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Oh SH, Suh YS, Eghan-Acquah E, Yurevich KM, Won SH, Baek MJ, Lee SJ, Choi SW. Unstable Vancouver B1 periprosthetic femoral fracture fixation: A biomechanical comparison between a novel C-shaped memory alloy implant and cerclage wiring. J Int Med Res 2024; 52:3000605241240946. [PMID: 38534086 PMCID: PMC10981230 DOI: 10.1177/03000605241240946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND To compare the biomechanical stability of a novel, C-shaped nickel-titanium shape memory alloy (SMA) implant (C-clip) with traditional cerclage wiring in the fixation of a Vancouver B1 (VB1) periprosthetic femoral fracture (PFF). METHODS In total, 18 synthetic femoral fracture models were constructed to obtain unstable VB1 fracture with an oblique fracture line 8 cm below the lesser trochanter. For each model, the distal portion was repaired using a 10-hole locking plate and four distal bi-cortical screws. The proximal portion was repaired using either three, threaded cerclage wirings or three, novel C-shaped implants. Specimens underwent biomechanical testing using axial compression, torsional and four-point bending tests. Each test was performed on three specimens. RESULTS The C-clip was statistically significantly stronger (i.e., stiffer) than cerclage wiring in the three biomechanical tests. For axial compression, medians (ranges) were 39 (39-41) and 35 (35-35) N/mm, for the C-clip and cerclage wiring, respectively. For torsion, medians (ranges) were, 0.44 (0.44-0.45) and 0.30 (0.30-0.33) N/mm for the C-clip and cerclage wiring, respectively. For the four-point bending test, medians (ranges) were 39 (39-41) and 28 (28-31) N/mm; for the C-clip and cerclage wiring, respectively. CONCLUSION Results from this small study show that the novel, C-shaped SMA appears to be biomechanically superior to traditional cerclage wiring in terms of stiffness, axial compression, torsion and four-point bending, and may be a valuable alternative in the repair of VB1 PFF. Further research is necessary to support these results.
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Affiliation(s)
- Seog-Hyun Oh
- Department of Biomedical Engineering, Inje University, Gimhae, 50834, 197 Inje-ro, Gimhae-si, Gyeongsangnam-do, Republic of Korea
| | - Yu-Sung Suh
- Department of Orthopedic Surgery, Soonchunhyang University College of Medicine, Seoul, 04401, 59 Daesagwan-ro, Yongsan-gu, Seoul, Republic of Korea
| | - Emmanuel Eghan-Acquah
- Department of Biomedical Engineering, Inje University, Gimhae, 50834, 197 Inje-ro, Gimhae-si, Gyeongsangnam-do, Republic of Korea
| | - Kollerov Mikhail Yurevich
- Department of Materials Science and Materials Technology, Moscow Aviation Institute, 121552, Kom.1, Dom 5, Orshanskaya Str. Moscow, Russia
| | - Sung-Hun Won
- Department of Orthopedic Surgery, Soonchunhyang University College of Medicine, Seoul, 04401, 59 Daesagwan-ro, Yongsan-gu, Seoul, Republic of Korea
| | - Min Jung Baek
- Department of Obstetrics and Gynecology, Bundang CHA Hospital, Seongnam, 13496, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sung-Jae Lee
- Department of Biomedical Engineering, Inje University, Gimhae, 50834, 197 Inje-ro, Gimhae-si, Gyeongsangnam-do, Republic of Korea
| | - Sung-Woo Choi
- Department of Orthopedic Surgery, Soonchunhyang University College of Medicine, Seoul, 04401, 59 Daesagwan-ro, Yongsan-gu, Seoul, Republic of Korea
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Pereira S, Bidolegui F, Garabano G, Pesciallo CA, Giordano V, Pires RE, Mariolani JR, Belangero WD. Does the type of medial plate fixation matter for supplemental fixation of distal femur fractures manage with a lateral pre-contoured locked plate? A Biomechanical study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:605-612. [PMID: 37661241 DOI: 10.1007/s00590-023-03685-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/13/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Fixation of distal femur fractures with a lateral pre-contoured locking plate provides stable fixation and is the standard treatment in most cases, allowing early range of motion with a high rate of union. However, in situations, the stability achieved with the lateral plate alone may be insufficient, predisposing to fixation failure. The objective of the study was to compare, in synthetic bone models, the biomechanical behaviour of the fixation with a distal femur lateral pre-contoured locking plate solely and associated with a 3.5 mm proximal humeral locking plate applied upside down or a 4.5 mm helical locking compression plate on the medial side. MATERIAL AND METHODS A total of 15 solid synthetic left femur samples were used. A metaphysical defect at the level of the medial cortex was simulated. The samples were randomly distributed into three groups equally. All groups received a 4.5/5.0 mm single lateral 9-hole distal femur lateral pre-contoured locking plate. Group 1 had no supplementary plate. Group 2 received a supplementary 6-hole 3.5 mm proximal humeral locking plate and Group 3 received a supplementary 4.5/5.0 mm helical 14-hole narrow locking compression plate. RESULTS Both supplementary plate types used in groups 2 and 3 contributed to increase the apparent stiffness of the construct, but pairwise comparison showed statically significant difference only between group 1 and 3. No significant difference was observed between groups 2 and 3. CONCLUSION Both supplementary plates might be considered for improving the fixation in distal femur fracture in selected cases.
