Biomechanical testing of a 3-hole versus a 4-hole sliding hip screw in the presence of a retrograde intramedullary nail for ipsilateral intertrochanteric and femur shaft fractures
Journal of Orthopaedic Trauma
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Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. Objective: The goal of this study was to compare a 3-hole versus a 4-hole sliding hip screw (SHS) in the presence of a retrograde intramedullary (RIM) nail for fixing intertrochanteric and comminuted midshaft femur fractures. Methods: Mechanical tests were performed on 10 matched pairs of human cadaveric femurs that were osteotomized and then fixed using a 3-hole SHS versus the traditional "gold standard" 4-hole SHS in the presence of an RIM nail. Results: Data showed no differences between the 3-hole SHS with RIM nail versus 4-hole SHS with RIM nail for stiffness (281 ± 127 vs. 260 ± 118 N/mm, P = 0.76), clinical failure at 10 mm of hip displacement (2014 ± 363 vs. 2134 ± 614 N, P = 0.52), or ultimate mechanical failure (3476 ± 776 vs. 3669 ± 755 N, P = 0.12). Conclusions: For this fracture pattern, a 3-hole SHS with RIM nail may be a suitable surgical alternative to the traditional "gold standard" method because it provides the same biomechanical properties while potentially reducing surgical time, blood loss, and hardware used.