Document Detail

Is Distal Locking Necessary? A Biomechanical Investigation of Intramedullary Nailing Constructs for Intertrochanteric Fractures.
MedLine Citation:
PMID:  23249889     Owner:  NLM     Status:  Publisher    
OBJECTIVES:: Unstable intertrochanteric fractures in the elderly occur frequently. Several studies have evaluated the biomechanical impact of distally locking long cephalomedullary nails under axial loading; however, the impact of torsional loading has not been investigated. The purpose of this study is to determine the rotational load to failure of unstable intertrochanteric fractures treated with long cephalomedullary nails, with and without distal interlocking. METHODS:: Eleven paired cadaveric femora treated with long cephalomedullary nails were randomized into 2 groups. Group 1 was left unlocked, while group 2 was distally locked. Osteotomies were completed to create unstable four part fractures. The femora were anatomically fixed proximally and distally and secured to the biomechanical testing machine to undergo internal rotation. Torque and rotational angle were measured until failure. RESULTS:: The locked group had a mean maximal torsional load of 57.9±19.0Nm and a mean rotational stiffness of 119.4±35.7Nm/rad. The femora treated with unlocked nails had a mean maximal torsional load of 29.1±12.2Nm and a mean rotational stiffness of 77.2±31.3Nm/rad. Distal locking resulted in a significant increase in maximal rotational load (p=.001) and rotational stiffness (p=.004) before failure. No significant difference was found in mean rotational angle at failure between groups (26.0±9.6˚, p=.263). CONCLUSION:: Maximal torsional load to failure for the unlocked group is within the functional range of rotational loads experienced at the hip for an average adult. The results show that distal locking significantly increases rotational load to failure. The authors highly recommend routine use of distal interlocking screws during cephalomedullary nail placement in unstable intertrochanteric fractures.
David Gallagher; Brock Adams; Hebah El-Gendi; Ashish Patel; Lauren Grossman; Jay Berdia; Yevgeniy Korshunov; Ariel Goldman
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-14
Journal Detail:
Title:  Journal of orthopaedic trauma     Volume:  -     ISSN:  1531-2291     ISO Abbreviation:  J Orthop Trauma     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8807705     Medline TA:  J Orthop Trauma     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1SUNY Downstate Medical Center, Brooklyn, New York.
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