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Affiliation(s)
- Sebastián Pereira
- Servicio de Ortopedia y Traumatologia, Sanatorio San Lucas, Belgrano 369, B1642, San Isidro, Buenos Aires, Argentina.
- Servicio de Ortopedia y Traumatologia, Hospital Sirio-Libanes, Campana 4658, C1419, Buenos Aires, Argentina.
| | - Fernando Bidolegui
- Servicio de Ortopedia y Traumatologia, Hospital Sirio-Libanes, Campana 4658, C1419, Buenos Aires, Argentina
- Servicio de Ortopedia y Traumatologia, Sanatorio Otamendi Miroli, Azcuénaga 870, C1115, Buenos Aires, Argentina
| | - Germán Garabano
- Servicio de Ortopedia y Traumatologia, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
| | - Cesar Angel Pesciallo
- Servicio de Ortopedia y Traumatologia, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
| | - Robinson Estevez Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - José Ricardo Mariolani
- Biomaterials Laboratory in Orthopedics (LABIMO), Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - William Dias Belangero
- Biomaterials Laboratory in Orthopedics (LABIMO), Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
- Department of Orthopedics, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
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Cheung ZB, Nasser P, Iatridis JC, Forsh DA. Orthogonal plating of distal femur fractures: A biomechanical comparison with plate-nail and parallel plating constructs. J Orthop 2023; 37:34-40. [PMID: 36974099 PMCID: PMC10039308 DOI: 10.1016/j.jor.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/26/2022] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
Purpose This study compared the biomechanical properties of orthogonal plating with plate-nail and parallel plating constructs for supracondylar distal femur fractures. Methods A supracondylar distal femur fracture was simulated using 15 synthetic osteoporotic femurs. Constructs included: (1) plate-nail (lateral locked distal femoral plate + retrograde intramedullary nail); (2) parallel plating (lateral locked distal femoral plate + medial 4.0 mm compression plate); and (3) orthogonal plating (lateral locked distal femoral plate + posterior one-third tubular plate). Specimens underwent nondestructive loading, fatigue loading, and loading to failure. Gapping at the fracture was measured using a three-dimensional motion capture system. Baseline torsional and axial stiffness, stiffness and strain after fatigue loading, and load to failure were determined. A case example of orthogonal plating is also presented. Results There was no difference in baseline torsional (p = 0.51) and axial stiffness (p = 0.53). Stiffness after fatigue loading was highest with parallel plating, with no difference between the plate-nail and orthogonal plating constructs (p = 0.84). Strain after fatigue loading was lowest in the parallel plating group (0.54 ± 0.19%), followed by the plate-nail (2.89 ± 0.83%) and orthogonal plating groups (3.04 ± 0.51%). Conclusion Orthogonal plating demonstrated comparable baseline stiffness to plate-nail and parallel plating constructs, and similar biomechanical performance in fatigue loading to plate-nail constructs. All specimens had ≤3% strain after fatigue loading, suggesting sufficient stability for fracture healing. The benefits of enhanced stability from dual-implant fixation may be achieved through orthogonal plating while avoiding an additional medial surgical approach, and therefore warrants further investigation as a novel alternative for distal femur fracture fixation.
