Bone cement augmentation of femoral nail head elements increases their cut-out resistance in poor bone quality- A biomechanical study | Health & Environmental Research Online (HERO)

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Citation
Tags

HERO ID

7410182

Reference Type

Journal Article

Title

Bone cement augmentation of femoral nail head elements increases their cut-out resistance in poor bone quality- A biomechanical study

Author(s)

Sermon, A; Zderic, I; Khatchadourian, R; Scherrer, S; Knobe, M; Stoffel, K; Gueorguiev, B

Year

2021

Is Peer Reviewed?

Yes

Journal

Journal of Biomechanics
ISSN: 0021-9290
EISSN: 1873-2380

Volume

118

Page Numbers

110301

Language

English

PMID

33582598

DOI

10.1016/j.jbiomech.2021.110301

Web of Science Id

WOS:000633040900008

Abstract

The aim of this study was to analyze biomechanically the impact of bone cement augmentation on the fixation strength and cut-out resistance of Proximal Femoral Nail Antirotation (PFNA) and Trochanteric Fixation Nail Advanced (TFNA) head elements within the femoral head in a human cadaveric model with poor bone quality. Methodology: Fifteen pairs of fresh-frozen human cadaveric femoral heads were randomized to three sets of five pairs each for center-center implantation of either TFNA blade, TFNA screw, or PFNA blade. By splitting the specimens of each pair for treatment with or without bone cement augmentation, six study groups were created. All specimens were biomechanically tested under progressively increasing cyclic loading featuring a physiologic loading trajectory in a setup simulating a reduced intertrochanteric fracture with lack of posteromedial support. Number of cycles to 5° varus collapse was evaluated together with the corresponding load at failure. Results: Compared to the non-augmented state, all types of implants demonstrated significantly higher numbers of cycles to failure and load at failure following augmentation, p ≤ 0.03. Augmented TFNA blades resulted in highest numbers of cycles to failure and loads at failure (30492; 4049 N) followed by augmented PFNA blades (30033; 4003 N) and augmented TFNA screws (19307; 2930 N), p = 0.11. Augmented TFNA screws showed similar numbers of cycles to failure and loads at failure compared to both non-augmented TFNA and PFNA blades, P = 0.98. From a biomechanical perspective, bone cement augmentation significantly increases the cut-out resistance of instrumented TFNA and PFNA head elements and is a valid supplementary treatment option to these nailing procedures in poor bone quality.