A Sliding Hip Screw Augmented with 2 Screws is Biomechanically Similar to an Inverted Triad of Cannulated Screws in Repair of a Pauwels Type-III Fracture

Patrick Atkinson; Theresa Atkinson; Bernard P. Kemker; Kevin M. Magone; Jonas K. Owen; Sidney M. Martin

doi:10.1016/j.injury.2017.05.013

A Sliding Hip Screw Augmented with 2 Screws is Biomechanically Similar to an Inverted Triad of Cannulated Screws in Repair of a Pauwels Type-III Fracture

Patrick Atkinson, Theresa Atkinson, Bernard P. Kemker, Kevin M. Magone, Jonas K. Owen, Sidney M. Martin

Kettering University

Research output: Contribution to journal › Article › peer-review

Abstract

<p> <h3 id="x-x-sect0010"> Objective </h3> <p id="x-x-spar0025"> Pauwels III <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/femoral-neck-fracture" title="Learn more about Femoral Neck Fracture from ScienceDirect's AI-generated Topic Pages"> femoral neck fractures </a> are highly unstable. These fractures are commonly treated with three cannulated screws or sliding hip screw (SHS) implants, however high rates of <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/nonunion" title="Learn more about Nonunion from ScienceDirect's AI-generated Topic Pages"> non-union </a> persist. A hybrid SHS construct has recently been proposed. The objective of the study was to compare this construct to the familiar inverted triad of cannulated screws and to a single SHS. <h3 id="x-x-sect0015"> Methods </h3> <p id="x-x-spar0030"> Fourth generation biomechanical <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/femur" title="Learn more about Femur from ScienceDirect's AI-generated Topic Pages"> femur </a> analogs were used to create a highly repeatable injury model. The hybrid SHS construct contained a SHS with two superior cannulated screws in an inverted triangle configuration. Eight samples for each construct were biomechanically evaluated and the results compared using ANOVA (p < 0.05). <h3 id="x-x-sect0020"> Results </h3> <p id="x-x-spar0035"> The cannulated triad and hybrid SHS provided similar stiffness and fracture gap motion. The single SHS exhibited significantly lower stiffness and larger fracture plane diastasis than either the inverted triangle of cannulated screws or hybrid SHS (p < 0.05). None of the constructs exhibited catastrophic failure during cyclic loading nor under loading up to 2.5 times body weight. <h3 id="x-x-sect0025"> Conclusions </h3> <p id="x-x-spar0040"> The single SHS provided the least stable <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/fracture-fixation" title="Learn more about Fracture Fixation from ScienceDirect's AI-generated Topic Pages"> fracture fixation </a> , while the inverted triad and hybrid SHS constructs were mechanically similar. The fracture repair simulated here illustrates how these repairs have the potential to return near pre-fracture strength in ideal conditions with young, healthy bone. However; in clinical situations where comminution impairs load transfer through the cortices the hybrid SHS may be the most favorable option. </p> </p> </p> </p></p>

Original language	American English
Journal	Injury
Volume	48
DOIs	https://doi.org/10.1016/j.injury.2017.05.013
State	Published - Aug 1 2017

Keywords

Femur Fracture
Femoral Neck Fracture
Pauwells III
Sliding Hip Screw
Dynamic Hip Screw
Cannulated Triad
Sawbones
Hip Biomechanics

Disciplines

Biomaterials
Biomedical Devices and Instrumentation
Biomedical Engineering and Bioengineering
Engineering

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10.1016/j.injury.2017.05.013License: CC BY

https://www.sciencedirect.com/science/article/abs/pii/S0020138317303364#!

Cite this

@article{f2487ab111244bcd9bce3d3b2c1c93ff,

title = "A Sliding Hip Screw Augmented with 2 Screws is Biomechanically Similar to an Inverted Triad of Cannulated Screws in Repair of a Pauwels Type-III Fracture",

abstract = " Objective Pauwels III femoral neck fractures are highly unstable. These fractures are commonly treated with three cannulated screws or sliding hip screw (SHS) implants, however high rates of non-union persist. A hybrid SHS construct has recently been proposed. The objective of the study was to compare this construct to the familiar inverted triad of cannulated screws and to a single SHS. Methods Fourth generation biomechanical femur analogs were used to create a highly repeatable injury model. The hybrid SHS construct contained a SHS with two superior cannulated screws in an inverted triangle configuration. Eight samples for each construct were biomechanically evaluated and the results compared using ANOVA (p < 0.05). Results The cannulated triad and hybrid SHS provided similar stiffness and fracture gap motion. The single SHS exhibited significantly lower stiffness and larger fracture plane diastasis than either the inverted triangle of cannulated screws or hybrid SHS (p < 0.05). None of the constructs exhibited catastrophic failure during cyclic loading nor under loading up to 2.5 times body weight. Conclusions The single SHS provided the least stable fracture fixation , while the inverted triad and hybrid SHS constructs were mechanically similar. The fracture repair simulated here illustrates how these repairs have the potential to return near pre-fracture strength in ideal conditions with young, healthy bone. However; in clinical situations where comminution impairs load transfer through the cortices the hybrid SHS may be the most favorable option. ",