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Affiliation(s)
- Zoe B. Cheung
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philip Nasser
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - David A. Forsh
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kubik JF, Bornes TD, Gausden EB, Klinger CE, Wellman DS, Helfet DL. Surgical outcomes of dual-plate fixation for periprosthetic femur fractures around a stable hip arthroplasty stem. Arch Orthop Trauma Surg 2022; 142:3605-3611. [PMID: 34003368 DOI: 10.1007/s00402-021-03950-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The incidence of periprosthetic femur fractures is increasing. Multiple treatment methods exist to treat fractures surrounding stable hip arthroplasty implants including locking plate fixation, cable fixation, allograft augmentation, and revision arthroplasty. No consensus regarding optimal treatment has been reached, and significant complications remain. Recently, biomechanical studies have demonstrated the benefits of orthogonal dual-plate fixation, but little clinical data exist. The purpose of the current study was to investigate the clinical and radiographic outcomes of dual-plated periprosthetic femur fractures around stable hip stems. MATERIALS AND METHODS Patients with periprosthetic femur fractures following hip arthroplasty with a stable femoral stem treated with dual-plate fixation were identified through chart review at a single institution. Fracture classification, fixation characteristics, radiographic outcomes, clinical outcomes and complications including re-operation were recorded. RESULTS Over a 12-year period, 31 patients (mean age 77 years at surgery, range 48-94) underwent dual plating by three traumatologists for implant-stable periprosthetic femur fractures surrounding a hip arthroplasty stem. There were 27 Vancouver B1-type and 9 inter-prosthetic fractures. Average follow-up was 2 years. Of the 26 patients with minimum 6-month follow-up, 24 (92%) united after index surgery (mean time to union 6.0 months, range 1.5-14.0). Mean time to full weight-bearing post-operatively was 2.6 months (range 1.5-4.0 months). Two patients required secondary surgery to address nonunion. CONCLUSIONS Dual-plating achieved high union rates with an acceptable complication profile for the treatment of periprosthetic femur fractures surrounding a stable hip arthroplasty stem. Our preferred fixation construct involves a lateral plate spanning the entire femur secured with non-locking bicortical screws supplemented with an anteriorly based reconstruction plate. Additional prospective research is required to confirm the results of this study.
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Affiliation(s)
- Jeremy F Kubik
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Troy D Bornes
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Elizabeth B Gausden
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Craig E Klinger
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - David S Wellman
- Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - David L Helfet
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
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Correlation of Bone Strength in an Animal Model (Rabbit) After Fracture and During the Period of Fixation with a Titanium Micro Plate. ACTA VET-BEOGRAD 2022. [DOI: 10.2478/acve-2022-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
The period of bone healing after trauma goes through certain physiological processes. In situations where a bone fracture occurs, our intention is to surgically position in an appropriate morpho-anatomical position. For osteosynthesis we used vipla wire and micro plates with corresponding screws.
The aim of our research was to evaluate the optimal time for the removal of the osteosynthetic material, fracture site biomechanical stability, and measurement of the callus thickness.
For this research ten 4 months old rabbits with right leg femur fracture were used. Osteosynthesis was done with titanium micro plates, corresponding screws and vipla wire. Experimental animals were observed through the post-operative period at the first and seventh postoperative day and there on at 2, 4, 6, 9, 12 weeks. Further additional fixation was needed in one of the rabbits in the second week.
The postoperative period provided us information about the optimal moment for the removal of titanium micro plates. It showed that over a period of six weeks, the bone had almost all normal biomechanical properties. Significantly greater strength and rigidity of the recovered femur were obtained after 12 weeks. Micro plates that were removed after 4, 6 or 9 weeks, did not need furhter fixation and therefore fixation was not applied, compared to those placed during the 12 weeks. X Ray evaluation provided us with follow up results of fracture healing.
The results suggest that it is acceptable to remove titanium micro plates after a period of healing, that is, after the formation of the callus and bridging of the fracture gap and diastasis with newly formed bone.
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He Z, Huang S, Ji T, Tang X, Yang R, Guo W. Plate configuration for biological reconstructions of femoral intercalary defect - a finite element evaluation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 224:107006. [PMID: 35816816 DOI: 10.1016/j.cmpb.2022.107006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/16/2022] [Accepted: 07/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Biological reconstruction was commonly used for femoral intercalary defect. The initial stability by plate fixation was believed to have an effect on bone union and implant failure. Our study was proposed to explore relationship of plate configuration and initial stability for femoral intercalary reconstruction using allo-/autograft. METHODS Femoral intercalary defect models were established with four different plate configurations: (1) Single lateral bridging plate, SLP (2) Lateral bridging plate + Orthogonal adjuvant plate, LP+OAP (3) Lateral bridging plate + Medial adjuvant plate, LP+MAP (4) Lateral bridging plate + Medial bridging plate, LP+MP. A diaphysis defect of 12 cm was simulated, and the removed native femoral bone was used as a structural allograft with the osteotomy gap of 2 mm. Models were analyzed by finite element simulations under an axial compression of 2000N and an axial moment of 10 Nm, respectively. RESULTS Axial load: (1) The peak von Mises stress of SLP, LP+OAP, LP+MAP, LP+MP were 993.50 MPa, 335.63 MPa, 240.03 MPa, 281.73 MPa, respectively and LP+MAP was the lowest (p < 0.01); (2) The mean displacement of SLP, LP+OAP, LP+MAP, LP+MP was 0.765, 0.130, 0.121, 0.235 mm, respectively. LP+MAP showed the best stability while SLP had a crash in the medial proximal gap; (3) The LP+MAP configuration had the most uniform stress distribution and the lowest maximum von Mises stress of 79.7 MPa within plates. Axial torsional load: (1) The peak von Mises stress of SLP, LP+OAP, LP+MAP, LP+MP were 431.66Mpa, 120.73 MPa, 72.31 MPa, 109.86 MPa, respectively; (2) The rotation angle of SLP, LP+OAP, LP+MAP, LP+MP was 4.30°, 1.35°, 1.20°, 1.57°, respectively. All of LP+OAP, LP+MAP and LP+MP showed an optimal torsional stability. CONCLUSIONS For femoral intercalary reconstruction using allo-/autograft fixed by plates, LP+MAP and LP+MP configurations showed superior stability in terms of axial compression and torsion load by FE simulation. A better stability was believed to be associated with higher union rate and lower hardware failure rate.
