title: Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly.
abstract: Femoral neck fractures represent a relatively uncommon injury in the non-elderly population often resulting from high-energy trauma. The cornerstone of their management is anatomic reduction and stable internal fixation of the femoral neck in an attempt to salvage the femoral head. Complications including avascular necrosis of the femoral head, non-union and post-traumatic osteoarthritis are not uncommon. The clinical outcomes of these patients can be improved with good pre-operative planning, optimization of surgical procedures and introduction of new improved implants and techniques. In the herein study, we attempt to describe the biomechanical properties of the hip and compare the performance of the most commonly used devices. Experimental evidence suggests that in Pauwels type III fracture patterns a cephalomedullary nail was significantly stronger in axial loading. Moreover, in unstable basicervical patterns cannulated screws (triangular configuration) demonstrated a lower ultimate load to failure, whereas in subcapital or transervical patterns both the cannulated screws (triangular configuration) and the sliding hip screw demonstrated no compromise in fixation strength. The fracture pattern appears to be the major determinant of the ideal type of implant to be selected. For a successful outcome each patient needs to be considered on an individual basis taking into account all patient and implant related factors.
authors.affiliation: Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK.
authors.forename: Michalis
authors.initials: M
authors.lastname: Panteli
authors.affiliation: Newcastle University, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Rodham
authors.affiliation: Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK; Newcastle University, UK; LIMM Section Musculoskeletal Disease, University of Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA Leeds, West Yorkshire, UK. Electronic address: pgiannoudi@aol.com.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Giannoudis
mesh_terms: D000328:Adult; D000367:Age Factors; D001696:Biomechanical Phenomena; D019317:Evidence-Based Medicine; D005265:Femoral Neck Fractures / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D005270:Femur Head / Q000033:anatomy & histology / Q000098:blood supply / Q000601:surgery*; D005271:Femur Head Necrosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011379:Prognosis
keywords: Biomechanics; Femoral neck fracture; Non-elderly; Young