PURPOSE: Proximal femoral fractures are among the most commonly sustained fractures. The current treatment of stable proximal femoral fractures located in trochanteric region primarily involves the use of two systems: extramedullary dynamic hip screws and intramedullary hip nails. Given that these fractures are mainly found in the elderly population, the necessity of a repeat, due to failure of the first, may jeopardize the patient's life. Decisive factors contributing to the healing of a fracture (or the failure thereof) include fracture pattern, technical implementation of the operation (i.e., position of the implant), implant's properties and its changes in relation to the surrounding bone tissue during loading. Each screw insertion variant results in damage to various load-bearing bone structures, which can be expected to influence healing quality and stability of newly formed bone. METHOD: With the aid of a numerical model and finite element methods, the authors analyzed several different positions of IMHN/PFH-nails in the proximal femur, with the objective of determining positions with an increased risk of failure. RESULTS AND CONCLUSION: In model situations, it has been shown that in stable fractures results do not depend on absolutely precise positioning and small deflections in the nails and neck screws positions do not significantly increase the risk of failure for the entire fixation. Damage to load-bearing structures relative to various implant placements does not impact the resultant overall fixation stability. Therefore, it is not necessary to re-introduce implants in the ideal position, which can lead to reduced patient radiation doses during surgery.

Center for Integrated Study of Pelvis 3rd Faculty of Medicine Charles University Prague and University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Anatomy 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Health Care Studies Colleague of Polytechnics Jihlava Tolsteho 16 586 01 Jihlava Czech Republic

Department of Mechanics Biomechanics and Mechatronics Faculty of Mechanical Engineering CTU Prague Prague Czech Republic

Department of Orthopaedics Hospital Pelhrimov Pelhrimov Czech Republic

Department of Orthopaedy and Traumatology 3rd Faculty of Medicine Charles University Prague and University Hospital Kralovske Vinohrady Prague Czech Republic

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