Augmentation by cerclage wire improves fixation of vertical shear femoral neck fractures—A biomechanical analysis

Kuan, Fa-Chuan; Yeh, Ming Long; Hong, Chih-Kai; Chiang, Florence L.; Jou, I‐Ming; Wang, Ping-Hui; Su, Wei-Ren

doi:10.1016/j.injury.2016.07.030

Cited by 18 publications

(17 citation statements)

References 28 publications

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“…Furthermore, the screw group showed 26% higher load-to-failure than the DHS group (3,879 vs. 3,087 N, p < 0.01). In a study by Kuan et al,9) the axial stiffness at the 7° ( p < 0.001) and 25° ( p < 0.001) valgus positions was significantly higher in the wire augmentation group. In addition, the mean load-to-failure was significantly higher in the wire augmentation group (3,686 ± 564 N) than in the non-treated group (2,602 ± 222 N, p < 0.001).…”

Section: Resultsmentioning

confidence: 85%

“…In a study by Kuan et al,9) cyclic displacement in the wire augmentation group (0.34 ± 0.16 mm) was statistically significantly smaller than that in the group without wire augmentation (0.13 ± 0.05 mm) ( p < 0.001). In one study, the displacement after loading (1,800 N) in the 135° four-hole DHS group, 135° four-hole DHS-blade group, and RoSA group was 8.9 ± 2.9 mm, 2.4 ± 1.2 mm, and 2.4 ± 1.2 mm, respectively ( p = 0.001) (Table 3).…”

Section: Resultsmentioning

confidence: 86%

“…In the included studies, the 25° adduction position was most commonly used in a standing condition 46911121415). The force at loading test varied from 300 N to 1,800 N. In normal activities of daily living, it is known that an average of 1,400–1,600 N is loaded to the hip joint.…”

Section: Discussionmentioning

confidence: 99%

“…In several studies,4619) the biomechanical properties of insertion using a calcar transverse screw were higher than those of screws placed in an inverted triangular configuration. Another method is to wrap a cerclage wire around the screw head to reduce toggling and loosening 9). Kuan et al9) reported that addition of a cerclage wire to the inverted triangular configuration resulted in improved mechanical behaviors.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, stable fixation of a Pauwels type III femoral neck fracture with an angle greater than 70° is often difficult to achieve 13). To overcome this difficulty, various implants including the dynamic hip screw (DHS) and blade type DHS (DHS-blade) have been used for fixation of this type of fracture 45678910111213)…”

mentioning

confidence: 99%

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Biomechanical Evaluation of Internal Fixation of Pauwels Type III Femoral Neck Fractures: A Systematic Review of Various Fixation Methods

et al. 2019

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Background The purpose of this systematic review was to investigate various fixation methods or implants used in the treatment of Pauwels type III femoral neck fractures. Methods PubMed Central, OVID Medline, Cochrane Collaboration Library, Web of Science, Embase, and AHRQ databases were searched to identify relevant studies published until August 2017 with English language restriction. Studies were selected on the basis of the following inclusion criteria: biomechanical study of Pauwels type III femoral neck fractures and the use of dynamic hip screw (DHS) or multiple screw fixation or other devices for fixation of the fracture. Results A total of 15 studies were included in the systematic review. Eight studies were conducted using cadavers, six studies using sawbones, and one using a finite element model. During the mechanical testing, each study measured mechanical stiffness, failure to cyclic loading, failure to vertical loading of each fixation device. DHS was included in 11 studies, multiple screw fixation in 10 studies, and other devices in six studies. Baitner et al. and Samsami et al. reported that the mechanical stiffness of DHS was superior to three inverted triangular screw fixation. Hawks et al. and Gumustas et al. reported that using a transverse calcar screw can withstand vertical loading better than three inverted triangular screw fixation. In addition, there were some studies where instruments such as Intertan nail, locking plate or other devices showed excellent biomechanical properties. Conclusions There are a variety of methods and instruments for fixation of the Pauwels type III fractures. However, it is difficult to conclude that any method is more desirable because there are advantages and disadvantages to each method. Therefore, we should pay attention to the implant choice and consider adequate weight bearing affecting the stiffness of the implant.

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Section: Resultsmentioning

confidence: 85%

Section: Resultsmentioning

confidence: 86%