ArticleArchives of orthopaedic and trauma surgery2026
Biomechanical comparison of inverted triangle and L-shaped screw configurations with medial buttress and anteromedial support plate in Pauwels type III femoral neck fractures.
Article in Archives of orthopaedic and trauma surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionSurgical stabilization of Pauwels Type III femoral neck fractures remains a significant challenge due to high vertical shear forces. While the medial buttress plate is a recognized solution, it requires extensive deep dissection. This study aims to compare the biomechanical performance of various screw configurations combined with either a medial buttress or anteromedial support plate. MATERIALS AND
methodsTwenty-five third-generation synthetic femurs were used to create a standardized 70-degree (Pauwels III) fracture model. Specimens were divided into five groups (n = 5): (A) Inverted triangle (IT) screws with a Pauwels screw, (B) Inverted triangle (IT) with medial buttress plate (MBP), (C) Inverted triangle with anteromedial support plate (ASP), (D) L-configuration with medial buttress plate (MBP), and (E) L-configuration with anteromedial support plate (ASP). Axial loading was applied at 2 mm/min until construct failure, defined objectively by the real-time force-distance curve.
resultsAlthough no statistically significant difference was found between groups (p = 0.102), a large effect size was observed (η² = 0.309). Group C (IT + ASP) demonstrated the highest mean failure load (1695 ± 494.6 N). Conversely, Group E (L-configuration + ASP) exhibited the lowest stability (977.2 ± 195.4 N) with a remarkably narrow standard deviation. The majority of failures occurred as transverse subtrochanteric fractures distal to the implants.
conclusionThe combination of an inverted triangle screw arrangement with an anteromedial support plate demonstrated comparable biomechanical stability to the medial buttress plate, while offering a potentially safer surgical corridor. Conversely, pairing L-shaped screw configurations with anteromedial support plates resulted in the lowest mean ultimate load-to-failure among the tested constructs, likely due to potential stress riser effects.
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