Intramedullary nailing confers an increased risk of medial migration compared to dynamic hip screw fixation in unstable intertrochanteric hip fractures |
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| Affiliation: | 1. National University Health System, Singapore;2. Singapore General Hospital, Singapore;3. Ng Teng Feng General Hospital, Singapore;4. National University Health System, Singapore;1. Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan;2. Department of Linguistics, Indiana University, Bloomington, IN, USA;3. Prehospital Emergency Care Center, Mackay Memorial Hospital, Taipei, Taiwan;4. Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea;5. Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia;6. Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu City, Taiwan;7. Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan;1. University of Bari “Aldo Moro”. Department of Basic Medical Sciences, Neuroscience and Sense Organs. Orthopaedic and Trauma Unit, Piazza Giulio Cesare, 11. 70124. Bari, Italy;2. Orthopaedic and Trauma Unit, Humanitas Research Hospital, Milano, Italy;1. Department of Orthopedic Trauma Surgery, Yantaishan Hospital, 91 Jiefang Road,Yantai 264001, Shandong Province, PR China;2. Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road,Shanghai 200090, PR China;1. Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India;2. Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India;3. Department of Orthopedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India;4. Mahatma Gandhi Mission Medical College, Aurangabad, India;5. Department of Orthopedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India;1. Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan;2. Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan |
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| Abstract: | IntroductionMedial migration of the femoral neck element (FNE) superomedially against gravity with respect to the intramedullary component of the cephalomedullary nail is a complication increasingly recognized to cause femoral head cut-out in intramedullary nailing of pertrochanteric hip fractures. Although cut-outs are common to both intra- and extramedullary fixation, especially in unstable pertrochanteric hip fractures, FNE medial migration in sliding hip screws continues to remain sparse despite increased awareness of the phenomenon. This study aims to investigate whether intramedullary nailing is biomechanically predisposed to FNE medial migration compared to extramedullary fixation with sliding hip screws to account for the discrepancy in reported FNE medial migration rates.Materials and methodsTwelve fourth-generation synthetic femurs (Sawbones) with unstable intertrochanteric fractures were divided into 2 groups (n=6 per group). Fracture fixation was performed using the Proximal Femoral Nail Antirotation (PFNA, Synthes) (n=6) in the first group, and the Dynamic Hip Screw (DHS, Synthes) (n=6) in the second group. Both groups were subjected to bidirectional cyclic loading (600N compression loading, 120N tensile loading) at 2 Hz for 5000 cycles. The medial migration distance (MMD) was recorded at the end of the testing cycles.ResultsThe mean MMD in the PFNA group was 4.56mm (SD 0.69mm) with consistent reproduction of medial migration across all constructs tested. This was significantly more compared to the MMD of 1.17mm (SD 0.69mm) in the DHS group (p<0.001).ConclusionIntramedullary nailing of unstable intertrochanteric hip fractures is inherently predisposed to FNE medial migration making it more susceptible to consequent cut-out compared to fixation with the DHS. |
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