Stability of L-shaped and inverted triangle fixation assemblies in treating Pauwels type II femoral neck fracture: a comparative mechanical study

• DOI: 10.1007/s00590-018-2207-x
• Publication Date: 2018-04-24T14:47:30Z
• Authors: Vincenzo Giordano; Roger Pletsch Paes; Danilo Diniz Alves; Arthur Bonfim Amaral; William D. Belangero; Marcos Giordano; Anderson Freitas; Hilton A. Koch
• Keywords: Adult; Models, Anatomic; Bone Screws; Biomechanical Phenomena; Femoral Neck Fractures; Fracture Fixation, Internal; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Humans; Femur; Mechanical Phenomena

The aim of our study is to compare the mechanical resistance of two screw configurations in fixating type II Pauwels femoral neck fractures.Fifteen synthetic models of femur bones in young adults were divided into three equal groups: intact (G1), models with fixation of a 5.0-mm failure zone created in the posterior cortex of the femoral neck using an L-shaped screw arrangement (G2, n = 5), and models with an identical failure zone fixated using an inverted triangle assembly (G3, n = 5). Model strength (axial loading) and rotational deviation of the fragments were load-tested until a 5.0-mm displacement was reached (step 1) and then until failure, here considered as 10.0 mm displacement in G2 and G3 or femoral neck fracture in G1 (step 2).In step 1, the mean resistance in G1 was 1593 N (standard deviation [SD] of 62 N); this value in G2 was 1261 N (SD 49 N) and in G3 was 1074 N (SD 153 N). During step 2, the value for G1 was 2247 N (SD 84 N), for G2 was 1895 N (SD 69 N), and for G3 was 1523 N (SD 280 N). G3 (the inverted triangle assembly) showed a significantly lower maximum load than the group using the L-shaped assembly (G2) and the control group (G1), which was significant using Kruskal-Wallis analysis of variance (p = 0.002).Under test conditions in synthetic bone, fixation using a L-shaped screw assembly provides greater mechanical resistance than an inverted triangle assembly.