A biomechanical analysis of the effect of hydroxyapatite augmentation for trochanteric femoral fractures

Takuya Usami; Naoya Takada; Hidetoshi Iwata; Hiroaki Sakai; Yusuke Hattori; Isato Sekiya; Yoshino Ueki; Yuko Nagaya; Hideki Murakami; Gen Kuroyanagi

doi:10.3892/etm.2023.11955

A biomechanical analysis of the effect of hydroxyapatite augmentation for trochanteric femoral fractures

Exp Ther Med. 2023 Apr 18;25(6):256. doi: 10.3892/etm.2023.11955. eCollection 2023 Jun.

Authors

Takuya Usami^{1

2}, Naoya Takada³, Hidetoshi Iwata³, Hiroaki Sakai¹, Yusuke Hattori^{1

2}, Isato Sekiya³, Yoshino Ueki^{1

4}, Yuko Nagaya², Hideki Murakami¹, Gen Kuroyanagi^{1

4}

Affiliations

¹ Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan.
² Department of Orthopedic Surgery, Nagoya City University East Medical Center, Nagoya, Aichi 464-8547, Japan.
³ Department of Orthopedic Surgery, Kainan Hospital, Yatomi, Aichi 498-8502, Japan.
⁴ Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan.

Abstract

Hydroxyapatite (HA) augments are used to treat trochanteric femoral fractures. However, the efficacy of HA augmentation has not been fully described in trochanteric femoral fracture surgery. In total, 85 patients were enrolled in the present study; all had trochanteric femoral fractures between January 2016 and October 2020, 45 with HA (HA group) and 40 without HA (N group). The intraoperative lag screw insertion torque was directly measured and the amount of lag screw telescoping with and without HA augmentation after surgery was analyzed. Maximum lag screw insertion torque (max-torque), bone mineral density in the opposite femoral neck (n-BMD), tip apex distance (TAD) of the lag screw, radiographic findings including fracture union, the amounts of lag screw telescoping and occurrence of complications were evaluated. A total of 12 patients were excluded if they were aged under 60 years old, had ipsilateral surgery and disorders in the hip joint, TAD of the lag screw ≥26 mm on postoperative radiographs and had measurement errors. A total of 73 fractures could be analyzed: HA group (n=36) and N group (n=37). Max-torque/n-BMD ratios were higher in the HA group compared with in the N group (7.23±2.71 vs. 5.93±1.91 g/cm²·N·m; P=0.04). The amounts of lag screw telescoping in the HA group were smaller compared with the N group (1.41±2.00 vs. 2.58±2.34; P=0.05). Evaluation of screw insertion torque showed maximum screw insertion torque correlated well with n-BMD in both groups, HA (R=0.57; P<0.01) and N group (R=0.64; P<0.01). No correlation was found between maximum screw insertion torque and TAD in both groups, HA (R=-0.10; P=0.62) and N group (R=0.02; P=0.93). All fractures were radiographically united without any complications. These results support the effectiveness of HA augmentation, indicating higher resistance against rotational instability and reduced lag screw telescoping in trochanteric femoral fracture treatment.

Keywords: hydroxyapatite; lag screw augmentation; trochanteric femoral fractures.

Associated data

figshare/10.6084/m9.figshare.21308985

Grants and funding

Funding: The present study was partly supported by a Grant-in-Aid for Scientific Research (grant no. 19K18471) from the Ministry of Education, Culture, Sports, Science and Technology of Japan, and a Grant-in-Aid for Research (grant no. 2213035) from Nagoya City University.