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Method and Instrumented Fixture for Femoral Fracture Testing in a Sideways Fall-on-the-Hip Position
Published on: August 17, 2017
Hip Fractures: Relevant Anatomy, Classification, and Biomechanics of Fracture and Fixation
1Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA, USA.
Insights
Hip fracture fixation requires understanding anatomy and biomechanics. While intramedullary nails offer stability, clinical outcomes are similar for properly applied sliding hip screws or cephalomedullary nails, though medial cutout risks exist with helical blades.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Geriatric Medicine
Background:
- Hip fractures pose a significant healthcare burden, impacting quality of life and increasing morbidity/mortality.
- Emerging complications within fixation constructs necessitate updated treatment strategies.
- Understanding fracture pathoanatomy and biomechanics is crucial for effective hip fracture management.
Purpose of the Study:
- To review hip fracture anatomy, classification, and fixation biomechanics.
- To address implant-related complications in hip fracture treatment.
- To inform surgical decision-making for optimal patient outcomes.
Main Methods:
- Review of relevant anatomy and classification of femoral neck and intertrochanteric fractures.
- Analysis of biomechanics of various hip fracture fixation strategies.
- Evaluation of implant-related complications associated with different fixation constructs.
Main Results:
- Intramedullary nails demonstrate superior biomechanical stability in laboratory settings.
- Clinical results are comparable between sliding hip screws and cephalomedullary nails when correctly applied.
- Cephalomedullary nails with helical blades show increased risk of atypical medial cutout compared to lag screws.
Conclusions:
- Optimal surgical treatment of hip fractures enables early mobilization and weight-bearing.
- Surgeons must understand anatomy and fracture patterns to select appropriate implants.
- Awareness of implant-specific complications and ongoing research are vital for cost-effective geriatric hip fracture care.
Introduction:
Hip fractures represent an important health-care dilemma, costing the US$ billions annually. Hip fractures can diminish quality of life and significantly increase morbidity and mortality if not properly treated. Recent research has brought forth new information regarding treatment as well as information on emerging complications seen within the fixation constructs themselves.
Significance:
Understanding the pathoanatomy of hip fractures and the biomechanics of surgical fixation constructs is critical for successful treatment. In this article, we review the relevant anatomy and classification of femoral neck and intertrochanteric fractures. Furthermore, the biomechanics of hip fracture fixation strategies as well as implant-related complications are addressed.
Results:
Even though laboratory testing demonstrated that intramedullary nails have greater biomechanical stability, the clinical results between fixation constructs have been similar when the chosen implant (ie, sliding hip screw vs cephalomedullary nail) has been correctly applied to the specific fracture pattern. Recently, data have shown that when using cephalomedullary nails, there is potential for increased failure with cutout when using the helical blade versus the lag screw, with majority being the atypical "medial cutout."
Conclusion:
The goal of surgical treatment of hip fractures is surgical treatment that allows for early mobilization and weight bearing. A full understanding of the anatomy and fracture characteristics will allow the surgeon to correctly apply the right implant to allow for uneventful healing. Surgeons need to be aware, however, of complications that can arise when using specific implants. Further research is ongoing to further determine the treatments that will allow optimal cost-effective care for the geriatric patient with hip fracture.
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