wang, Weijie Yang, Kai Ding, Yanbin Zhu, Yifan Zhang, Chuan Ren, Kuo Zhao, Qi Zhang, Wei Chen & Yingze Zhang

  2. Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Haicheng Wang, Weijie Yang, Kai Ding, Yanbin Zhu, Yifan Zhang, Chuan Ren, Kuo Zhao, Qi Zhang, Wei Chen & Yingze Zhang

  3. Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Haicheng Wang, Weijie Yang, Kai Ding, Yanbin Zhu, Yifan Zhang, Chuan Ren, Kuo Zhao, Qi Zhang, Wei Chen & Yingze Zhang

  4. NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, China

    Wei Chen & Yingze Zhang

  5. Chinese Academy of Engineering, Beijing, 100088, China

    Yingze Zhang

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Contributions

Y Z, W C and Q Z conceived the idea and designed the study. H W, W Y, and K D collected the relevant data. Y Z and K Z prepared the figures and tables. Y Z and C R performed the statistical analyses. All the authors interpreted the data and contributed to preparation of the manuscript. H W, W Y, and K D wrote the manuscript.

Corresponding authors

Correspondence to Qi Zhang or Wei Chen.

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Wang, H., Yang, W., Ding, K. et al. Biomechanical study on the stability and strain conduction of intertrochanteric fracture fixed with proximal femoral nail antirotation versus triangular supporting intramedullary nail. International Orthopaedics (SICOT) 46, 341–350 (2022). https://doi.org/10.1007/s00264-021-05250-8

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