A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study

Hwang, Jin Ho; Garg, Anant Kumar; Oh, Jong‐Keon; Oh, Chang-Wug; Lee, Sung–Jae; Cho, Michael; Kim, Min-Keun; Kim, Hyun Ah

doi:10.4103/0019-5413.104186

Cited by 23 publications

(13 citation statements)

References 33 publications

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“…Biomechanical studies have shown that the blade has a higher resistance to head collapse than commonly used screw design [ 11 , 14 ]. The first biomechanical study of the PFNA device suggests that the inferior position of the helical blade in the frontal plane and center position in the sagittal plane is superior to the center-center position in both planes and provides better biomechanical stability [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Functional and Radiological Results of Proximal Femoral Nail Antirotation (PFNA) Osteosynthesis in the Treatment of Unstable Pertrochanteric Fractures

Radaideh

Qudah

Audat

et al. 2018

JCM

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Pertrochanteric femur fractures are considered amongst the most commonly encountered fractures in the geriatric age group. We evaluated radiographic and functional outcomes of patients with unstable pertrochanteric fractures treated with the proximal femur nail antirotation (PFNA). Between March 2013 and December 2015, fifty patients (28 male and 22 females with a mean age of 72.8 years (range, 20–94)) with unstable pertrochanteric fractures (AO 31.A2 and 31.A3) were fixed with the PFNA at our institution, and they were retrospectively evaluated. Forty one patients were treated with short PFNA and nine with long PFNA. Operative time ranged between 30 and 150 (average 73.60) min, blood loss ranged between 50 and 250 (average 80) milliliter and hospital stay ranged between 3 and 18 (6.86) days. The mean follow-up period was 18 months (range, 11–31). At final follow-up, solid union of all fractures had been achieved without any implant-related complications, the mean Harris Hip Score (HHS) was 79.34 ± 9.10 points and the mean neck-shaft angle was 127.2° ± 5.07°. No significant differences were encountered between the functional and radiographic outcomes of the PFNA with regards to the AO fracture classification and the implant version. PFNA is a recommended option for the treatment of unstable pertrochanteric fractures owing to its easy insertion, reduced blood loss, stable fixation and satisfactory functional and radiological outcomes.

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Section: Discussionmentioning

confidence: 99%

Functional and Radiological Results of Proximal Femoral Nail Antirotation (PFNA) Osteosynthesis in the Treatment of Unstable Pertrochanteric Fractures

Radaideh

Qudah

Audat

et al. 2018

JCM

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“…Center-center placement is recommended. All blades to migrate an acceptable distance but do so statistically less in center-center followed by center-inferior placement compared to others [16,17] . Reduction with slight valgus is greatly described in both sliding hip screw and intramedullary devices.…”

Section: Discussionmentioning

confidence: 99%

Anatomical and biomechanical parameters relating to migration of the helical blade in proximal femoral fractures fixed by proximal femoral nail anti-rotation

Limbu¹,

Rijal²,

Shah³

et al. 2021

Nat. J. Clin. Orthop.

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Introduction: Proximal femoral fractures fixation pose dilemma on fixation device to use. Western designed copied proximal femoral nail anti rotation is being used in South-East Asian population extensively. The study aims to study of migration in our population representative of the developing nations. Methods: 92 patients enrolled in prospective cross-sectional study for 9 months; 89 were evaluated for final migration studies as 3 major complications occurred. The effects of age, fracture, tip-apex distance, quadrant position in femoral head, blade size and length and Neck Shaft angle on migration were analyzed. Results: There were 42 males and 50 females with the mean age was 68.14 years. At the time of fixation mean Tip Apex Distance was 12.2 mm (7.0mm -25mm). At 6 months follow-ups, migration occurred in 78.65%. On univariate analysis, there was no effect of fracture pattern on migration (p=0.524). Femoral-Neck shaft angles were fixed in varus in 7, 5 in valgus and 77 within normal range. Relatively higher migration did occur with varus fixation but was not statistically significant (p=0.306). Multivariate analyses were done for nail diameter, nail length, old age and fracture patterns with no statistically significant interactions. The position of helical blade in the quadrant of the femoral head with centercenter having minimum migration (p= 0.000). Major complications occurred in 3 patients. Conclusions: All helical blades do migrate but within acceptable range provided fixation in acceptable Tip Apex Distance. Bone Mineral Density should be kept as co-variable in further studies.