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Affiliation(s)
- Ziyang He
- Investigation performed at Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China
| | - Siyi Huang
- Investigation performed at Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China
| | - Tao Ji
- Investigation performed at Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China.
| | - Xiaodong Tang
- Investigation performed at Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China
| | - Rongli Yang
- Investigation performed at Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China
| | - Wei Guo
- Investigation performed at Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China.
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Schopper C, Luger M, Hipmair G, Schauer B, Gotterbarm T, Klasan A. The race for the classification of proximal periprosthetic femoral fractures : Vancouver vs Unified Classification System (UCS) - a systematic review. BMC Musculoskelet Disord 2022; 23:280. [PMID: 35321671 PMCID: PMC8944079 DOI: 10.1186/s12891-022-05240-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Periprosthetic femoral fractures (PFFs) represent a major cause for surgical revision after hip arthroplasty with detrimental consequences for patients. The Vancouver classification has been traditionally used since its introduction in 1995. The Unified Classification System (UCS) was described in 2014, to widen the spectrum by aiming for a more comprehensive approach. The UCS also aimed to replace the Vancouver classification by expanding the idea of the Vancouver classification to the whole musculoskeletal apparatus. After introduction of the UCS, the question was raised, whether the UCS found its place in the field of analysing PFFs. Therefore, this systematic review was performed to investigate, the use of the UCS compared to the established Vancouver classification. Methods Medline was searched for reports published between 1 January 2016 and 31 November 2020, without language restriction. Included were original articles, irrespective of the level of evidence and case reports reporting on a PFF and using either the Vancouver or the UCS to classify the fractures. Excluded were reviews and systematic reviews. Results One hundred forty-six studies were included in the analysis. UCS has not been used in a single registry study, giving a pooled cohort size of 3299 patients, compared to 59,178 patients in studies using the Vancouver classification. Since 2016, one study using UCS was published in a top journal, compared to 37 studies using the Vancouver classification (p=0.29). During the study period, the number of yearly publications remained stagnant (p=0.899). Conclusions Despite valuable improvement and expansion of the latter UCS, to date, the Vancouver system clearly leads the field of classifying PFFs in the sense of the common use. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05240-w.
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Affiliation(s)
- Clemens Schopper
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria.
| | - Günter Hipmair
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Bernhard Schauer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Antonio Klasan
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
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Chen X, Myers CA, Clary CW, DeWall RJ, Fritz B, Blauth M, Rullkoetter PJ. Simplified Mechanical Tests Can Simulate Physiological Mechanics of a Fixation Construct for Periprosthetic Femoral Fractures. J Biomech Eng 2022; 144:1119458. [PMID: 34505126 DOI: 10.1115/1.4052372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Indexed: 11/08/2022]
Abstract
Plate fractures after fixation of a Vancouver Type B1 periprosthetic femoral fracture (PFF) are difficult to treat and could lead to severe disability. However, due to the lack of direct measurement of in vivo performance of the PFF fixation construct, it is unknown whether current standard mechanical tests or previous experimental and computational studies have appropriately reproduced the in vivo mechanics of the plate. To provide a basis for the evaluation and development of appropriate mechanical tests for assessment of plate fracture risk, this study applied loads of common activities of daily living (ADLs) to implanted femur finite element (FE) models with PFF fixation constructs with an existing or a healed PFF. Based on FE simulated plate mechanics, the standard four-point-bend test adequately matched the stress state and the resultant bending moment in the plate as compared with femur models with an existing PFF. In addition, the newly developed constrained three-point-bend tests were able to reproduce plate stresses in models with a healed PFF. Furthermore, a combined bending and compression cadaveric test was appropriate for risk assessment including both plate fracture and screw loosening after the complete healing of PFF. The result of this study provides the means for combined experimental and computational preclinical evaluation of PFF fixation constructs.
