Salvage procedures for trochanteric femoral fractures after internal fixation failure: Biomechanical comparison of a plate fixator and the dynamic condylar screw

Abstract

The aim of this study was the biomechanical evaluation of the reversed less invasive stabilization system (LISS) internal fixation as a joint-preserving salvage procedure for trochanteric fractures. Five LISS plates and five dynamic condylar screws (DCS) were tested using synthetic femora (Sawbones^®) with an osteotomy model similar to a type-A2.3 pertrochanteric fracture. The constructs were subjected to axial loading up to 1000 N for five cycles. Then, the force was continuously increased until fixation failure. For the evaluation of the biomechanical behaviour, the stiffness levels were recorded and the osteotomy gap displacement was mapped three-dimensionally. The average stiffness for the constructs with LISS plates was 412 N/mm (with a standard deviation (SD) of 103N/mm) and 572 N/mm (SD of 116 N/mm) for the DCS constructs (p = 0.051). Local displacement at the osteotomy gap did not yield any significant differences. The LISS constructs failed at a mean axial compression of 2103 N (SD of 519 N) and the DCS constructs at a mean of 2572 N (SD of 372 N) (p = 0.14). It is concluded that the LISS plate offers a reliable fixation alternative for salvage procedures.