Biomechanical Test after Hip Cannulated Screw Removal (in vitro Analysis)

Objective  This study aims to evaluate, through biomechanical tests, the resistance and energy required for proximal femoral fracture in synthetic bones after removing cannulated screws shaped as an inverted triangle, comparing the obtained results to those of a reinforcement technique with polymethylmethacrylate (PMMA) as bone cement. Methods  Twenty synthetic bones were used: 10 units for the control group (CG), 5 units for the test group without reinforcement (TGW/O), and 5 units for the test group using a reinforcement technique with PMMA (TGW). The biomechanical analysis simulated a fall on the large trochanter using a servo-hydraulic machine. Results  All TGW/O and CG specimens had a basicervical fracture. Three TGW specimens presented a basicervical fracture, and two suffered a fracture near the fixation point of the device (femoral diaphyseal region), with one of them being associated with a femoral neck fracture. A mean PMMA volume of 8.2 mL was used to fill the 3 screw holes in the TGW group. According to the one-way analysis of variance (ANOVA) and the Tukey multiple comparisons tests at a 5% level, the TGW presented a statistically significant difference when compared with the other groups in all parameters: maximal load ( p  = 0.001) and energy until fracture ( p  = 0.0001). Conclusion  The simple removal of the cannulated screws did not reduce significantly the maximum load and energy for fracture occurrence, but the proximal femoral reinforcement with PMMA significantly increased these parameters, modifying the fracture pattern.