The biomechanics of ipsilateral intertrochanteric and femoral shaft fractures: A comparison of 5 fracture fixation techniques

Objectives: The aim of the present study was to examine biomechanically 5 different construct combinations for fixation of ipsilateral intertrochanteric and femoral shaft fractures. Methods: Twenty-five fresh-frozen adult human femora (age range = 58-91 years, average age = 75.4 years) were tested in physiological bending and in torsion to characterize initial bending and torsional stiffness and stiffness following fixation of combined intertrochanteric and femoral shaft fractures. Five fracture fixation device constructs were assessed-construct A: long dynamic hip screw (long DHS); construct B: reconstruction nail; construct C: DHS plus low-contact dynamic compression plate; construct D: DHS plus retrograde intramedullary nail; and construct E: long intramedullary hip screw. Axial stiffness, torsional stiffness, and axial load-to-failure were the main measurements recorded. Results: There were no differences between constructs in terms of axial stiffness (P = 0.41), external rotation stiffness (P = 0.13), and axial load-to-failure (P = 0.16). However, there was a borderline statistically significant difference in internal rotation stiffness between the constructs (P = 0.048). Specifically, construct C Was significantly stiffer than construct E (P = 0.04). Conclusions: All constructs showed no statistical differences when compared with one another, with the exception of construct E, which provided the least torsional stiffness. However, the Current in vitro model did not simulate fracture healing or support offered by soft tissues, both of which would affect the stiffness and load-to-failure levels reached.