The impact on lateral wall fractures by a sliding hip screw device in trochanteric fractures

Listen to Brian and Lisa discuss the paper 'The impact on lateral wall fractures by a sliding hip screw device in trochanteric fractures' published in the May 2025 issue of Bone & Joint Open.

Click here to read the paper.

Be the first to know when the next episode is live! Follow our social media accounts, @BoneJointPortal and @BoneJointOpen on X for updates!

Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we're discussing the paper, 'The impact on lateral wall fractures by a sliding hip screw device in trochanteric fractures', published in May 2025 by M Høgevold and colleagues. I am Brian and I'm joined by my co-host Lisa.

Hello, Brian and hello to all our listeners. This paper delves into the mechanical failures associated with trochanteric fractures and the use of sliding hip screw devices. These kinds of fractures, especially with unstable characteristics, can present significant challenges during treatment. So Brian, what caught your attention about this study?

Well, Lisa, it's fascinating how the study investigates the failure mechanics of trochanteric fractures. Particularly when the lateral wall thickness is reduced or the lesser trochanter is detached. The researchers used cadaveric femora to create different [00:01:00] fracture patterns and tested them until failure using a sliding hip screw device. It offers deep insights into how these mechanical failures occur.

Indeed, the study was meticulous in its methodology including testing 14 pairs of embalmed femora, and multiple osteotomy groups. Each group represented specific fracture patterns, according to the AO/Orthopaedic Trauma Association classification. For instance, Group A had a thick lateral wall and an intact lesser trochanter. While Group D had both a thin lateral wall and a detached lesser trochanter, this setup allowed the researchers to study the variables in isolation.

Yes, and what is particularly interesting is how they conducted both quasi-static and dynamic axial compression tests to observe how these specimens would fail. They measured stiffness, deformation, load to failure, and the failure patterns. A very comprehensive data collection.

The results were quite enlightening. They [00:02:00] found that lateral wall fractures occurred in 10 out of the 28 specimens. Notably specimens with both a thin lateral wall and a detached lesser trochanter exhibited a significantly higher rate of lateral wall fractures and a lower load to failure. For instance, Group D with both characteristics had a failure load of approximately 1,673 N compared to 2,922 N in specimens with only one or neither characteristic. That's quite a drop.

The role of the lesser trochanter was notable, specimens with the detached lesser trochanter showed a higher rate of lateral wall fractures even more so than reduced lateral wall thickness alone. This emphasizes the importance of the medial stability provided by the lesser trochanter in preventing these fractures.

The authors conclude that a detached lesser trochanter, combined with a reduced lateral wall thickness greatly [00:03:00] diminishes the structural integrity of the bone when fixed with a sliding hip screw device. This can lead to mechanical failures at relatively low loading levels, which is important information for surgeons when planning treatments.

Another takeaway from this study is their suggestion to use more stable constructs for these kinds of fractures. Perhaps by reducing the lesser trocanter or adding extra lateral support like a trochanteric stabilizing plate. This could potentially reduce the risk of mechanical failure.

That's an important point. Ensuring that these unstable fractures receive the most stable fixation possible, can potentially reduce reoperation rates and improve patient outcomes.

To summarize this study highlights the biomechanical challenges of trochanteric fractures in the crucial role that both the lateral wall and the lesser trocanter play in mechanical stability. The research underscores the necessity of tailored surgical approaches to address these specific fracture [00:04:00] characteristics.

Well said Brian. Thank you to everyone for tuning into AI Talks with Bone & Joint. Join us next time as we continue exploring the latest in orthopaedic research and innovations.

Thank you, Lisa, and thank you to our listeners. Until next time, take care.