Are piriformis reconstruction implants ideal for prophylactic femoral neck fixation?

Shieh, Alvin K.; Refaat, Motasem; Heyrani, Nasser; Garcia-Nolen, Tanya; Lee, Mark A.; Eastman, Jonathan Garland

doi:10.1016/j.injury.2018.10.018

Cited by 6 publications

(12 citation statements)

References 18 publications

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“…Stemming from a prior study, we attempted to answer the question of whether a piriformis entry or a greater trochanteric entry cephalomedullary nail would be preferred based on mechanical testing. 8 The results of this biomechanical study demonstrate that the greater trochanteric nail with 2 proximal interlocks leads to a higher load to failure in comparison with piriformis start nails. Consistent with previously published results, this study confirmed that an isolated entry portal at the piriformis fossa significantly decreases the load to failure for the femoral neck and the placement of a piriformis nail with 2 screws does not provide any additional strength.…”

Section: Discussionmentioning

confidence: 73%

A Biomechanical Comparison of Trochanteric Versus Piriformis Reconstruction Nails for Femoral Neck Fracture Prophylaxis

Shieh

Bravin

Shelton

et al. 2021

Journal of Orthopaedic Trauma

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Objectives: To compare piriformis fossa to greater trochanteric entry cephalomedullary implants in an evaluation of femoral neck load to failure when the device is used for femoral shaft fractures with prophylaxis of an associated femoral neck fracture.Methods: Thirty fourth-generation synthetic femur models were separated into 5 groups: intact femora, entry sites alone at the piriformis fossa or greater trochanter, and piriformis fossa and greater trochanteric entry sites after the insertion of a cephalomedullary nail. Each model was mechanically loaded with a flat plate against the superior femoral head along the mechanical axis and load to failure was recorded.Results: Mean load to failure was 5487 6 376 N in the intact femur, 3126 6 387 N in the piriformis fossa entry site group, 3772 6 558 N in the piriformis entry nail, 5332 6 292 N for the greater trochanteric entry site, and 5406 6 801 N for the greater trochanteric nail group. Both piriformis groups were significantly lower compared with the intact group. Both greater trochanteric groups were similar to the intact group and were statistically higher than the piriformis groups.Conclusions: A piriformis fossa entry site with or without an intramedullary implant weakens the femoral neck in load to failure testing. A greater trochanteric entry yields a load to failure equivalent to that of an intact femoral neck. Instrumentation with a greater trochanteric cephalomedullary nail is significantly stronger than a piriformis fossa cephalomedullary nail during axial loading in a composite femur model.

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Section: Discussionmentioning

confidence: 73%

A Biomechanical Comparison of Trochanteric Versus Piriformis Reconstruction Nails for Femoral Neck Fracture Prophylaxis

Shieh

Bravin

Shelton

et al. 2021

Journal of Orthopaedic Trauma

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“…Measured outcomes varied across studies but tended to use comparative measures like change in fracture load and energy as primary end points (Table ). When compared to maximum failure loads in the control group, augmentations resulted in femurs ranging from 58% weaker (IM nailing 20 ) or 82% stronger (PMMA injections 31 ). Six studies also analyzed changes in construct stiffness due to augmentation, and multi‐test studies incorporated more test‐specific outcome parameters like degree of fracture displacement (dislocation) or change in femoral neck‐shaft angle.…”

Section: Resultsmentioning

confidence: 99%

“…Shieh's group went beyond this and tested the effect of cortical holes made during implantation by including control groups (nonaugmented) with entry holes in the greater trochanter 19 and piriformis fossa. 20 We sorted studies based on whether they ran single or multiple mechanical tests in their protocol. A total of 19 studies were categorized as "single-test" studies, presenting the following approach to testing: first, augment the specimen with the prescribed method(s); second, evaluate the augmentation(s) with a single loading scenario.…”

Section: Resultsmentioning

confidence: 99%

“…This was performed using either the donor's contralateral femur for cadaveric specimens or native (unmodified) femur samples for synthetic specimens. Shieh's group went beyond this and tested the effect of cortical holes made during implantation by including control groups (nonaugmented) with entry holes in the greater trochanter 19 and piriformis fossa 20 …”

Section: Resultsmentioning

confidence: 99%

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Evaluating femoral augmentation to prevent geriatric hip fracture: A scoping review of experimental methods

Bliven

Fung

Cripton

et al. 2023

Journal Orthopaedic Research

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Various femoral augmentation designs have been investigated over the past decade for the prevention of geriatric hip fracture. The experimental methods used to evaluate the efficacy of these augmentations have not been critically evaluated or compared in terms of biofidelity, robustness, or ease of application. Such parameters have significant relevance in characterizing future clinical success. In this study we aimed to use a scoping review to summarize the experimental studies that evaluate femoral augmentation approaches, and critically evaluate commonly applied protocols and identify areas for concordance with the clinical situation. We conducted a literature search targeting studies that used experimental test methods to evaluate femoral augmentation to prevent geriatric fragility fracture. A total of 25 studies met the eligibility criteria. The most commonly investigated augmentation to date is the injection of bone cement or another material that cured in situ, and a popular subsequent method for biomechanical evaluation was to load the augmented proximal femur until fracture in a sideways fall configuration. We noted limitations in the clinical relevance of sideways fall scenarios being modeled and large variance in the concordance of many of the studies identified. Our review brings about recommendations for enhancing the fidelity of experimental methods modeling clinical sideways falls, which include an improved representation of soft tissue effects, using outcome metrics beyond load‐to‐failure, and applying loads inertially. Effective augmentations are encouraging for their potential to reduce the burden of hip fracture; however, the likelihood of this success is only as strong as the methods used in their evaluation.

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“…8 Piriformis entry may also weaken the intact proximal femur. 9,10 Finally, a posterior entry point may increase the risk of anterior cortical perforation in the distal femur in patients with a pronounced femoral bow. 11 Trochanteric entry nailing reportedly requires less time and fluoroscopy 2 and is optimally placed centrally on the femoral neck to allow central screw placement.…”

Section: Introductionmentioning

confidence: 99%

A Central Collinear Start Point for Reconstruction Nailing of Femur Fractures: A Technical Trick and Case Series

Robles

DeSanto

Earhart³

et al. 2023

Journal of Orthopaedic Trauma

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Summary:Selecting the optimal entry point for reconstruction nailing is critical to avoid iatrogenic malalignment and optimize mechanical stability. In-line nailing is familiar to surgeons and desirable for its on-axis position. However, there are several potential drawbacks. We describe a modified entry point and present an accompanying clinical series emphasizing an entry point in line with the medullary canal and central on the femoral neck. This central collinear start point is anterior to the traditional piriformis start point and may obviate some of the potential drawbacks with traditional piriformis nailing.

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Are piriformis reconstruction implants ideal for prophylactic femoral neck fixation?

Cited by 6 publications

References 18 publications

A Biomechanical Comparison of Trochanteric Versus Piriformis Reconstruction Nails for Femoral Neck Fracture Prophylaxis

A Biomechanical Comparison of Trochanteric Versus Piriformis Reconstruction Nails for Femoral Neck Fracture Prophylaxis

Evaluating femoral augmentation to prevent geriatric hip fracture: A scoping review of experimental methods

A Central Collinear Start Point for Reconstruction Nailing of Femur Fractures: A Technical Trick and Case Series

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