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.
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