European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2016
Effect of varus and valgus alignment on implant loading after proximal femur fracture fixation.
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Marmor Meir, Liddle Kate, Buckley Jenni, Matityahu Amir
Аннотация
INTRODUCTION: More than 10 % of proximal femur fractures repaired with either a sliding hip screw and side plate (SHS-P) or a sliding hip screw and intramedullary nail (SHS-IMN) demonstrate varus malreduction. The purpose of this study was to compare the effect of varus or valgus loading on comminuted intertrochanteric fractures repaired with SHS-P or SHS-IMN constructs.
METHODS: Unstable intertrochanteric fractures with segmental comminution were generated in 12 cadaver proximal femurs, six of which were fixed with an SHS-P and six with an SHS-IMN. Both implants had a strain gauge at the lag screw-nail-plate interface to assess implant load bearing. The load on the implants was measured with the specimens in neutral position and at 5°, 10°, and 15° of varus and valgus.
RESULTS: Loads on both SHS-IMN and SHS-P constructs were significantly increased when loading the implants in varus and significantly decreased when loading the implants in valgus. Unlike the SHS-IMN, the SHS-P trended toward increased load bearing at 15° varus (159.1 vs. 118.5 %, P = .065) and trended toward less load bearing at 15° valgus (42.3 vs. 59.8 %, P = .06).
CONCLUSIONS: Regardless of implant choice, avoiding varus loading on the fixation construct reduces the load on the implant. SHS-P constructs may be more affected by varus or valgus malalignment than SHS-IMN constructs.
METHODS: Unstable intertrochanteric fractures with segmental comminution were generated in 12 cadaver proximal femurs, six of which were fixed with an SHS-P and six with an SHS-IMN. Both implants had a strain gauge at the lag screw-nail-plate interface to assess implant load bearing. The load on the implants was measured with the specimens in neutral position and at 5°, 10°, and 15° of varus and valgus.
RESULTS: Loads on both SHS-IMN and SHS-P constructs were significantly increased when loading the implants in varus and significantly decreased when loading the implants in valgus. Unlike the SHS-IMN, the SHS-P trended toward increased load bearing at 15° varus (159.1 vs. 118.5 %, P = .065) and trended toward less load bearing at 15° valgus (42.3 vs. 59.8 %, P = .06).
CONCLUSIONS: Regardless of implant choice, avoiding varus loading on the fixation construct reduces the load on the implant. SHS-P constructs may be more affected by varus or valgus malalignment than SHS-IMN constructs.