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Should extramedullary fixations for hip fractures be removed after bone union?
Sebastian Eberle1, Christof Wutte, Christoph Bauer
1Institute of Biomechanics, Trauma Center Murnau, Murnau, Germany. sebastian.eberle@bgu-murnau.de
Clinical Biomechanics (Bristol, Avon)
|January 18, 2011
Summary
Removing osteosynthesis implants after femoral neck fracture healing restores bone strain to pre-fracture levels. This may prevent bone loss caused by stress shielding and reduce future fracture risk.
Area of Science:
- Orthopedic biomechanics
- Bone healing and regeneration
- Surgical implantology
Background:
- Osteosynthesis implants can alter bone strain distribution after fracture union.
- Reduced bone strain may lead to stress shielding and increased fracture risk.
Purpose of the Study:
- To investigate if extramedullary fixation removal is necessary after femoral neck fracture union.
- To prevent strain reduction in the bone cortex.
Main Methods:
- Biomechanical experiment using human cadaver femora.
- Strain gauges applied to measure surface strains during axial compression tests.
- Comparison of strains before surgery, after implant placement (compression hip screw or femoral neck plate), and after implant removal.
Main Results:
- Both implants significantly reduced strain at the superior neck.
- The femoral neck plate also increased strain at the inferior neck and lesser trochanter.
- Implant removal largely restored pre-fracture strain levels, with a minor persistent reduction for the compression hip screw.
Conclusions:
- Implant removal after bone union normalizes bone strain.
- This may mitigate stress shielding and subsequent bone loss.
- Consideration of implant removal is important for long-term bone health.
