• L Konstantinidis, C Papaioannou, A Hirschmüller, T Pavlidis, S Schroeter, N P Südkamp, and P Helwig.
• Department of Orthopaedics and Traumatology, Albert-Ludwigs-University Freiburg, Germany. lukas.konstantinidis@uniklinik-freiburg.de
• Injury. 2013 Jun 1;44(6):784-90.

BackgroundCurrent recommendations with regard to central or caudal positioning of the femur head carrier in the management of trochanteric fractures are contradictory.MethodsA standardised pertrochanteric osteotomy was stabilised in 15 pairs of cadaver femurs by means of intramedullary osteosynthesis (5xPFN-A-Synthes, 5xIntertan-Smith&Nephew, 5xTargon-PF-Aesculap). For each pair randomised central (group A) or caudal (group B) implantation of the femoral neck component was performed. Subsequently, the constructs were axially loaded to 2100N. In the absence of cut out after 20,000 cycles, load was increased to a maximum force of 3100N. Angular displacement was recorded based on ultrasound. Migration of the load carrier in the femoral head was monitored radiologically.Findings DisplacementNo significant difference between groups (p>0.15) was found for the first 50 load cycles. A significantly greater degree of varus deformity was observed in group A (p=0.049) after 2000 load cycles and became more apparent as the number of load cycles increased (after 6000 cycles p=0.039, after 20,000 cycles p=0.034, after 22,000 cycles p=0.016). Angular displacement in the other two planes did not differ significantly across groups. CUT OUT: Migration of the load carrier in the femoral head was not significantly different for the two groups. Overall cut out occurred in 9 constructs, 3 in group A and 6 in group B. The difference in cut-out rate was not significant (p=0.213, chi-squared test).ConclusionBiomechanical superiority can be shown for caudal positioning of the femoral neck load carrier in terms of reduced varus deformity. The incidence of cut out is however unaffected by the position of the load carrier.Copyright © 2013 Elsevier Ltd. All rights reserved.

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