The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study

Abstract Background The major objective of the present study is to investigate the differences in the load and strain changes in the intertrochanteric region of human cadaveric femora between the loss of medial or lateral wall and after treatment with proximal femoral nail antirotation (PFNA). Metho...

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Main Authors: Boyuan Nie, Xueying Chen, Jing Li, Dou Wu, Qiang Liu
Format: Article
Language:English
Published: BMC 2017-12-01
Series:Journal of Orthopaedic Surgery and Research
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13018-017-0673-1
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spelling doaj-da74417197a14614838b1670af9a73812020-11-25T01:04:20ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2017-12-011211910.1186/s13018-017-0673-1The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical studyBoyuan Nie0Xueying Chen1Jing Li2Dou Wu3Qiang Liu4Department of Orthopedic Surgery, Dayi Hospital of Shanxi Medical UniversityBiological Material R&D Center, China Institute for Radiation ProtectionBiological Material R&D Center, China Institute for Radiation ProtectionDepartment of Orthopedic Surgery, Dayi Hospital of Shanxi Medical UniversityDepartment of Orthopedic Surgery, Dayi Hospital of Shanxi Medical UniversityAbstract Background The major objective of the present study is to investigate the differences in the load and strain changes in the intertrochanteric region of human cadaveric femora between the loss of medial or lateral wall and after treatment with proximal femoral nail antirotation (PFNA). Methods After measuring the geometry of the proximal femur region and modeling the medial or lateral wall defect femoral models, six pairs of freshly frozen human femora were randomly assigned in the medial or lateral wall group. According to a single-leg stance model, an axial loading was applied, and the strain distribution was measured before and after PFNA implantation. The strains of each specimen were recorded at load levels of 350, 700, and 1800 N and the failure load. Paired t test was performed to assess the differences between two groups. Results The failure mode of almost all defect model femora was consistent with that of the simulated type of intertrochanteric fractures. After the PFNA implantation, the failure mode of almost all stabilized femora was caused by new lateral wall fractures. The failure load of the lateral wall group for defect model femora was significantly higher than that of the medial wall group (p < 0.001). However, the difference disappeared after the PFNA was implanted (p = 0.990). The axial stiffness in all defect model femora showed the same results (p < 0.001). After the PFNA implantation, the axial stiffness of the lateral wall group remained higher than that of the medial wall group (p = 0.001). However, the axial stiffness of the lateral wall group showed that the femora removed from the lateral wall were higher than the PFNA-stabilized femora (p = 0.020). For the axial strain in the anterior wall after the PFNA implantation, the strain of the lateral wall group was significantly lower than that of the medial group (p = 0.003). Nevertheless, for the axial strain of the posterior wall after the PFNA implantation, the strain of the medial wall group was significantly lower than that of the lateral group (p < 0.001). Conclusions In summary, this study demonstrated that PFNA is an effective intramedullary fixation system for treating unstable intertrochanteric fractures. Compared with the lateral wall, the medial femoral wall is a more important part in the intertrochanteric region. We suggest that in treating intertrochanteric femoral fractures with medial wall fractures, the medial wall fragment should be reset and fixed as much as possible.http://link.springer.com/article/10.1186/s13018-017-0673-1Medial wallLateral wallFemoral intertrochanteric regionProximal femoral nail antirotationBiomechanical testingCadaver femur
collection DOAJ
language English
format Article
sources DOAJ
author Boyuan Nie
Xueying Chen
Jing Li
Dou Wu
Qiang Liu
spellingShingle Boyuan Nie
Xueying Chen
Jing Li
Dou Wu
Qiang Liu
The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study
Journal of Orthopaedic Surgery and Research
Medial wall
Lateral wall
Femoral intertrochanteric region
Proximal femoral nail antirotation
Biomechanical testing
Cadaver femur
author_facet Boyuan Nie
Xueying Chen
Jing Li
Dou Wu
Qiang Liu
author_sort Boyuan Nie
title The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study
title_short The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study
title_full The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study
title_fullStr The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study
title_full_unstemmed The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study
title_sort medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall: a biomechanical study
publisher BMC
series Journal of Orthopaedic Surgery and Research
issn 1749-799X
publishDate 2017-12-01
description Abstract Background The major objective of the present study is to investigate the differences in the load and strain changes in the intertrochanteric region of human cadaveric femora between the loss of medial or lateral wall and after treatment with proximal femoral nail antirotation (PFNA). Methods After measuring the geometry of the proximal femur region and modeling the medial or lateral wall defect femoral models, six pairs of freshly frozen human femora were randomly assigned in the medial or lateral wall group. According to a single-leg stance model, an axial loading was applied, and the strain distribution was measured before and after PFNA implantation. The strains of each specimen were recorded at load levels of 350, 700, and 1800 N and the failure load. Paired t test was performed to assess the differences between two groups. Results The failure mode of almost all defect model femora was consistent with that of the simulated type of intertrochanteric fractures. After the PFNA implantation, the failure mode of almost all stabilized femora was caused by new lateral wall fractures. The failure load of the lateral wall group for defect model femora was significantly higher than that of the medial wall group (p < 0.001). However, the difference disappeared after the PFNA was implanted (p = 0.990). The axial stiffness in all defect model femora showed the same results (p < 0.001). After the PFNA implantation, the axial stiffness of the lateral wall group remained higher than that of the medial wall group (p = 0.001). However, the axial stiffness of the lateral wall group showed that the femora removed from the lateral wall were higher than the PFNA-stabilized femora (p = 0.020). For the axial strain in the anterior wall after the PFNA implantation, the strain of the lateral wall group was significantly lower than that of the medial group (p = 0.003). Nevertheless, for the axial strain of the posterior wall after the PFNA implantation, the strain of the medial wall group was significantly lower than that of the lateral group (p < 0.001). Conclusions In summary, this study demonstrated that PFNA is an effective intramedullary fixation system for treating unstable intertrochanteric fractures. Compared with the lateral wall, the medial femoral wall is a more important part in the intertrochanteric region. We suggest that in treating intertrochanteric femoral fractures with medial wall fractures, the medial wall fragment should be reset and fixed as much as possible.
topic Medial wall
Lateral wall
Femoral intertrochanteric region
Proximal femoral nail antirotation
Biomechanical testing
Cadaver femur
url http://link.springer.com/article/10.1186/s13018-017-0673-1
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