ArticleJournal of orthopaedic surgery and research2016
Load distribution between cephalic screws in a dual lag screw trochanteric nail.
Article in Journal of orthopaedic surgery and research, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
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Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.
- The role of Poller screws in intramedullary nailing for lower limb extra-isthmic fractures.Journal of orthopaedic surgery and research · 2026Pooled it
- Optimal position of intramedullary nails in the femoral head following spiral blade resection for revision of intertrochanteric fractures: a biomechanical analysis.Journal of orthopaedic surgery and research · 2026Article
- Inferior Screw Referenced Calcar Tip Apex Distance as the Most Accurate Predictor of Mechanical Cut Out in Dual-Screw Proximal Femoral Nails.Medicina (Kaunas, Lithuania) · 2025Article
- Biomechanical analysis of anatomical intramedullary nails and proximal femoral anti-rotation-II intramedullary nails for the treatment of unstable intertrochanteric fractures (AO type 31-A2.2) in older patients.Journal of orthopaedic surgery and research · 2025Article
- Intertrochanteric Fractures: Ten Commandments for Getting Good Results with Proximal Femoral Nailing.Indian journal of orthopaedics · 2025Article
- The proximal femoral universal nail system (PFUN): a novel intramedullary nail for treating complex proximal femoral fractures and its biomechanical comparison with the proximal femoral nail anti-rotation (PFNA).Journal of orthopaedic surgery and research · 2025Article
- Does the Proximal Humerus Nail with 2 Distal Screws Provide Sufficient Rotational Stability?Clinics in orthopedic surgery · 2025Article
- A novel nail-plate construct for the treatment of AO/OTA 31-A3.3 intertrochanteric fractures: a finite element analysis.Frontiers in bioengineering and biotechnology · 2025Article
- Is an additional cannulated screw necessary for unstable femoral neck fractures with comminuted posteromedial cortex by femoral neck system (FNS) fixation? a biomechanical and clinical study.Frontiers in bioengineering and biotechnology · 2025Article
- Initial construct stability of long cephalomedullary nails with superior locking for a complex trochanteric fracture model AO31A2.2- a biomechanical study.Journal of orthopaedic surgery and research · 2024Article
- Evaluating three internal fixation techniques for Pauwels III femoral neck fractures via finite element analysis.Scientific reports · 2024Article
- Biomechanical evaluation of ortho-bridge system and proximal femoral nail antirotation in intertrochanteric fractures with lateral wall fracture based on finite element analysis.Frontiers in bioengineering and biotechnology · 2024Article
- Biomechanical Behavior of Dynamic vs. Static Distal Locking Intramedullary Nails in Subtrochanteric Femur Fractures.Bioengineering (Basel, Switzerland) · 2023Article
- A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures.Journal of orthopaedic surgery and research · 2023Article
- Biomechanical analysis analyzing association between bone mineral density and lag screw migration.Scientific reports · 2023Article
- What is the most fixable intramedullary implant for basicervical fracture and transcervical shear fracture? - A finite element study.Journal of clinical orthopaedics and trauma · 2022Article
- In Silico Finite Element Modeling of Stress Distribution in Osteosynthesis after Pertrochanteric Fractures.Journal of clinical medicine · 2022Article
- A finite element analysis and cyclic load experiment on an additional transcortical-type hole formed around the proximal femoral nail system's distal locking screw.BMC musculoskeletal disorders · 2022Article
- Fracture reduction has a dominant effect over cerclage wiring in increasing stiffness of intertrochanteric OTA/AO 31-A3.1 (reverse oblique) fractures managed with cephalomedullary osteosynthesis.OTA international : the open access journal of orthopaedic trauma · 2021Article
- Proposal for a New Fixation Method for Pauwels Type III Femoral Neck Fracture-Metaphyseal Stem: A Finite-Element Analysis.Indian journal of orthopaedics · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIt has been observed clinically that the Z-effect is a potential cause of failure of an intramedullary nail with two cephalic screws. It describes the migration behavior of the cephalic screws in the femoral head. The primary objective was to examine different cephalic screw configurations and test the load distribution between them as a function of their relative placement and their relative movement in the nail. It has been hypothesized that different cephalic screw positions may have an influence on the stress in the implant and bone and therefore on implant failures, such as the Z-effect.
methodsTo quantify the load distribution of a dual cephalic screw intramedullary femoral nail (Citieffe, Calderara di Reno, BO, Italy), a finite element model of the femur, focusing on the loading of the cephalic screws, was prepared. Four different screw lengths (90-105 mm) were examined. The investigation considered the stresses and strains in the bone and implant as well as the relative movement of the screws.
resultsIf the inferior cephalic screw had a shorter length, then the superior one and the femoral nail had to bear higher loads. In that case, the "equivalent von Mises stress" increased up to 10 % at the superior cephalic screw and up to 5 % at the femoral nail. The analysis of the relative movement showed that sliding of the inferior cephalic screw occurred in the nail. The total movement ranged from 0.47 to 0.73 mm for the different screw configurations.
conclusionsThe stresses were distributed more equally between the two cephalic screws in the bone and the implant if a longer inferior screw was used. The stresses in the bone and implant were reduced with a longer inferior cephalic screw. Therefore, a configuration using a longer inferior cephalic screw is preferable for trochanteric fracture fixation with a dual cephalic screw intramedullary device.
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