Malpositioning of the Lag Screws by 1- or 2-screw Nailing Systems for Pertrochanteric Femoral Fractures: A Biomechanical Comparison of Gamma 3 and Intertan

Objectives: The aim of this investigation was to perform a biomechanical comparison between 1- and 2-screw systems used for the treatment of intertrochanteric fractures for centralized and decentralized placement of femoral neck screws of failure loads, stiffness, survival rates, tip apex distance (TAD), and failure mode. Methods: As fracture model, an AO 31A2.3 fracture was used. Twelve pairs of human cadaver femora were tested. Femoral neck screws were implanted in the femoral head in center/center, posterior/central, and anterior/superior position in axial/frontal plane. A single-screw system (Gamma 3 Locking Nail; Stryker GmbH & Co. KG) and a 2-screw system (Trigen-Intertan; Smith & Nephew GmbH) were used. To simulate the load in situ, a cyclic load was carried for 10,000 cycles in a material testing machine. If no cyclic failure occurred, femora were loaded until the failure. The systems were compared according to the stiffness, survivability through 10 k cycles, TAD, and load to failure. Results: None of the tested bones failed at center/center location in the decentralized positions 3 Gamma Nail and 2 Intertan specimens failed during cyclic testing. The 2-screw system resisted higher forces in all positions (Gamma: 5370N +/- 1924, Intertan: 7650N +/- 2043; P = 0.014). Conclusions: Based on these data, it is clear that both the nail systems showed a higher biomechanical stability with a lower TAD. The 2 specimens that failed with the Intertan in the cyclic tests had a TAD >= 49 mm. The cutout failures that we detected during cyclic testing in the Gamma system had a TAD >= 30 mm. Thus, it is clear that the TAD affects failure independent of the implant used. With a less than ideal lag screw placement, however, the Intertan system with 2 integrated screws was able to withstand higher loads in this study.