TY - JOUR AU - Chen, Po-Quang AB - Abstract The effect of stress distribution due to the changes of the distal screw alignment in relation to the Gamma nail and the femoral shaft is thoroughly studied in this paper. Failure of the Gamma nail composite occurs through the cranial aperture of the distal screws and the insertion hole for the lag screw due to nonunion, delayed-union and continued weight-bearing. A three-dimensional finite element model was used to study the fractured femur, the Gamma nail, the lag screw and the distal locking screws. The first and the second distal screws were inserted into the Gamma nail in four different configurations. We found that the stress of the Gamma nail composite was substantially reduced with the two screws configured in the anterior to posterior direction. This alignment can bear greater loading in the more demanding fracture types. In the subtrochanteric fracture or the comminuted fractures at the proximal femur, the optimal alignment of the two distal screws was in the anterior to posterior direction. Fractured femur, Finite element method, Gamma nail References [1] Gaebler C. , Stanzl-Tschegg S. , Tschegg E. K. , Kukla C. , Menth-Chiari W. A. , Wozasek G. E. and Heinz T. , “ Implant Failure of the Gamma Nail ,” Injury , 30 ( 2 ), pp. 91 – 99 ( 1999 ). Google Scholar Crossref Search ADS PubMed WorldCat [2] Valverde J. A. , Alonso M. G. , Porro J. G. , Rueda D. , Larrauri P. M. and Soler J. J. , “ Use of the Gamma Nail in the Treatment of Fractures of the Proximal Femur ,” Clinical Orthopaedics & Related Research , 350 , pp. 56 – 61 ( 1998 ). OpenURL Placeholder Text WorldCat [3] van den Brink W. A. and Janssen I. M. C. , “ Failure of the Gamma Nail in a Highly Unstable Proximal Femur Fracture: Report of Four Cases Encountered in the Netherlands ,” Journal of Orthopaedic Trauma , 9 ( 1 ), pp. 53 – 56 ( 1995 ). Google Scholar Crossref Search ADS PubMed WorldCat [4] Leung K. S. , So W. S. , Shen W. Y. and Hui P. W. , “ Gamma Nails and Dynamic Hip Screws for Peritrochanteric Fractures, A Randomised Prospective Study in Elderly Patients ,” Journal of Bone & Joint Surgery — British Volume , 74 ( 3 ), pp. 345 – 351 ( 1992 ). OpenURL Placeholder Text WorldCat [5] Lentz W. , “Pohl's Sliding Screw,” in: Maatz R , Lentz W , Arens W , Beck H , eds., Intramedullary Nailing and Other Intramedullary Osteosyntheses , Philadelphia , etc: W. B. Saunders , pp. 198 – 207 ( 1986 ). Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC [6] Davis T. R. C. , Sher J. L. and Horsman A. , et al. “ Intertrochanteric Femoral Fractures: Mechanical Failure after Internal Fixation ,” Journal of Bone & Joint Surgery—British Volume , 72 ( B ), pp. 26 – 31 ( 1990 ). OpenURL Placeholder Text WorldCat [7] Simpson A. H. R. W. , Varty K. and Dodd C. A. F. , “ Sliding Hip Screws: Modes of Failure ,” Injury , 20 , pp. 227 – 231 ( 1989 ). Google Scholar Crossref Search ADS PubMed WorldCat [8] Amis A. A. , Bromage J. D. and Larvin M. , “ Fatigue Fracture of a Femoral Sliding Compression Screw-Plate Device after Bone Union ,” Biomaterials , 8 , pp. 153 – 157 ( 1987 ). Google Scholar Crossref Search ADS PubMed WorldCat [9] Manoli A. , “ Malassembly of the Sliding Screw-Plate Device ,” Journal of Trauma , 26 , pp. 916 – 922 ( 1986 ). Google Scholar Crossref Search ADS PubMed WorldCat [10] Haynes R. C. , Poll R. G. , Miles A. W. and Weston R. B. , “ An Experimental Study of the Failure Modes of the Gamma Locking Nail and AO Dynamic Hip Screw Under Static Loading: a Cadaveric Study ,” Medical Engineering & Physics , 19 ( 5 ), pp. 446 – 453 ( 1997 ). Google Scholar Crossref Search ADS PubMed WorldCat [11] Mahomed N. , Harrington I. , Kellam J. , Maistrelli G. , Hearn T. and Vroemen J. , “ Biomechanical Analysis of the Gamma Nail and Sliding Hip Screw ,” Clinical Orthopaedics & Related Research , 304 , pp. 280 – 288 ( 1994 ). OpenURL Placeholder Text WorldCat [12] Wang C. J. , Yettram A. L. , Yao M. S. and Procter P. , “ Finite Element Analysis of a Gamma Nail Within a Fractured Femur ,” Medical Engineering & Physics , 20 ( 9 ), pp. 677 – 683 ( 1998 ). Google Scholar Crossref Search ADS PubMed WorldCat [13] Rosenblum S. F. , Zuckerman J. D. , Kummer F. J. and Tam B. S. , “ A Biomechanical Evaluation of the Gamma Nail ,” Journal of Bone & Joint Surgery —British Volume , 74 ( 3 ), pp. 352 – 357 ( 1992 ). OpenURL Placeholder Text WorldCat [14] Taylor M. E. , Tanner K. E. , Freeman M. A. and Yettram A. L. , “ Stress and Strain Distribution Within the Intact Femur: Compression or Bending ,” Medical Engineering & Physics , 18 ( 2 ), pp. 122 – 131 ( 1996 ). Google Scholar Crossref Search ADS PubMed WorldCat [15] Prendergast P. J. and Taylor D. , “ Stress Analysis of the Proximo-Medial Femur after Total Hip Replacement ,” Journal of Biomedical Engineering , 12 ( 5 ), pp. 379 – 382 ( 1990 ). Google Scholar Crossref Search ADS PubMed WorldCat [16] Voor M. J. , Verst D. A. , Mladsi S. W. , Khalily C. and Seligson D. , “ Fatigue Properties of a Twelve-Hole Versus a Five-Hole Intramedullary Supracondylar Nail ,” Journal of Orthopaedic Trauma , 11 ( 2 ), pp. 98 – 102 ( 1997 ). Google Scholar Crossref Search ADS PubMed WorldCat [17] Zimmerman K. W. and Klasen H. J. , “ Mechanical Failure of Intramedullary Nails after Fracture Union ,” Journal of Bone & Joint Surgery—British Volume , 65 ( 3 ), pp. 274 – 275 ( 1983 ). OpenURL Placeholder Text WorldCat This content is only available as a PDF. Author notes * Professor ** Graduate student © The Society of Theoretical and Applied Mechanics, R.O.C. 2002 The Society of Theoretical and Applied Mechanics, R.O.C. © The Society of Theoretical and Applied Mechanics, R.O.C. 2002 TI - Optimal Distal Screw Alignment in the Gamma Nail JF - Journal of Mechanics DO - 10.1017/s1727719100002069 DA - 2002-06-01 UR - https://www.deepdyve.com/lp/oxford-university-press/optimal-distal-screw-alignment-in-the-gamma-nail-k8gNlyprkc SP - 103 EP - 108 VL - 18 IS - 2 DP - DeepDyve ER -