The impact on lateral wall fractures by a sliding hip screw device in trochanteric fractures: a biomechanical study
Aims: Trochanteric fractures with a reduced lateral wall thickness and a detached lesser trochanter are unstable. These characteristics can lead to failure through a lateral wall fracture after fixation with a sliding hip screw device (SHS). However, the precise mechanism by which these characteris...
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2025-05-01
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| Series: | Bone & Joint Open |
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| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.65.BJO-2024-0266.R1 |
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| author | Magnus Høgevold Carl E. Alm Bryan J. Wright Lydia Ragan Frede Frihagen Stephan M. H. Röhrl Jan E. Madsen Jan E. Brattgjerd |
| author_facet | Magnus Høgevold Carl E. Alm Bryan J. Wright Lydia Ragan Frede Frihagen Stephan M. H. Röhrl Jan E. Madsen Jan E. Brattgjerd |
| author_sort | Magnus Høgevold |
| collection | DOAJ |
| description | Aims: Trochanteric fractures with a reduced lateral wall thickness and a detached lesser trochanter are unstable. These characteristics can lead to failure through a lateral wall fracture after fixation with a sliding hip screw device (SHS). However, the precise mechanism by which these characteristics contribute to lateral wall fractures remains unclear. Accordingly, we examined the impact on failure by incremental decrease of both lateral wall thickness and lesser trochanter attachment in trochanteric fracture fixation using a SHS ex vivo. Methods: We tested 14 pairs of embalmed femora, randomly assigned to four osteotomy groups, each representing a specific 31A1 or 31A2 fracture pattern according to the AO/Orthopaedic Trauma Association (OTA) classification. After fixation with a SHS, the specimens underwent quasi-static and dynamic axial compression until failure. Outcome measures included stiffness, deformation, load to failure, and failure pattern following a set protocol. Results: We found lateral wall fractures in ten out of 28 specimens. Specimens with a thin lateral wall and a detached lesser trochanter exhibited both a significantly higher rate of lateral wall fractures (5/7 vs 5/21, p = 0.023) and a lower load to failure than specimens with only one or none of these characteristics (1,673 N (SD 810) vs 2,922 N (SD 897), p = 0.003). The specimens with a detached lesser trochanter themselves demonstrated a significantly higher rate of lateral wall fractures than those with an attached lesser trochanter (9/14 vs 1/14, p = 0.004). Conclusion: Our findings emphasize the role of a detached lesser trochanter in initiating lateral wall fractures, with a reduction in load to failure when combined with reduced lateral wall thickness. Biomechanically, this suggests a failure mechanism whereby placing a load-sharing implant could overload a fragile lateral wall in unstable trochanteric fractures. Cite this article: Bone Jt Open 2025;6(5):582–589. |
| format | Article |
| id | doaj-art-f1e2918b43df4e4da11ab9ff4f04a740 |
| institution | OA Journals |
| issn | 2633-1462 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj-art-f1e2918b43df4e4da11ab9ff4f04a7402025-08-20T02:34:03ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622025-05-016558258910.1302/2633-1462.65.BJO-2024-0266.R1The impact on lateral wall fractures by a sliding hip screw device in trochanteric fractures: a biomechanical studyMagnus Høgevold0Carl E. Alm1Bryan J. Wright2Lydia Ragan3Frede Frihagen4Stephan M. H. Röhrl5Jan E. Madsen6Jan E. Brattgjerd7 Department of Orthopaedic Surgery, Diakonhjemmet Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway Aleris Health, Oslo, Norway Division of Anatomy, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway Kalnes Hospital, Fredrikstad, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway Division of Orthopaedic Surgery, Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway Aims: Trochanteric fractures with a reduced lateral wall thickness and a detached lesser trochanter are unstable. These characteristics can lead to failure through a lateral wall fracture after fixation with a sliding hip screw device (SHS). However, the precise mechanism by which these characteristics contribute to lateral wall fractures remains unclear. Accordingly, we examined the impact on failure by incremental decrease of both lateral wall thickness and lesser trochanter attachment in trochanteric fracture fixation using a SHS ex vivo. Methods: We tested 14 pairs of embalmed femora, randomly assigned to four osteotomy groups, each representing a specific 31A1 or 31A2 fracture pattern according to the AO/Orthopaedic Trauma Association (OTA) classification. After fixation with a SHS, the specimens underwent quasi-static and dynamic axial compression until failure. Outcome measures included stiffness, deformation, load to failure, and failure pattern following a set protocol. Results: We found lateral wall fractures in ten out of 28 specimens. Specimens with a thin lateral wall and a detached lesser trochanter exhibited both a significantly higher rate of lateral wall fractures (5/7 vs 5/21, p = 0.023) and a lower load to failure than specimens with only one or none of these characteristics (1,673 N (SD 810) vs 2,922 N (SD 897), p = 0.003). The specimens with a detached lesser trochanter themselves demonstrated a significantly higher rate of lateral wall fractures than those with an attached lesser trochanter (9/14 vs 1/14, p = 0.004). Conclusion: Our findings emphasize the role of a detached lesser trochanter in initiating lateral wall fractures, with a reduction in load to failure when combined with reduced lateral wall thickness. Biomechanically, this suggests a failure mechanism whereby placing a load-sharing implant could overload a fragile lateral wall in unstable trochanteric fractures. Cite this article: Bone Jt Open 2025;6(5):582–589.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.65.BJO-2024-0266.R1biomechanical studycadaveric boneosteotomiestrochanteric fracturelateral walllesser trochantersliding hip screwtrochanteric fracturessliding hip screwfractureslesser trochanterorthopaedic traumastiffnessfemoralag screwfemoral head |
| spellingShingle | Magnus Høgevold Carl E. Alm Bryan J. Wright Lydia Ragan Frede Frihagen Stephan M. H. Röhrl Jan E. Madsen Jan E. Brattgjerd The impact on lateral wall fractures by a sliding hip screw device in trochanteric fractures: a biomechanical study Bone & Joint Open biomechanical study cadaveric bone osteotomies trochanteric fracture lateral wall lesser trochanter sliding hip screw trochanteric fractures sliding hip screw fractures lesser trochanter orthopaedic trauma stiffness femora lag screw femoral head |
| title | The impact on lateral wall fractures by a sliding hip screw device in trochanteric fractures: a biomechanical study |
| title_full | The impact on lateral wall fractures by a sliding hip screw device in trochanteric fractures: a biomechanical study |
| title_fullStr | The impact on lateral wall fractures by a sliding hip screw device in trochanteric fractures: a biomechanical study |
| title_full_unstemmed | The impact on lateral wall fractures by a sliding hip screw device in trochanteric fractures: a biomechanical study |
| title_short | The impact on lateral wall fractures by a sliding hip screw device in trochanteric fractures: a biomechanical study |
| title_sort | impact on lateral wall fractures by a sliding hip screw device in trochanteric fractures a biomechanical study |
| topic | biomechanical study cadaveric bone osteotomies trochanteric fracture lateral wall lesser trochanter sliding hip screw trochanteric fractures sliding hip screw fractures lesser trochanter orthopaedic trauma stiffness femora lag screw femoral head |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.65.BJO-2024-0266.R1 |
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