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Affiliation(s)
- Xiang Chen
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO 80208
| | - Casey A Myers
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO 80208
| | - Chadd W Clary
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO 80208
| | | | | | | | - Paul J Rullkoetter
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO 80208; Department of Engineering & Computer Science, 2155 East Wesley Avenue, Denver, CO 80208
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Kösters C, den Toom D, Märdian S, Roßlenbroich S, Metzlaff S, Daniilidis K, Everding J. LOQTEQ ® VA Periprosthetic Plate-A New Concept for Bicortical Screw Fixation in Periprosthetic Fractures: A Technical Note. J Clin Med 2022; 11:jcm11051184. [PMID: 35268275 PMCID: PMC8911225 DOI: 10.3390/jcm11051184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Internal fixation using angle stable plates is the treatment standard in periprosthetic fractures around stable implants. To provide instant postoperative full weight-bearing, bicortical screw fixation is advisable but often surgically demanding. This work presents the first clinical results of the LOQTEQ® VA Periprosthetic Plate (aap Implantate AG, Berlin, Germany), a new plate system to simplify screw placement around implants. This plate system uses insertable hinges that allow for variable angle screw anchorage. Data of 26 patients with a mean age of 80 years and a mean follow-up of 13.9 months were retrospectively collected. Patients were clinically and radiologically examined. Bony union was achieved in 14 out of 15 patients with no signs of non-union or implant loosening. One patient, however, presented with implant failure. Clinical scores demonstrated acceptable results. Since the hinge plates are easy to apply, the first results are promising.
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Affiliation(s)
- Clemens Kösters
- Klinik für Orthopädie, Unfall-und Handchirurgie, Maria-Josef-Hospital Greven, 48268 Greven, Germany;
- Correspondence: ; Tel.: +49-2571-502-12001
| | - Daniel den Toom
- Klinik für Orthopädie, Unfall-und Handchirurgie, Maria-Josef-Hospital Greven, 48268 Greven, Germany;
| | - Sven Märdian
- Centrum für Muskuloskelettale Chirurgie, Charité Berlin, 13353 Berlin, Germany;
| | - Steffen Roßlenbroich
- Klinik für Unfall-, Hand-und Wiederherstellungschirurgie, Universitätsklinikum Münster, 48149 Münster, Germany; (S.R.); (J.E.)
| | - Sebastian Metzlaff
- Klinik für Orthopädie und Unfallchirurgie, St. Joseph Krankenhaus Berlin, 12101 Berlin, Germany;
| | | | - Jens Everding
- Klinik für Unfall-, Hand-und Wiederherstellungschirurgie, Universitätsklinikum Münster, 48149 Münster, Germany; (S.R.); (J.E.)
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Khwaja A, Mahoney W, Johnson J, Trompeter A, Lowe J. Biomechanics of periprosthetic femur fractures and early weightbearing. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:861-869. [PMID: 33852066 DOI: 10.1007/s00590-021-02969-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The incidence of periprosthetic fractures is expected to rise increase by 4.6% every 10 years between 2015 and 2060. There are few large series examining optimal fixation constructs or the influence of early ambulation on outcome. The purpose of this narrative review is to investigate the published biomechanical considerations for periprosthetic fracture fixation, with specific consideration of early postoperative weightbearing. METHODS A literature review was performed to identify fracture incidences, etiology, and current trends in weightbearing after fixation. Benefits of early weightbearing, current constructs, and biomechanics are reviewed. RESULTS The limited data available support medical benefits and increased union rates with early mobilization. Optimal fixation constructs are not agreed upon, but mechanical studies suggest that dual implant constructs can support physiologic weightbearing loads. CONCLUSION Further clinical trials are required to investigate fracture union and hardware complications in dual implant construct.
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Affiliation(s)
- Ansab Khwaja
- Department of Orthopaedics, University of Arizona, 1625 N Campbell Avenue, Tucson, AZ, 85719, USA.
