ArticleBone & joint research2019
Medial migration in cephalomedullary nail fixation of pertrochanteric hip fractures: A biomechanical analysis using a novel bidirectional cyclic loading model.
Article in Bone & joint research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- The clinical efficacy of Medial Sustain Nail(MSN) and Proximal femoral nail anti-rotation(PFNA) for fixation of medial comminuted trochanteric fractures: a prospective randomized controlled trial.International orthopaedics · 2024Trial
- A novel biomechanical model for reproducing and analysing the causal mechanisms of PFNA "cut-in" phenomenon.Archives of orthopaedic and trauma surgery · 2026Article
- The Effect of Lag Screw Position on Rotational Stability and Stress Concentration in Unstable Basicervical Intertrochanteric Fractures: A Finite Element Analysis.Journal of clinical medicine · 2026Article
- Biomechanical Analysis of Fixation Strength in Unstable Intertrochanteric Femoral Fracture Models Based on the Caput-Collum-Diaphyseal Angle of Cephalomedullary Nails and Position of Lag Screws.Journal of clinical medicine · 2025Article
- What is the appropriate axial position in cannulated screw fixation for femoral neck fractures? A finite element analysis.BMC musculoskeletal disorders · 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
- Endovascular assisted removal of intrapelvic lag screw after intramedullary proximal femoral nail: A case report and literature review.Trauma case reports · 2023Article
- Residual lateral wall width predicts a high risk of mechanical complications in cephalomedullary nail fixation of intertrochanteric fractures: a retrospective cohort study with propensity score matching.International orthopaedics · 2023Article
- Successful Revision with INTERTAN for a Blade Cut Through in PFNA Fixation: A Case Report.Orthopaedic surgery · 2023Article
- Finite-Element Analysis of a Novel Cephalomedullary Nail for Restricted Sliding to Reduce Risk of Implant Failure in Unstable Intertrochanteric Fractures.Orthopaedic surgery · 2022Article
- Effect of the additional anteroposterior blocking screw on nail/medullary canal mismatch after cephalomedullary nailing in unstable pertrochanteric fracture : a finite element analysis.Bone & joint research · 2022Article
- Bent or broken: analysis of set screw fracture in the TFNa implant.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2021Article
- Biomechanical comparison of medial sustainable nail and proximal femoral nail antirotation in the treatment of an unstable intertrochanteric fracture.Bone & joint research · 2020Article
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Authors and funding
6 authors.
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No grant is acknowledged in the PubMed record.
Abstract
objectivesThe paradoxical migration of the femoral neck element (FNE) superomedially against gravity, with respect to the intramedullary component of the cephalomedullary device, is a poorly understood phenomenon increasingly seen in the management of pertrochanteric hip fractures with the intramedullary nail. The aim of this study was to investigate the role of bidirectional loading on the medial migration phenomenon, based on unique wear patterns seen on scanning electron microscopy of retrieved implants suggestive of FNE toggling.
methodsA total of 18 synthetic femurs (Sawbones, Vashon Island, Washington) with comminuted pertrochanteric fractures were divided into three groups (n = 6 per group). Fracture fixation was performed using the Proximal Femoral Nail Antirotation (PFNA) implant (Synthes, Oberdorf, Switzerland; n = 6). Group 1 was subjected to unidirectional compression loading (600 N), with an elastomer (70A durometer) replacing loose fracture fragments to simulate surrounding soft-tissue tensioning. Group 2 was subjected to bidirectional loading (600 N compression loading, 120 N tensile loading), also with the elastomer replacing loose fracture fragments. Group 3 was subjected to bidirectional loading (600 N compression loading, 120 N tensile loading) without the elastomer. All constructs were tested at 2 Hz for 5000 cycles or until cut-out occurred. The medial migration distance (MMD) was recorded at the end of the testing cycles.
resultsThe MMDs for Groups 1, 2, and 3 were 1.02 mm, 6.27 mm, and 5.44 mm respectively, with reliable reproduction of medial migration seen in all groups. Bidirectional loading groups showed significantly higher MMDs compared with the unidirectional loading group (p < 0.01).
conclusionOur results demonstrate significant contributions of bidirectional cyclic loading to the medial migration phenomenon in cephalomedullary nail fixation of pertrochanteric hip fractures.
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