Kimberly A. Anderson

Forces required to initiate sliding in second-generation intramedullary nails

Second-generation intramedullary nails, which allow the fixation screw that is placed in the femoral head to slide distally and thus allow compression of the fracture of the femoral neck, have become a popular option for the treatment of ipsilateral fractures of the femoral neck and shaft. However, the sliding characteristics of the screw within the barrel of the nail or the side-plate have not been assessed biomechanically, to our knowledge. The goal of the current study was to investigate the forces required to initiate sliding of the proximal screw in intramedullary devices and to compare these forces with those required to initiate sliding of hip screws. The loading configuration simulated the typical angle of 135 degrees between the intramedullary nail and the proximal screw. The forces required to initiate sliding of the proximal screw, with the screw extended fifty-one, seventy-six, eighty-six, and 102 millimeters beyond the proximal end of the barrel, were measured for three different types of second-generation intramedullary nails (Recon, ZMS, and Gamma), a sliding compression hip screw, and an intramedullary hip screw, and these forces were then compared. With each amount of extension of the screw, the hip screws required lower forces to initiate sliding than did the second-generation intramedullary devices. Of the second-generation devices, the Gamma nail required the highest forces to initiate sliding; the Recon and ZMS nails required 20 to 40 percent lower forces compared with the Gamma nail. None of the devices jammed in any of the loading configurations that were tested. When the extension of the screw was increased, higher forces were required to initiate sliding. CLINICAL RELEVANCE: Since sliding allows continued compression of the fracture, surgeons should be aware that, compared with hip screws, the second-generation nails that we tested required higher loads to initiate sliding and to generate subsequent compression of the fracture.