| | - William Mahoney
- Department of Orthopaedics, University of Arizona, 1625 N Campbell Avenue, Tucson, AZ, 85719, USA
| | - Jay Johnson
- Department of Orthopaedics, University of Arizona, 1625 N Campbell Avenue, Tucson, AZ, 85719, USA.,Banner University Medical Group, Banner Health System Phoenix, Phoenix, AZ, USA
| | | | - Jason Lowe
- Department of Orthopaedics, University of Arizona, 1625 N Campbell Avenue, Tucson, AZ, 85719, USA.,Banner University Medical Group, Banner Health System Phoenix, Phoenix, AZ, USA
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Ross LA, Keenan OJF, Magill M, Brennan CM, Clement ND, Moran M, Patton JT, Scott CEH. Management of low periprosthetic distal femoral fractures. Bone Joint J 2021; 103-B:635-643. [PMID: 33789473 DOI: 10.1302/0301-620x.103b4.bjj-2020-1710.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS Debate continues regarding the optimum management of periprosthetic distal femoral fractures (PDFFs). This study aims to determine which operative treatment is associated with the lowest perioperative morbidity and mortality when treating low (Su type II and III) PDFFs comparing lateral locking plate fixation (LLP-ORIF) or distal femoral arthroplasty (DFA). METHODS This was a retrospective cohort study of 60 consecutive unilateral (PDFFs) of Su types II (40/60) and III (20/60) in patients aged ≥ 60 years: 33 underwent LLP-ORIF (mean age 81.3 years (SD 10.5), BMI 26.7 (SD 5.5); 29/33 female); and 27 underwent DFA (mean age 78.8 years (SD 8.3); BMI 26.7 (SD 6.6); 19/27 female). The primary outcome measure was reoperation. Secondary outcomes included perioperative complications, calculated blood loss, transfusion requirements, functional mobility status, length of acute hospital stay, discharge destination and mortality. Kaplan-Meier survival analysis was performed. Cox multivariate regression analysis was performed to identify risk factors for reoperation after LLP-ORIF. RESULTS Follow-up was at mean 3.8 years (1.0 to 10.4). One-year mortality was 13% (8/60). Reoperation was more common following LLP-ORIF: 7/33 versus 0/27 (p = 0.008). Five-year survival for reoperation was significantly better following DFA; 100% compared to 70.8% (95% confidence interval (CI) 51.8% to 89.8%, p = 0.006). There was no difference for the endpoint mechanical failure (including radiological loosening); ORIF 74.5% (56.3 to 92.7), and DFA 78.2% (52.3 to 100, p = 0.182). Reoperation following LLP-ORIF was independently associated with medial comminution; hazard ratio (HR) 10.7 (1.45 to 79.5, p = 0.020). Anatomical reduction was protective against reoperation; HR 0.11 (0.013 to 0.96, p = 0.046). When inadequately fixed fractures were excluded, there was no difference in five-year survival for either reoperation (p = 0.156) or mechanical failure (p = 0.453). CONCLUSION Absolute reoperation rates are higher following LLP fixation of low PDFFs compared to DFA. Where LLP-ORIF was well performed with augmentation of medial comminution, there was no difference in survival compared to DFA. Though necessary in very low fractures, DFA should be used with caution in patients with greater life expectancies due to the risk of longer term aseptic loosening. Cite this article: Bone Joint J 2021;103-B(4):635-643.
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Affiliation(s)
- Lauren A Ross
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Oisin J F Keenan
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Matthew Magill
- Department of Orthopaedics, Ninewells Hospital, Dundee, UK
| | | | - Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Matt Moran
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - James T Patton
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Chloe E H Scott
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, The University of Edinburgh, Edinburgh, UK
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Biomechanical evaluation of retrograde docking nailing to a total hip arthroplasty stem in a periprosthetic femur fracture model. Injury 2021; 52:53-59. [PMID: 33129493 DOI: 10.1016/j.injury.2020.10.086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/11/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Slotted nails allow a connection to a total hip arthroplasty (THA) stem and act as intramedullary load carrier. This study compares construct stiffness, cycles to failure and failure load between a retrograde slotted femur nail construct docked to a THA stem and a lateral locking plate in a human periprosthetic femur fracture model. MATERIALS AND METHODS In seven pairs of fresh-frozen human anatomic femora with cemented THA, a transverse osteotomy was set simulating a Vancouver type B1 fracture. The femora were instrumented pairwise with either a retrograde slotted nail coupled to the prosthesis stem, or a locking plate plus a locking attachment plate. Four-point mediolateral bending, torsional and axial bending construct stiffness was investigated via non-destructive tests. Cyclic testing under progressively increasing physiologic loading was performed at 2 Hz until catastrophic construct failure. RESULTS Mediolateral bending stiffness did not differ significantly between the two groups (P=0.17) but exhibited a biphasic profile with significantly increased stiffness in both groups (P<0.01). Nail constructs provided a significantly lower torsional stiffness (0.49 ± 0.66 Nm/°) than plate constructs (1.70 ± 0.86 Nm/°), P=0.03. Axial bending stiffness did not differ significantly between the groups (Nail: 605 ± 511 N/mm; Plate: 381 ± 428 N/mm), P=0.61. Cycles to failure and failure load were significantly higher for the plate constructs (25'700 ± 8'341; 3'070 ± 1334 N) compared with the nail constructs (20'729 ± 7'949; 2'573 ± 1295 N), P=0.04. CONCLUSION The docking nail construct provides an intramedullary fixation with connection to the prosthesis stem; however, it is biomechanically weaker in stable fractures compared to the plate construct.