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“…Three black markers 1 mm in diameter, which were not located collinearly, were placed at the front of the femoral head. Each specimen was positioned so that it could move within the 3D space defined by the calibration frame [22]. Two cameras were placed at 30° to the center of the specimen to measure the migration of the proximal fragment according to each axis (x-, y-, and z-axes) (Figure 3).…”

Section: Methodsmentioning

confidence: 99%

“…This test was carried out by applying a load of 1400 N [25]. However, the final load value was set to 750 N because of the occurrence of femoral shaft fracture at 1100 to 1200 N [22]. The loading protocols were as follows.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical Comparison of Three Different Intramedullary Nails for Fixation of Unstable Basicervical Intertrochanteric Fractures of the Proximal Femur: Experimental Studies

Kwak

Kim

Lee

et al. 2018

BioMed Research International

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Objectives This biomechanical study was conducted to compare fixation stability of the proximal fragments and their mechanical characteristics in proximal femur models of unstable basicervical IT fractures fixed by cephalomedullary nailing using 3 different types of the femoral head fixation. Methods A total of 36 composite femurs corresponding to osteoporotic human bone were used. These specimens were fixed with Gamma 3 (hip screw type; group 1) in 12, Gamma 3 U-blade (screw-blade hybrid type; group 2) in 12, and proximal femoral nail antirotation-II (helical blade type; group 3) in 12, respectively, and an unstable basicervical IT fracture was created by an engraving machine. After preloading and cyclic loading, the migration of the proximal fragment according to 3 axes was assessed by the stereophotogrammetric method and the migration of screw or blade tip within the femoral head was measured radiographically. Next, the vertical load was continued at a speed of 10 mm/min until the construct failure occurred. Finite element analysis was additionally performed to measure the stress and compressive strain just above the tip of screw or blade within the femoral head. Results The rotational change of the proximal fragment according to the axis of screw or blade was much greater in group 1 than in groups 2 and 3 (p=0.016 and p=0.007, respectively). Varus collapse was greater in group 3 than in group 2 (p=0.045). Cranial and axial migration of screw or blade within the femoral head were significantly greater in group 3 than in both group 1 (p=0.001 and p=0.002, respectively) and group 2 (p=0.002 and p=0.016, respectively). On finite element analysis, group 3 showed the highest peak von-Mises stress value (13.3 MPa) and compressive strain (3.2%) just above the tip of the blade within the femoral head. Meanwhile, groups 1 and 2 showed similar results on two values. Conclusions Screw-blade hybrid type and blade type would be more effective in minimizing rotation instability of the proximal fragment in unstable basicervical IT fractures. However, varus collapse of the proximal fragment and cranial and axial migration within the femoral head were greater with blade type than screw-blade hybrid type.

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A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study

Cited by 23 publications

References 33 publications

Functional and Radiological Results of Proximal Femoral Nail Antirotation (PFNA) Osteosynthesis in the Treatment of Unstable Pertrochanteric Fractures

Functional and Radiological Results of Proximal Femoral Nail Antirotation (PFNA) Osteosynthesis in the Treatment of Unstable Pertrochanteric Fractures

Anatomical and biomechanical parameters relating to migration of the helical blade in proximal femoral fractures fixed by proximal femoral nail anti-rotation

Biomechanical Comparison of Three Different Intramedullary Nails for Fixation of Unstable Basicervical Intertrochanteric Fractures of the Proximal Femur: Experimental Studies

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