Biomechanical comparison of three second-generation reconstruction nails in an unstable subtrochanteric femur fracture model

Abstract

The purpose of this study is to determine if a biomechanical difference exists in dynamic stiffness, fatigue life, and fracture site displacement by comparing three cephalomedullary reconstruction nails. An examination was made of the Biomet Uniflex reconstruction nail, the Biomet Vector nail, and the Stryker Howmedica Long Gamma nail in the fixation of an unstable subtrochanteric femur fracture model, using a synthetic bone model. Mean stiffness for each nail was initially determined in control specimens (i.e. no fracture and no instrumentation). The nail stiffness values were 1764.0 N/mm (controls), 373.61 N/mm (Uniflex), 294.27 N/mm (vector), and 656.36 N/mm (Gamma). The Gamma was statistically stiffer than the Uniflex and Vector ( p<0.002). Mean fatigue life measurements were: Uniflex at 52 891 cycles, failing at the most distal of the proximal two screw holes; Vector at 45 344 cycles, failing in the nail at the level of the fracture site; Gamma at 88 748 cycles failing at the lag screw hole. The p value between the Gamma and Vector was less than 0.01 and between Gamma and Uniflex was less than 0.05. The mean maximal axial displacement at the fracture site was 2.448 mm, 2.305 mm, and 0.790 mm for the Uniflex, Vector and Gamma, respectively. The p value between the Gamma and the other nails was < 0.01. The mean maximal transverse displacement at the fracture site was 1.223 mm, 1.197 mm, and 0.280 mm respectively. The p value between the Long Gamma and the other two nails was < 0.01. In conclusion, the Long Gamma nail demonstrated statistically significant fixation superiority in stiffness, resistance to fatigue, and fracture site displacement compared to the Uniflex and Vector nails. This biomechanical information may aid in choosing implants for fixation of unstable, subtrochanteric femur fractures.