Biomechanical Comparison of Three Different Fixation Methods for Unstable Basicervical Intertrochanteric Fractures Using a Novel Cephalomedullary Nail

Abstract

Background and Objectives: This biomechanical study aimed to compare the fixation stability of proximal fragments and assess the mechanical properties in models of unstable basicervical intertrochanteric fractures. Materials and Methods: Thirty-six synthetic femur models were utilized. After cephalomedullary nail insertion, unstable basicervical intertrochanteric fractures were created using an engraving machine. Specimens were divided into three groups based on the femoral head fixation method: Group 1 (n = 12, single 100 mm lag screw); Group 2 (n = 12, lag screw + 75 mm anti-rotation screw); and Group 3 (n = 12, lag screw + 95 mm anti-rotation screw). The anti-rotation screws were full-threaded locking screws positioned just below the lag screw. After applying 10,000 vertical cyclic loads, stereophotogrammetry was used to evaluate the proximal fragment rotation in three planes (coronal, sagittal, and axial), and screw-tip displacement was measured radiographically. Vertical load was then applied at a 10 mm/min rate until structural failure. Results: Rotational change in the sagittal plane was least in Group 3 (Group 1 = 1.7 +/- 1.3 degrees, Group 2 = 1.0 +/- 0.8 degrees, Group 3 = 0.6 +/- 0.6 degrees, p = 0.038). Varus (coronal plane) and retroversion (axial plane) collapse did not differ significantly among the three groups. While cranial migration showed no difference, axial migration was the significantly lowest in Group 3 (Group 1 = 1.07 +/- 0.62 mm, Group 2 = 0.60 +/- 0.57 mm, Group 3 = 0.50 +/- 0.43 mm, p = 0.040). Failure load was slightly higher in Groups 2 and 3 than in Group 1, but without statistical significance. No significant differences were observed between Group 2 and Group 3 in any biomechanical outcomes. Conclusions: The novel cephalomedullary nail with a long inferior anti-rotation screw significantly reduced rotational instability and axial migration compared to a single-lag screw. There was no significant difference in the rotational stability between the 75 mm and 95 mm anti-rotation screw groups. This novel nail demonstrates superior biomechanical properties in this experimental model and warrants clinical evaluation for treating unstable basicervical intertrochanteric fractures.