ArticleArchives of orthopaedic and trauma surgery2026
A novel biomechanical model for reproducing and analysing the causal mechanisms of PFNA "cut-in" phenomenon.
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
introduction"Cut-in" is a rare but serious complication associated with cephalomedullary nail fixation for intertrochanteric hip fractures, particularly with Proximal Femoral Nail Antirotation (PFNA). This phenomenon involves paradoxical superomedial migration of the helical blade through the femoral head. Although increasingly recognised, the underlying mechanisms remain incompletely defined. This study aims to describe a new superolateral tensile loading set up in a bidirectional loading model, with the aim of incorporating possible mechanical deviations introduced by abductor weakness. MATERIALS AND
methodsThis study was conducted in two stages. An initial stage with synthetic femurs (SYNBONE
resultsThe initial stage demonstrated partial cut-in more frequently in specimens with larger canal diameters (18 mm), but did not produce any full cut-in. The final stage with an 18 mm canal diameter achieved full cut-in in all five specimens.
conclusionsOur bidirectional loading model with superolateral tensile loading reproduced full 'cut-in' in all 5 specimens of the final stage, serving as a proof-of-concept tool. Larger studies are warranted for validation.
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