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Comparison of the biomechanical stability of transverse and oblique screw trajectories in retrograde intramedullary nailing of supracondylar femur fractures

  • Muturi G. Muriuki
    Correspondence
    Corresponding author.
    Affiliations
    Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital. P.O. Box 5000 (151L), Hines, IL 60141, USA
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  • Kevin A. Sonn
    Affiliations
    Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL 60153, USA
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  • Author Footnotes
    1 Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
    Elyse J. Brinkmann
    Footnotes
    1 Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
    Affiliations
    Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL 60153, USA
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  • Kenneth R. Blank
    Affiliations
    Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital. P.O. Box 5000 (151L), Hines, IL 60141, USA
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  • Robert M. Havey
    Affiliations
    Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital. P.O. Box 5000 (151L), Hines, IL 60141, USA
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  • Avinash G. Patwardhan
    Affiliations
    Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital. P.O. Box 5000 (151L), Hines, IL 60141, USA

    Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL 60153, USA
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  • Author Footnotes
    2 McGill University, 1650 Cedar Avenue, Montréal, Québec, H3G 1A4, Canada.
    Mitchell Bernstein
    Footnotes
    2 McGill University, 1650 Cedar Avenue, Montréal, Québec, H3G 1A4, Canada.
    Affiliations
    Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL 60153, USA
    Search for articles by this author
  • Author Footnotes
    1 Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
    2 McGill University, 1650 Cedar Avenue, Montréal, Québec, H3G 1A4, Canada.

      Highlights

      • Simulated stair climbing was more challenging than standing to fracture fixation.
      • In 15/16, 10° of motion occurred at the fracture site before 10 mm of motion.
      • Additional intramedullary nail locking screws did not improve fracture fixation.

      Abstract

      Background

      The goal was to determine the effect of addition of oblique trajectory distal interlock screws to a retrograde intramedullary femoral nail on implant stability (stiffness), cycles to failure and mode of failure. The hypothesis was that addition of oblique screws would increase implant stability and number of loading cycles to failure.

      Methods

      Eight matched pairs were tested; one femur implanted with a femoral nail with only transverse distal interlock screws and the other with transverse and oblique interlock screws. Axial compressive load was applied to the femoral head and the gluteal tendon was tensioned vertically to simulate standing or at 45° to the sagittal plane to simulate stair climbing. Loads were cycled to increasing amplitude until failure of fixation (10 mm displacement or 10° rotation).

      Findings

      In simulated standing, oblique screw specimen had greater sagittal bending (bowing) than transverse only specimen. Transverse (axial) plane motion was higher in simulated stair climbing in oblique screw specimen. Oblique screw specimen had higher sagittal plane translation at 600 N of load. At 300 N, oblique screw specimen had lower internal-external rotation than transverse only specimen. A larger number of cycles to failure were observed in four oblique screw of seven paired specimen. Failure (10 mm or 10 degrees of motion) was only achieved during simulated stair climbing.

      Interpretation

      Our hypothesis that adding oblique screws improves fixation was rejected. Activities of daily living other than standing may constitute a challenge to fracture fixation; fixation failure occurred at lower loads in simulated stair climbing than standing.

      Keywords

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