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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Article info
Publication history
Published online: October 10, 2022
Accepted:
October 6,
2022
Received:
March 30,
2022
Identification
Copyright
Published by Elsevier Ltd.
