Biomechanical Analysis of Four Types of Internal Fixation in Subtrochanteric Fracture Models

Abstract

Four types of internal fixation achieve better stabilities for type I subtrochanteric fractures. PFN and PFLP produce reliable stability in type IIIA subtrochanteric fractures. If the medial buttress is restored, DCS can be considered. For type IV subtrochanteric fractures, only PFN provides stable fixation. PFLP is suitable for comminuted fractures with large fragments.

Our experience of management of sub trochanteric fractures of femur by proximal femoral nail

“…6% of patients in Schipper series had the problem of "cut out"; Various studies have considered proximal femoral nail as an excellent minimally invasive implant for sub trochanteric fractures. [17][18][19][20] The final outcome was good to excellent in 82.9% and fair in 11.4% of our patients; and our results have been comparable with other such studies in the literature. Younger age group patients irrespective of their fracture pattern had excellent outcome in our series while most of the poor results were seen in the elderly age group.…”

“…17 Chakraborty and Thapa (2012) in their study on sub trochanteric fractures declared PFN as a reliable cephalo medullary implant which gave best fixation and excellent results. They say that eccentrically placed devices like plates were susceptible to breakage due to mechanical load shearing effect; and also lead to excessive soft tissue dissection, severe blood loss besides non-union and implant failure.…”

Reducing Subtrochanteric Femur Fractures

“…10 The authors could not advocate for the use of screw-and side-plate constructs because of a high rate of reduction loss, fixation failure, and need for reoperation. [13][14][15] Superior stiffness is inherent in IMN, because of its closed-section design, which yields bending stiffness similar to that of an intact femur. 10 Also, the other types of fixation, using the varying types of proximal, femoral locking-plate technology, have also been described.…”

The use of a proximal femoral nail as a hip prosthesis: A biomechanical analysis of a newly designed implant

“…In a meta-analysis of displaced femoral neck fracture, Lu-Yao et al 11 showed that the complication rates of PFN were between 20% and 36% in the 2-year period after internal fixation, most of which were related to nonunion and avascular necrosis. Wang et al 12 reported that the main initial load time after surgery was a risk factor of failure. Older age, severe osteoporosis, a complex fracture pattern, and the operation waiting period all make the reduction difficult, and therefore, increase the rate of device failure.…”