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13
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Tuncay İ, Tözün R, Aliyev O, Dikmen G, Uzer G, Özden VE, Yıldız F. Onlay fibula autografting technique and its comparison with cortical allograft for the reconstruction of periprosthetic bone defects around the femur. INTERNATIONAL ORTHOPAEDICS 2020; 45:71-81. [PMID: 33206205 DOI: 10.1007/s00264-020-04876-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bone defect around the femur related to revisions or periprosthetic fractures (PFF) is an issue. We present a bone defect reconstruction technique in femoral revisions and/or PFF using fibula autograft and compared our radiological and clinical results to that of allograft. METHODS A total of 53 patients who underwent revision hip arthroplasty and/or PFF fixation with the use of cortical fibula autograft (FG group) or cortical allograft (CG group) were evaluated. After exclusions, 20 patients who had minimum two years of follow-up were investigated for each group, for their radiological and clinical outcomes. RESULTS In FG and CG groups, the median ages were 69.5(44-90) and 62(38-88) years, follow-ups were 59(28-72) and 120(48-216) months, defect lengths were seven (1-10) and ten (1-17) cm, and grafts lengths were 16.5(10-30) and 20(12-37) cm, respectively. The rate of graft incorporation was 90% in each group and median time to incorporations were seven (4-12) and 12(6-24) months (p < 0.001), and graft resorption (moderate and severe) rates were 10% and 25% (p = 0.41), respectively. Median Harris Hip (77.6 vs 78.0), WOMAC (23.2 vs 22), SF-12 physical (50.0 vs 46.1), and SF-12 mental (53.8 vs 52.5) scores were similar between the groups, respectively. Kaplan-Meier survivorship analyses revealed an estimated mean survival of 100% at six years in FG group and 90% at 14 years in CG group. CONCLUSION In the reconstruction of periprosthetic bone defects after femoral revision or PPF, onlay cortical fibula autografts provide comparable clinical and radiological outcomes to allografts. Its incorporation is faster, it is cost-effective and easy to obtain without apparent morbidity.
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Affiliation(s)
- İbrahim Tuncay
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey
| | - Remzi Tözün
- Department of Orthopedics and Traumatology, School of Medicine, Mehmet Ali Aydınlar University, Acibadem Maslak Hospital, Darüşşafaka Büyükdere Caddesi No No:40, Sarıyer, Istanbul, 34457, Turkey
| | - Orkhan Aliyev
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey
| | - Göksel Dikmen
- Department of Orthopedics and Traumatology, School of Medicine, Mehmet Ali Aydınlar University, Acibadem Maslak Hospital, Darüşşafaka Büyükdere Caddesi No No:40, Sarıyer, Istanbul, 34457, Turkey
| | - Gökçer Uzer
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey
| | - Vahit Emre Özden
- Department of Orthopedics and Traumatology, School of Medicine, Mehmet Ali Aydınlar University, Acibadem Maslak Hospital, Darüşşafaka Büyükdere Caddesi No No:40, Sarıyer, Istanbul, 34457, Turkey
| | - Fatih Yıldız
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey.
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Dhason R, Roy S, Datta S. A biomechanical study on the laminate stacking sequence in composite bone plates for vancouver femur B1 fracture fixation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 196:105680. [PMID: 32763643 DOI: 10.1016/j.cmpb.2020.105680] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Composite bone plates are proposed for fracture fixation in periprosthetic femoral fracture. Metallic plates, having high stiffness compared to bone lead to stress shielding, reduce the compression force in the fracture site, affectthe healing process. Reduction of stiffness in the axial direction due to above reason without lowering the stiffness in transverse to avoid much of shear strain and thus avoiding instability at the fracture site leads to selective stress shielding. This can only be achieved through meticulously designed fiber reinforced composite. In the present work varied fiber orientations in the stacked laminates with varied fiber types are employed in a post-operative femur fixation for the in-silico analyses of their effectiveness using finite element analysis. METHODS In this study a Total Hip Arthroplasty (THA) model is constructed with composite bone plates. Three-dimensional narrow type metal plate is modeled with 12 holes and length of 194 mm. Three different types of composite bone plates are modeled with 12 holes of different size for the analysis i.e. Type 1 (5.6 mm thickness and 16 mm width), Type 2 (6 mm thickness and 16 mm width) and Type 3(6 mm thickness and 18 mm width). Anatomical 3D FE models of THA with composite bone plates are constructed to find out the interfacial stresses and strains. The finite element software ANSYS is used to perform the analysis. RESULTS A three-dimensional FE model of immediately post-operative femur fixation is developed and studied the maximum stress distribution, strain and movement in axial/shear direction in the metal and composite bone plate near to the fracture site. In the present study, the metal and composite plate (carbon/epoxy, glass/epoxy and flax/epoxy) used for most common Vancouver type B1 fracture to observe the biomechanical behavior of different models in IPO condition using FEA. CONCLUSIONS Optimizing the fiber orientations of composite bone plates of Total Hip Arthroplasty (THA) model by controlling the biomechanical stresses could be a favorable approach. The finite element analysis approach gives a viable solution to design the composite bone plate and for designing future models that preserves the biomechanical function of THA with composite bone plate.
