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The Problem of Fracture Fixation Augmentation and Description of a Novel Technique and Implant for Femoral Neck Stabilization

Fracture augmentation for osteopenic bone is a widely accepted concept but not commonly used due to the difficulty with application of the materials in conjunction with surgical implants in fracture repair. Until recently there was little choice of materials for augmentation, but new formulations of structural orthobiological matrix (SOM) have been developed, which have better flow and setting properties than the original polymethylmethacrylate and calcium phosphate ceramics materials. In addition, a new class of injectable implants with the ability to deliver some of these newer SOMs has been designed and received regulatory clearance as fracture fixation devices. This cadaveric study was undertaken to assess the feasibility of using the N-Force Fixation System in a femoral neck fracture model with 6 different SOMs. A new property of SOM was discovered regarding the flow characteristics of the tested materials within the proximal femur. Intrusion and extrusion characteristics were observed and were SOM specific. C-arm fluoroscopy and CT studies revealed the ability of intrusion-type SOM to intrude into cancellous bone trabeculae and minimize the chance of joint extrusion through fracture lines, whereas extrusion-type SOM would not intrude into trabecular spaces and demonstrated a tendency for fracture site extrusion and fracture contact interposition, risking compromise of fracture healing and angiogenesis. The instrumentation and implants gave reproducible implant placement and SOM delivery with low-pressure application and circumferential augmentation from the near cortex extending into the femoral neck and head in a tapering cone-type pattern.