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Lag screws for hip fracture fixation: Evaluation of migration resistance under simulated walking
Author(s) -
Ehmke Larry W.,
Fitzpatrick Daniel C.,
Krieg James C.,
Madey Steven M.,
Bottlang Michael
Publication year - 2005
Publication title -
journal of orthopaedic research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.041
H-Index - 155
eISSN - 1554-527X
pISSN - 0736-0266
DOI - 10.1016/j.orthres.2005.05.002.1100230614
Subject(s) - cadaveric spasm , fixation (population genetics) , lag screw , dynamic hip screw , materials science , gait , orthodontics , stiffness , implant , biomechanics , internal fixation , medicine , surgery , composite material , anatomy , physical medicine and rehabilitation , population , environmental health
Previous mechanical studies concerning cut‐out of lag screws for pertrochanteric hip fractures have relied on static or dynamic uniaxial loading regimens to induce construct failure by varus collapse and superior cut‐out. However, the hip is loaded in a multiplanar, dynamic manner during normal gait. We designed a hip implant performance simulator (HIPS) system to evaluate lag screw cut‐out under multiplanar loading representative of normal gait. Five surrogate pertrochanteric fracture specimens with lag screw fixation were loaded up to 20,000 cycles using a biaxial rocking motion (BRM) gait simulation protocol. Another five specimens were loaded using a standard uniaxial loading protocol. The BRM loading group exhibited combined varus collapse (5.4 ± 2.9°) and backward rotation (7.2 ± 2.8°). The uniaxial loading group exhibited four times less varus collapse (1.4 ± 1.1°) as compared to the BRM group, and only negligible rotation. For correlation of lag screw migration in surrogate specimens to that in native bone, six human cadaveric specimens were subjected to BRM loading. The degree of varus collapse (8.5 ± 7.7°) and rotation (7.2 ± 6.4°) in cadaveric specimens were comparable to that in surrogate specimens, with the surrogate specimens showing significantly less variability. The results demonstrate that accounting for clinically realistic multiplanar loading vectors significantly affects implant migration, and therefore should be considered when evaluating the fixation strength of hip screw implants. © 2005 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.