Does screw configuration affect subtrochanteric fracture after femoral neck fixation?

Jerome W. Oakey, Michael D. Stover, Hobie D. Summers*, Mark Sartori, Robert M. Havey, Avinash G. Patwardhan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


A subtrochanteric femur fracture after cannulated screw fixation of a femoral neck fracture is a devastating complication. We hypothesized that an apex-distal screw orientation would tolerate higher loads to subtrochanteric fracture. Human cadaveric femora were instrumented with three cannulated screws in either an apex-distal or an apex-proximal configuration. Specimens were loaded along the mechanical axis to failure creating a subtrochanteric femur fracture. Ultimate load to failure and the effect of bone density on load to failure were compared between groups. There was a greater load to failure in the apex-distal group compared with the apex-proximal group. The mean force to fracture in the apex-distal group (11,330 N; standard deviation = 3151 N) was greater than the mean force to fracture in the apex-proximal group (7795 N; standard deviation = 3194 N). Previous investigations have shown improved femoral neck fixation with an apex-distal configuration, but none has examined the relationship between screw orientation and subtrochanteric fractures. Our observations support the use of an apex-distal configuration for cannulated screw fixation of femoral neck fractures.

Original languageEnglish (US)
Pages (from-to)302-306
Number of pages5
JournalClinical orthopaedics and related research
Issue number443
StatePublished - Feb 2006

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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