Can an Intramedullary Nail Be Used for Hip Fracture Prevention in a Sideways Fall Scenario?

Fragility fracture of the hip is a global health concern with generally poor outcomes. Clinical studies have shown prophylactic augmentation of the femur to be a plausible intervention with success in some approaches; however, its use is not yet widespread in the clinical community. We aimed to evaluate the efficacy and clinical safety of prophylactic intramedullary nailing for hip fracture prevention after a fall impact in six cadaveric pelvis–femurs. Post-fall fracture status of the native specimens was determined in a virtual control group built using a validated and peer-reviewed finite element method. A commercially available intramedullary nailing system was prophylactically implanted in all specimens. After augmentation, specimens were subjected to an experimental sideways fall impact and inspected for fracture. Overall, fracture status was unchanged or lowered in severity in the augmented group compared to the native control group. No sign of femur fracture was found in the group augmented by intramedullary nailing, but two augmented specimens exhibited pelvis fractures after the impact. No safety concerns associated with prophylactic nailing were found. These results suggest that prophylactic nailing may reduce the potential for hip fracture in a sideways fall impact but would not reduce the likelihood of pelvis fracture, and may shift femur fractures to instead be pelvis fractures. This study provides a robust biomechanical evaluation of prophylactic augmentation with a device already familiar to orthopedic surgeons, broadening the options currently considered for the prevention of hip fractures.