Publication: Orthopedics

Date: July 2013

Authors: Kane PM, Vopat B, Paller D, Koruprolu S, Born CT

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The objective of this study was to evaluate the torsion stiffness of locked and unlocked distal fixation of long cephalomedullary nail constructs, in both a fresh fracture and healed, stable intertrochanteric fracture model. Samples were tested in both internal and external rotation (0±3 Nm) for a duration of 10 cycles. Each femur was tested without instrumentation (intact femur), with instrumentation and no fracture (healed intertrochanteric fracture), and with instrumentation with an osteotomy creating a stable intertrochanteric fracture (fresh fracture). All specimens were instrumented with a long cephalomedullary nail. A distal interlock was placed in the dynamic position in 1 femur, and the other femur of the matched pair was left unlocked. Mean external (ER) and internal (IR) rotation stiffness for intact femurs without instrumentation (ER, 2.1±0.5 Nm/degree; IR, 2.2±0.5 Nm/degree) was statistically stiffer (P<.05 for all) compared with fresh fractured locked (ER, 1.1±0.2 Nm/degree; IR, 1.1±0.3 Nm/degree) and fresh fractured unlocked (ER, 0.9±0.3 Nm/degree; IR, 1.0±0.2 Nm/degree) samples. Similarly, healed locked (ER, 2.5±0.2 Nm/degree; IR, 2.8±0.1 Nm/degree) and healed unlocked (ER, 2.5±0.5 Nm/degree; IR, 2.4±0.3 Nm/degree) samples had statistically higher stiffness compared with fresh fractured treatments. These results suggest that the unlocked distal constructs provide similar torsional strength compared with locked fixation in these models.