keywords = "Femur Fracture, Femoral Neck Fracture, Pauwells III, Sliding Hip Screw, Dynamic Hip Screw, Cannulated Triad, Sawbones, Hip Biomechanics",

author = "Patrick Atkinson and Theresa Atkinson and Kemker, {Bernard P.} and Magone, {Kevin M.} and Owen, {Jonas K.} and Martin, {Sidney M.}",

year = "2017",

month = aug,

day = "1",

doi = "10.1016/j.injury.2017.05.013",

language = "American English",

volume = "48",

journal = "Injury",

}

TY - JOUR

T1 - A Sliding Hip Screw Augmented with 2 Screws is Biomechanically Similar to an Inverted Triad of Cannulated Screws in Repair of a Pauwels Type-III Fracture

AU - Atkinson, Patrick

AU - Atkinson, Theresa

AU - Kemker, Bernard P.

AU - Magone, Kevin M.

AU - Owen, Jonas K.

AU - Martin, Sidney M.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Objective Pauwels III femoral neck fractures are highly unstable. These fractures are commonly treated with three cannulated screws or sliding hip screw (SHS) implants, however high rates of non-union persist. A hybrid SHS construct has recently been proposed. The objective of the study was to compare this construct to the familiar inverted triad of cannulated screws and to a single SHS. Methods Fourth generation biomechanical femur analogs were used to create a highly repeatable injury model. The hybrid SHS construct contained a SHS with two superior cannulated screws in an inverted triangle configuration. Eight samples for each construct were biomechanically evaluated and the results compared using ANOVA (p < 0.05). Results The cannulated triad and hybrid SHS provided similar stiffness and fracture gap motion. The single SHS exhibited significantly lower stiffness and larger fracture plane diastasis than either the inverted triangle of cannulated screws or hybrid SHS (p < 0.05). None of the constructs exhibited catastrophic failure during cyclic loading nor under loading up to 2.5 times body weight. Conclusions The single SHS provided the least stable fracture fixation , while the inverted triad and hybrid SHS constructs were mechanically similar. The fracture repair simulated here illustrates how these repairs have the potential to return near pre-fracture strength in ideal conditions with young, healthy bone. However; in clinical situations where comminution impairs load transfer through the cortices the hybrid SHS may be the most favorable option.

AB - Objective Pauwels III femoral neck fractures are highly unstable. These fractures are commonly treated with three cannulated screws or sliding hip screw (SHS) implants, however high rates of non-union persist. A hybrid SHS construct has recently been proposed. The objective of the study was to compare this construct to the familiar inverted triad of cannulated screws and to a single SHS. Methods Fourth generation biomechanical femur analogs were used to create a highly repeatable injury model. The hybrid SHS construct contained a SHS with two superior cannulated screws in an inverted triangle configuration. Eight samples for each construct were biomechanically evaluated and the results compared using ANOVA (p < 0.05). Results The cannulated triad and hybrid SHS provided similar stiffness and fracture gap motion. The single SHS exhibited significantly lower stiffness and larger fracture plane diastasis than either the inverted triangle of cannulated screws or hybrid SHS (p < 0.05). None of the constructs exhibited catastrophic failure during cyclic loading nor under loading up to 2.5 times body weight. Conclusions The single SHS provided the least stable fracture fixation , while the inverted triad and hybrid SHS constructs were mechanically similar. The fracture repair simulated here illustrates how these repairs have the potential to return near pre-fracture strength in ideal conditions with young, healthy bone. However; in clinical situations where comminution impairs load transfer through the cortices the hybrid SHS may be the most favorable option.

KW - Femur Fracture

KW - Femoral Neck Fracture

KW - Pauwells III

KW - Sliding Hip Screw

KW - Dynamic Hip Screw

KW - Cannulated Triad

KW - Sawbones

KW - Hip Biomechanics

UR - https://digitalcommons.kettering.edu/mech_eng_facultypubs/47

UR - https://www.sciencedirect.com/science/article/abs/pii/S0020138317303364#!

U2 - 10.1016/j.injury.2017.05.013

DO - 10.1016/j.injury.2017.05.013

M3 - Article

VL - 48

JO - Injury

JF - Injury

ER -

A Sliding Hip Screw Augmented with 2 Screws is Biomechanically Similar to an Inverted Triad of Cannulated Screws in Repair of a Pauwels Type-III Fracture

Abstract

Keywords

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