The role of the medial plate for Pauwels type III femoral neck fracture: a comparative mechanical study using two fixations with cannulated screws

Vincenzo Giordano,Marcos Giordano,Hilton A Koch,Arthur Bonfim Amaral,Roger Pletsch Paes,Ney Pecegueiro Do Amaral,Anderson Freitas,Danilo Diniz Alves,William Belangero

doi:10.1186/s40634-019-0187-3

Abstract

BackgroundThe biomechanical behavior of Pauwels type III fractures should be taken into consideration when performing internal fixation, since this repair should resist the shear force inherent in the vertical fracture line to the greatest extent possible. Recently, the use of a small fragment plate on the medial face of the femoral neck has been proposed by some authors, with satisfactory initial results. In the current study we analyze the mechanical role a medial plate used as a buttress plate for Pauwels type III femoral neck fractures, comparing the resistance of two fixation configurations using three cannulated screws.MethodsPauwels type III fractures were simulated in synthetic bones models and two groups were created, one of those using two parallel screws at the bottom of the femoral neck and the third screw crossing the fracture horizontally (G1), and the other fixed in the same arrangement as G1, but with the addition of a medial side plate at the apex of the fracture (G2).The constructs were subjected to axial loading until catastrophic failure.ResultsThe addition of a medial plate buttressing the femoral neck increased significantly the resistance to maximum loading (p = 0.003).ConclusionUse of a medial buttress plate results in a mechanically superior construction for Pauwels type III fractures fixed with multiple cannulated screws.Lebel of evidence Level IV. Biomechanical comparative study.

Highlights

The biomechanical behavior of Pauwels type III fractures should be taken into consideration when performing internal fixation, since this repair should resist the shear force inherent in the vertical fracture line to the greatest extent possible (Panteli et al, 2015; Shen et al, 2016; Gümüstas et al, 2014)
The bones were divided into two equal groups: group 1 (G1), which had Pauwels type III fractures fixated using two parallel screws at the bottom of the femoral neck and the third screw crossing the fracture horizontally, and group 2 (G2), which had Pauwels type III fractures fixated in the same arrangement as G1, but with the addition of a medial side plate at the apex of the fracture
In terms of rigidity and resistance to support maximum load, we found that G1 was less rigid and resistant than G2

Summary

Introduction

The biomechanical behavior of Pauwels type III fractures should be taken into consideration when performing internal fixation, since this repair should resist the shear force inherent in the vertical fracture line to the greatest extent possible. The biomechanical behavior of Pauwels type III fractures should be taken into consideration when performing internal fixation, since this repair should resist the shear force inherent in the vertical fracture line to the greatest extent possible (Panteli et al, 2015; Shen et al, 2016; Gümüstas et al, 2014). Several studies have suggested that the ideal osteosynthesis for Pauwels type III femoral neck fractures should consider this characteristic, no consensus has been reached on the best type of fixation

Objectives

Methods

Discussion

Conclusion