Implant-related complications in the treatment of unstable intertrochanteric fractures: meta-analysis of dynamic screw-plate versus dynamic screw-intramedullary nail devices

Audigé, Laurent; Hanson, Beate; Swiontkowski, Marc F.

doi:10.1007/s00264-003-0457-6

Cited by 94 publications

(58 citation statements)

References 22 publications

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“…So the choice of the implant is particularly critical in unstable fractures. This is reflected in the clinical situation where the failure rate in unstable fractures is significantly increased compared to stable fractures [1,21,29]. Although these complications in unstable fractures are largely related to the local mechanical situation at the fracture site, no standardized biomechanical model exists to study the mechanical characteristics of hip fracture osteosynthesis [12].…”

Section: Introductionmentioning

confidence: 99%

Type of Hip Fracture Determines Load Share in Intramedullary Osteosynthesis

Eberle

Gerber

Oldenburg

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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The choice of the appropriate implant continues to be critical for fixation of unstable hip fractures. Therefore, the goal of this study was to develop a numerical model to investigate the mechanical performance of hip fracture osteosynthesis. We hypothesized that decreasing fracture stability results in increasing load share of the implant and therefore higher stress within the implant. We also investigated the relationship of interfragmentary movement to the fracture stability. A finite element model was developed for a cephalomedullary nail within a synthetic femur and simulated a pertrochanteric fracture, a lateral neck fracture, and a subtrochanteric fracture. The femur was loaded with a hip force and was constrained physiologically. The FE model was validated by mechanical experiments. All three fractures resulted in similar values for stiffness (462-528 N/mm). The subtrochanteric fracture resulted in the highest local stress (665 MPa), and the pertrochanteric fracture resulted in a lower stress (621 MPa) with even lower values for the lateral neck fracture (480 MPa). Thus, intramedullary implants can stabilize unstable hip fractures with almost the same amount of stiffness as seen in stable fractures, but they have to bear a higher load share, resulting in higher stresses in the implant.

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Section: Introductionmentioning

confidence: 99%

Type of Hip Fracture Determines Load Share in Intramedullary Osteosynthesis

Eberle

Gerber

Oldenburg

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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“…A recent meta-analysis of 17 randomized studies comparing dynamic screw IM nailing devices (DSIN) and dynamic screw-plate devices for unstable intertrochanteric fractures found no significant difference in the occurrence of screw cut-out among the different devices. 5 The authors concluded that significant controversy remains as DSIN devices seem to reduce cutout in studies on unstable fractures while the opposite is true for studies combining stable and unstable fractures. No clear clinical advantage was identified in either device.…”

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confidence: 99%

“…1 The cutout rate for intramedullary (IM) nails has been reported to be as high as 8.3%. 1,5 Screw cut-out or migration can occur in either an axial or cephalad direction or a combination of both. Axial migration is also referred to as ''axial penetration'' or ''axial impaction.''…”

mentioning

confidence: 99%

Hip screw migration testing: First results for hip screws and helical blades utilizing a new oscillating test method

Born

Karich²,

Bauer

et al. 2010

Journal Orthopaedic Research

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Despite continued improvement in the methods and devices used to treat intertrochanteric fractures, there remains an unacceptable amount of failures. The cut-out rate for hip screws has been recorded up to 8.3%. To evaluate the migration of different implants under physiological loads, a multiplanar biomechanical test method for hip screws was developed, the first to incorporate a simulation of the human gait cycle by an oscillating flexion/extension movement of the test device. The new method was used to compare different hip screw and blade designs with respect to their directional migration resistance. The test method generated failure modes that were consistent with those observed clinically. Under cyclic loading, the hip screws migrated predominantly in a cephalad direction. In contrast, the helical blades exhibited a distinct migration in their axial direction. The Gamma3 hip screw design showed a significantly higher migration resistance compared with other screw and helical blade designs. The results demonstrate the ability of hip screws to significantly reduce axial migration and prevent cut-out under simulated walking loads. Further, the new multiplanar test method creates a physiological environment that can be used to optimize designs for intertrochanteric fracture fixation. ß

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“…Potential disadvantages are related to greater risk of jamming of the sliding mechanism and stress risers at the site of the tip of the nail and distal locking bolts. It has been suggested, without supporting clinical data, that the IMNs are superior for unstable trochanteric fractures, reverse oblique fractures and sub-trochanteric fractures [2,3]. Controversy, therefore, continues regarding the optimum choice of implant for these unstable fractures [14].…”

Section: Introductionmentioning

confidence: 99%

Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures

Jones

Johnston

Parker

2006

International Orthopaedics (SICO

155

102

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Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures Abstract The purpose of this meta-analysis was to compare the fixation outcome between the sliding hip screw (SHS) and intramedullary nails (IMN) in stable and unstable extracapsular proximal femoral fractures. All randomised controlled studies comparing IMNs with a SHS were considered for inclusion. Data was independently extracted and trial methodology assessed. Twentyfour randomised trials involving 3,202 patients with 3,279 fractures were included. Pooled results gave no statistically significant difference in the cut-out rate between the IMN and SHS (41/1,556 vs 37/1,626; relative risk 1.19; 95% confidence interval 0.78-1.82). Total failure rate (1,03/1,495 and 58/1,565, relative risk 1.83; 95% confidence interval 1.35-2.50) and re-operation rate (57/1,357 and 35/1,415, relative risk 1.63; 95% confidence interval 1.11-2.40) were greater with the IMN compared with the SHS. There was no evidence for a reduced failure rate with IMN in unstable trochanteric fractures.Résumé Le but de cette méta-analyse était de comparer le résultat de la fixation par vis glissante et clou centromé-dullaire dans les fractures extracapsulaires fémorales proximales stables et instables. Toutes les études randomisées et contrôlées qui comparent des clous centromédul-laires avec une vis glissante ont été considérées pour l'inclusion. Les données ont été extraites indépendamment, et la méthodologie de l'étude étudiée. 24 essais randomisés qui concernent 3,202 malades avec 3,279 fractures ont été inclus. Les résultats mis en commun n'ont donné aucune différence statistiquement notable entre le clou centromé-dullaire et la vis glissante (41/1,556 vs 37/1,626; risque relatif 1.19; 95% intervalle de confidence 0.78-1.82). Le taux d'échec total (103/1,495 vs 58/1,565, risque relatif 1.83; 95% intervalle de confiance 1.35-2.50) et tle aux de la ré -opération (57/1,357 vs 35/1,415, risque relatif 1.63; 95% intervalle de confiance 1.11-2.40) étaient plus grands avec le clou centromédullaire comparé a la vis glissante. Il n'y avait aucune preuve qu'il y ait un taux de défaillance réduit avec le clou centromédullaire dans les fractures trochanterienne instables.

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Implant-related complications in the treatment of unstable intertrochanteric fractures: meta-analysis of dynamic screw-plate versus dynamic screw-intramedullary nail devices

Cited by 94 publications

References 22 publications

Type of Hip Fracture Determines Load Share in Intramedullary Osteosynthesis

Type of Hip Fracture Determines Load Share in Intramedullary Osteosynthesis

Hip screw migration testing: First results for hip screws and helical blades utilizing a new oscillating test method

Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures

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