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  • Title: Biomechanical comparison of a 2 and 3 proximal screw-configured antegrade piriformis intramedullary nail with a trochanteric reconstruction nail in an unstable subtrochanteric fracture model.
    Author: Fissel B, Moed BR, Bledsoe JG.
    Journal: J Orthop Trauma; 2008; 22(5):337-41. PubMed ID: 18448988.
    Abstract:
    OBJECTIVE: The objective of this study was to test the stiffness and ultimate load to failure of new intramedullary (IM) nail proximal screw configurations as compared to a trochanteric reconstruction nail. METHODS: Twenty-one synthetic composite femurs were mounted on a Material Testing System and tested in axial compression 5 times. The femurs had an 1 of 2 IM nail types inserted with 1 of 3 proximal screw configurations: a 3-screw configuration with 2 transverse screws and a screw angled into the femoral neck; a 2-screw design with a single transverse screw and a single screw angled into the femoral neck; 2 parallel screws angled into the femoral neck. There were 7 specimens in each group. An unstable fracture (OTA/AO 32-C3.2) was created. and the stiffness of these constructs was tested in compression 5 times. Each construct was then loaded to failure in compression. RESULTS: The 3-screw construct provided more axial stiffness (214 N/mm +/- 75) than either the 2-screw construct (123 N/mm +/- 32) or the trochanteric reconstruction nail (127 N/mm +/- 21) (P = 0.017 and 0.035 for 3-screw vs. 2-screw and recon respectively, P = 0.45 for 2-screw vs. recon). Load-to-failure testing demonstrated similarity among the different screw configurations (3-screw = 2230 N +/- 265, 2-screw = 2283 N +/- 260, Reconstruction nail = 2121 N +/- 156) (P = 1.0 all groups). CONCLUSIONS: The proximal 3-screw configuration provided more stiffness than either the 2-screw configuration or trochanteric reconstruction nail. The 2-screw configuration performed equally to a standard trochanteric reconstruction nail in stiffness testing. The ultimate loads to failure for the 3 tested constructs were not significantly different.
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