Screw-blade fixation systems for implant anchorage in the femoral head: Horizontal blade orientation provides superior stability

Clemens Schopper,Katharina Keck,Ivan Zderic,Filippo Migliorini,Björn-Christian Link,Frank J.P Beeres,Reto Babst,Sven Nebelung,Daphne Eschbach,Tom Knauf,Bergita Ganse,Carsten Schoeneberg,Frank Hildebrand,Boyko Gueorguiev,Matthias Knobe

doi:10.1016/j.injury.2021.04.058

Abstract

ObjectivesDespite continual improvement in the methods and devices used for treatment of proximal femoral fractures, unacceptably high failure rates remain. Novel screw-blade implant systems, combining a lag screw with a blade – the latter adding rotational stability to the femoral head – offer improvement of osseous purchase, especially in osteoporotic bone. The aim of this study was to compare biomechanically the head element (HE) anchorage of two screw-blade implant systems differing in blade orientation in the femoral head – vertical versus horizontal. MethodsTwenty paired human cadaveric femoral heads were assigned to four groups (n = 10), implanted with either Rotationally Stable Screw-Anchor HE (RoSA-HE, vertical blade orientation) or Gamma3 Rotation Control Lag Screw (Gamma-RC, horizontal blade orientation) in center or off-center position, and biomechanically tested until failure under progressively increasing cyclic loading at 2 Hz. ResultsCycles to failure and failure load were significantly higher for Gamma-RC versus RoSA-HE in center position and not significantly different between them in off-center position, p = 0.03 and p = 0.22, respectively. In center position, the progression of both rotation around implant axis and varus deformation over time demonstrated superiority of the implant with horizontal versus vertical blade orientation. Compared with center positioning, off-center implant placement led to a significant decrease in stiffness, cycles to failure and failure load for Gamma-RC, but not for RoSA-HE, p < 0.01 and p = 0.99, respectively. ConclusionHorizontal blade orientation of screw-blade implant systems demonstrates better anchorage in the femoral head versus vertical blade orientation in center position. As the stability of the implant system with horizontal blade orientation drops sharply in off-center position, central insertion is its placement of choice.

Highlights

ObjectivesDespite continual improvement in the methods and devices used for treatment of proximal femoral fractures, unacceptably high failure rates remain
Twenty paired human cadaveric femoral heads were assigned to four groups (n = 10), implanted with either Rotationally Stable Screw-Anchor head element (HE) (RoSA-HE, vertical blade orientation) or Gamma3 Rotation Control Lag Screw (Gamma-RC, horizontal blade orientation) in center or off-center position, and biomechanically tested until failure under progressively increasing cyclic loading at 2 Hz
As the stability of the implant system with horizontal blade orientation drops sharply in off-center position, central insertion is its placement of choice

Summary

Objectives

Despite continual improvement in the methods and devices used for treatment of proximal femoral fractures, unacceptably high failure rates remain. Novel screw-blade implant systems, combining a lag screw with a blade – the latter adding rotational stability to the femoral head – offer improvement of osseous purchase, especially in osteoporotic bone. The aim of this study was to compare biomechanically the head element (HE) anchorage of two screw-blade implant systems differing in blade orientation in the femoral head – vertical versus horizontal

Methods

Results

Discussion

Conclusion