A biomechanical evaluation of orthopaedic implants for hip fractures by finite element analysis and in-vitro tests.

The aim of this study was to test the hypothesis that a reinforced gamma nail for the fixation of subtrochanteric fractures would experience less stress during loading compared with a common gamma nail. The issue of whether the use of the stronger implant would result in more stress shielding in the surrounding bone was also addressed. A finite element analysis (FEA) of a synthetic bone was employed to calculate the stress distribution in implant and bone for two fracture types (AO 31-A3.1 and AO 31-A3.3). The FEA was validated by mechanical tests on six synthetic femurs. To test the hypothesis in vitro, mechanical tests on six pairs of fresh-frozen human femurs were conducted. The femurs were supplied with a common or a reinforced gamma nail in a cross-over study design. Strains were measured on the nail shaft to quantify the loading of the nail. The FEA resulted in 3-51 per cent lower stresses for the reinforced gamma nail. No increase in stress shielding could be observed. In the in-vitro tests, the reinforced gamma nail experienced less strain during loading (p < 0.016). The study demonstrated the benefit of a reinforced gamma nail in subtrochanteric fractures. It experienced less stress but did not result in more stress shielding.