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Updated: May 16, 2026

Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
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Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner

Published on: June 6, 2025

Should Inter-Prosthetic Screws Be Placed When Prophylactically Plating a Femur?

Aaron Beck1, Herman Feller1, Cameron Trotter1

  • 1Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin.

The Journal of Arthroplasty
|May 14, 2026
PubMed
Summary
This summary is machine-generated.

Placing a screw in the bone gap between two femoral implants significantly weakens the bone. Avoiding screws in gaps less than 10 cm prevents fractures, making the bone as strong as native bone.

Keywords:
biomechanical studygeriatric fracturesinterprosthetic femoral fractureprophylactic platingrevision arthroplasty

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Area of Science:

  • Orthopedic surgery
  • Biomechanical engineering
  • Materials science

Background:

  • Apposing intramedullary femoral implants increase interprosthetic fracture risk.
  • Optimal screw configuration for prophylactic plating is undetermined.

Purpose of the Study:

  • Determine the optimal screw configuration for prophylactic plating of femurs with interprosthetic segments.
  • Evaluate the biomechanical impact of screw placement in the interprosthetic distance (IPD).

Main Methods:

  • 2- and 10-cm IPD created in 21 composite femora with intramedullary implants.
  • 4.5 mm plates applied with either one screw (IP-1) or zero screws (IP-0) in the IPD.
  • Femora loaded to failure in four-point bending; force-at-failure (FAF) and energy-to-failure (ETF) compared.
  • Digital image correlation (DIC) analyzed surface strain distributions.

Main Results:

  • IP-0 configurations (no screws in IPD) showed significantly higher FAF and ETF than IP-1.
  • FAF and ETF for 10-cm IPD without screws were comparable to native femora.
  • Strain analysis revealed concentrated stress at screw tips exiting the medial cortex.

Conclusions:

  • A bicortical screw in the IPD acts as a stress riser, reducing FAF and ETF.
  • Femora with IPD ≥ 10 cm exhibit biomechanical properties similar to native bone.
  • Bridging constructs are recommended for prophylactic plating of femora with IPD < 10 cm to mitigate fracture risk.