Stability of L-shaped and inverted triangle fixation assemblies in treating Pauwels type II femoral neck fracture: a comparative mechanical study

  • Vincenzo GiordanoEmail author
  • Roger Pletsch Paes
  • Danilo Diniz Alves
  • Arthur Bonfim Amaral
  • William D. Belangero
  • Marcos Giordano
  • Anderson Freitas
  • Hilton A. Koch
Original Article • HIP - FRACTURES



The aim of our study is to compare the mechanical resistance of two screw configurations in fixating type II Pauwels femoral neck fractures.


Fifteen synthetic models of femur bones in young adults were divided into three equal groups: intact (G1), models with fixation of a 5.0-mm failure zone created in the posterior cortex of the femoral neck using an L-shaped screw arrangement (G2, n = 5), and models with an identical failure zone fixated using an inverted triangle assembly (G3, n = 5). Model strength (axial loading) and rotational deviation of the fragments were load-tested until a 5.0-mm displacement was reached (step 1) and then until failure, here considered as 10.0 mm displacement in G2 and G3 or femoral neck fracture in G1 (step 2).


In step 1, the mean resistance in G1 was 1593 N (standard deviation [SD] of 62 N); this value in G2 was 1261 N (SD 49 N) and in G3 was 1074 N (SD 153 N). During step 2, the value for G1 was 2247 N (SD 84 N), for G2 was 1895 N (SD 69 N), and for G3 was 1523 N (SD 280 N). G3 (the inverted triangle assembly) showed a significantly lower maximum load than the group using the L-shaped assembly (G2) and the control group (G1), which was significant using Kruskal–Wallis analysis of variance (p = 0.002).


Under test conditions in synthetic bone, fixation using a L-shaped screw assembly provides greater mechanical resistance than an inverted triangle assembly.


Hip fractures Femoral neck Internal fracture fixation Bone screws Analysis of equipment failure Mechanical torsion L-shaped assembly L shaped 


Authors’ contribution

VG helped in protocol creation, manuscript creation, manuscript editing, data collection, and data analysis. RPP, DDA, and ABA contributed to protocol creation and data collection. WB, MG, and AF helped in manuscript editing and critical review. Senior author HAK contributed to manuscript editing and critical review.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Vincenzo Giordano
    • 1
    • 2
    Email author
  • Roger Pletsch Paes
    • 1
  • Danilo Diniz Alves
    • 1
  • Arthur Bonfim Amaral
    • 1
  • William D. Belangero
    • 3
  • Marcos Giordano
    • 4
  • Anderson Freitas
    • 5
  • Hilton A. Koch
    • 6
  1. 1.Serviço de Ortopedia E Traumatologia Prof. Nova MonteiroHospital Municipal Miguel Couto, Clínica São VicenteRio de JaneiroBrazil
  2. 2.Núcleo Especializado de Ortopedia e TraumatologiaClínica São VicenteRio de JaneiroBrazil
  3. 3.Departamento de Ortopedia e TraumatologiaUniversidade Estadual de CampinasCampinasBrazil
  4. 4.Serviço de Traumato-OrtopediaHospital de Força Aérea do GaleãoRio de JaneiroBrazil
  5. 5.Serviço de Quadril – Hospital Ortopédico e Medicina Especializada – HOMEBrasíliaBrazil
  6. 6.Departamento de RadiologiaUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil

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