title: In vitro comparison of resistance to implant failure in unstable trochanteric fractures fixed with intramedullary single screw versus double screw device.
abstract: BACKGROUND
  The purpose of this study was to compare the resistance of intramedullary single screw device (Gamma nail) and double screw device proximal femoral nail (PFN) in unstable trochanteric fractures in terms of the number of cycles sustained, subsidence and implant failure in an axial loading test in cadaveric femora.
  
  
  METHODS
  The study was conducted on 18 dry cadaveric femoral specimens, 9 of these were implanted with a Gamma nail and 9 with PFN. There was no significant difference found in average dual energy X-ray absorptiometry value between both groups. The construct was made unstable (AO type 31A3.3) by removing a standard sized posteromedial wedge. These were tested on a cyclic physiological loading machine at 1 cycle/s with a load of 200 kg. The test was observed for 50,000 loading cycles or until implant failure, whichever occurred earlier. Peak displacements were measured and analysis was done to determine construct stiffness and gap micromotion in axial loading.
  
  
  RESULTS
  It was observed that there was statistically significant difference in terms of displacement at the fracture gap and overall construct stiffness of specimens of both groups. PFN construct group showed a mean subsidence of 1.02 mm and Gamma nail construct group showed mean subsidence of 2.36 mm after cycling. The average stiffness of Gamma nail group was 62.8 ± 8.4 N/mm which was significantly lower than average stiffness of the PFN group (80.4 ± 5.9 N/mm) (P = 0.03). In fatigue testing, 1 out of 9 PFN bone construct failed, while 5 of 9 Gamma nail bone construct failed.
  
  
  CONCLUSIONS
  When considering micromotion (subsidence) and incidence of implant/screw failure, double screw device (PFN) had statistically significant lower micromotion across the fracture gap with axial compression and lower incidence of implant failure. Hence, double screw device (PFN) construct had higher stability compared to single screw device (GN) in an unstable trochanteric fracture femur model.
authors.affiliation: Department of Orthopaedics, Institute of Medical Sciences, Varanasi, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.affiliation: Department of Orthopaedics, Institute of Medical Sciences, Varanasi, India.
authors.forename: Gr
authors.initials: G
authors.lastname: Arun
authors.affiliation: Department of Metallurgical Engineering, Institute of Technology, BHU, Varanasi, India.
authors.forename: Vakil
authors.initials: V
authors.lastname: Singh
authors.affiliation: Department of Orthopaedics, Institute of Medical Sciences, Varanasi, India.
authors.forename: Anant
authors.initials: A
authors.lastname: Singh
authors.affiliation: Department of Orthopaedics, Mayo Institute of Medical Sciences, Barabanki, Uttar Pradesh, India.
authors.forename: Ashutosh K
authors.initials: AK
authors.lastname: Singh
authors.affiliation: Department of Orthopaedics, Institute of Medical Sciences, Varanasi, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Kumaraswamy
keywords: Cyclic loading; Gamma nail; proximal femoral nail; subsidence