Summary: Fractures of the femoral neck can occur in young healthy individuals due to high loads occurring during motor vehicle accidents, impacts, or falls. Failure forces are lower if impacts occur sideways onto the greater trochanter as compared with vertical loading of the hip. Bone density, bone geometry, and thickness of cortical bone at the femoral neck contribute to its mechanical strength. Femoral neck fractures in young adults require accurate reduction and stable internal fixation. The available techniques for fracture fixation at the femoral neck (cannulated screws, hip screw systems, proximal femur plates, and cephallomedullary nails) are reviewed with respect to their competence to provide biomechanical stability. Mechanically unstable fractures require a load-bearing implant, such as hip screws, with antirotational screws or intramedullary nails. Subcapital or transcervical fracture patterns and noncomminuted fractures enable load sharing and can be securely fixed with cannulated screws or solitary hip screw systems without compromising fixation stability.

Background:A novel bicycle helmet concept has been developed to mitigate rotational head acceleration, which is a predominant mechanism of traumatic brain injury (TBI). This WAVECEL concept employs a collapsible cellular structure that is recessed within the helmet to provide a rotational suspension. This cellular concept differs from other bicycle helmet technologies for mitigation of rotational head acceleration, such as the commercially available Multi-Directional Impact Protection System (MIPS) technology which employs a slip liner to permit sliding between the helmet and the head during impact. This study quantified the efficacy of both, the WAVECEL cellular concept, and a MIPS helmet, in direct comparison to a traditional bicycle helmet made of rigid expanded polystyrene (EPS).Methods:Three bicycle helmet types were subjected to oblique impacts in guided vertical drop tests onto an angled anvil: traditional EPS helmets (CONTROL group); helmets with a MIPS slip liner (SLIP group); and helmets with a WAVECEL cellular structure (CELL group). Helmet performance was evaluated using 4.8 m/s impacts onto anvils angled at 30°, 45°, and 60° from the horizontal plane. In addition, helmet performance was tested at a faster speed of 6.2 m/s onto the 45° anvil. Five helmets were tested under each of the four impact conditions for each of the three groups, requiring a total of 60 helmets. Headform kinematics were acquired and used to calculate an injury risk criterion for Abbreviated Injury Score (AIS) 2 brain injury.Results:Linear acceleration of the headform remained below 90 g and was not associated with the risk of skull fracture in any impact scenario and helmet type. Headform rotational acceleration in the CONTROL group was highest for 6.2 m/s impacts onto the 45° anvil (7.2 ± 0.6 krad/s2). In this impact scenario, SLIP helmets and CELL helmets reduced rotational acceleration by 22% (p = 0003) and 73% (p < 0.001), respectively, compared to CONTROL helmets. The CONTROL group had the highest AIS 2 brain injury risk of 59 ± 8% for 6.2 m/s impacts onto the 45° anvil. In this impact scenario, SLIP helmets and CELL helmets reduced the AIS 2 brain injury risk to 34.2% (p = 0.001) and 1.2% (p < 0.001), respectively, compared to CONTROL helmets.Discussion:Results of this study are limited to a narrow range of impact conditions, but demonstrated the potential that rotational acceleration and the associated brain injury risk can be significantly reduced by the cellular WAVECEL concept or a MIPS slip liner. Results obtained under specific impact angles and impact velocities indicated performance differences between these mechanisms. These differences emphasize the need for continued research and development efforts toward helmet technologies that further improve protection from brain injury over a wide range a realistic impact parameters.

Background: Axial dynamization of fractures can promote healing, and overly stiff fixation can suppress healing. A novel technology, termed active plating, provides controlled axial dynamization by the elastic suspension of locking holes within the plate. This prospective, controlled animal study evaluated the effect of active plates on fracture-healing in an established ovine osteotomy model. We hypothesized that symmetric axial dynamization with active plates stimulates circumferential callus and delivers faster and stronger healing relative to standard locking plates. Methods: Twelve sheep were randomly assigned to receive a standard locking plate or an active locking plate for stabilization of a 3-mm tibial osteotomy gap. The only difference between plates was that locking holes of active plates were elastically suspended, allowing up to 1.5 mm of axial motion at the fracture. Fracture-healing was analyzed weekly on radiographs. After sacrifice at nine weeks postoperatively, callus volume and distribution were assessed by computed tomography. Finally, to determine their strength, healed tibiae and contralateral tibiae were tested in torsion until failure. Results: At each follow-up, the active locking plate group had more callus (p < 0.001) than the standard locking plate group. At postoperative week 6, all active locking plate group specimens had bridging callus at the three visible cortices. In standard locking plate group specimens, only 50% of these cortices had bridged. Computed tomography demonstrated that all active locking plate group specimens and one of the six standard locking plate group specimens had developed circumferential callus. Torsion tests after plate removal demonstrated that active locking plate group specimens recovered 81% of their native strength and were 399% stronger than standard locking plate group specimens (p < 0.001), which had recovered only 17% of their native strength. All active locking plate group specimens failed by spiral fracture outside the callus zone, but standard locking plate group specimens fractured through the osteotomy gap. Conclusions: Symmetric axial dynamization with active locking plates stimulates circumferential callus and yields faster and stronger healing than standard locking plates. Clinical Relevance: The stimulatory effect of controlled motion on fracture-healing by active locking plates has the potential to reduce healing complications and to shorten the time to return to function.