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Affiliation(s)
- Raja Dhason
- Department of Mechanical Engineering, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu-603203, India
| | - Sandipan Roy
- Department of Mechanical Engineering, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu-603203, India.
| | - Shubhabrata Datta
- Department of Mechanical Engineering, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu-603203, India.
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Periprosthetic fracture fixation in Vancouver B1 femoral shaft fractures: A biomechanical study comparing two plate systems. J Orthop Translat 2020; 24:150-154. [PMID: 33101965 PMCID: PMC7548384 DOI: 10.1016/j.jot.2020.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 01/26/2023] Open
Abstract
Introduction Periprosthetic fractures of the femur are an increasing problem in today's trauma and orthopaedic surgery. Owing to the hip stem, implant anchorage is very difficult in the proximal femur. This study compares two plate systems regarding their biomechanical properties and the handling in periprosthetic fracture fixation of the proximal femur. Materials and methods Using eight pairs of fresh, frozen human proximal femora the Locking Compression Plate/Locking Attachment Plate construct (LCP/LAP) (group I, DePuy Synthes) was compared to the new LOQTEQ® periprosthetic distal lateral femur plate (group II, AAP Implantate AG). After implantation of press fit femoral hip stems a Vancouver B1 fracture model was used. Biomechanical testing was performed by cyclic axial loading with a constant increment of 0.1 N/cycle starting from 750 N axial loading. Every 250 cycles an a.p. x-ray was done to evaluate failure. Results The Group II showed significant higher axial stiffness (+42%) compared with Group I. In addition, Group II withstood significantly more load-cycles until failure (20%). The mode of catastrophic failure was plate breakage in Group II, whereas, in Group I, all plates showed an early bending followed by plate breakage. Discussion and conclusion Both plate systems enable screw placement around hip stems. The hinge plate showed superior biomechanical results compared with the locking compression plate/locking attachment plate construct. Furthermore, the hinge plate offers variable hinges and variable angel locking making bicortical screw placement around hip stems more comfortable and safe. The translational potential of this article The results of this study can be directly transferred to patient care. With the innovative hinge plate, the surgeon has a biomechanically superior implant, which also offers improved options for screw placement compared to a standard locking plate.
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16
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Everding J, Schliemann B, Raschke MJ. [Periprosthetic fractures: basics, classification and treatment principles]. Chirurg 2020; 91:794-803. [PMID: 32564108 DOI: 10.1007/s00104-020-01219-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Periprosthetic fractures (PPFx) are becoming an increasingly important topic in orthopedics and trauma surgery due to the rising number of endoprosthetic joint replacements. The recently published unified classification system (UCS) has replaced numerous historical classification systems and can be applied to all PPFx regardless of the bone or joint involved. The treatment of PPFx requires individual therapeutic concepts taking patient-dependent and patient-independent factors into consideration. The conservative treatment of PPFx is only justified in exceptional situations. In contrast, the choice between operative treatment and deciding between osteosynthesis or revision arthroplasty is particularly based on the assessment of the implant stability. In order to achieve fracture consolidation and also a good functional outcome, knowledge of the basic biomechanical principles of operative (osteosynthesis or endoprosthesis) treatment of periprosthetic fractures is necessary.
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Affiliation(s)
- J Everding
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyer Straße 1, 48149, Münster, Deutschland.
| | - B Schliemann
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyer Straße 1, 48149, Münster, Deutschland
| | - M J Raschke
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyer Straße 1, 48149, Münster, Deutschland
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Chatziagorou G, Lindahl H, Kärrholm J. Lower reoperation rate with locking plates compared with conventional plates in Vancouver type C periprosthetic femoral fractures: A register study of 639 cases in Sweden. Injury 2019; 50:2292-2300. [PMID: 31653501 DOI: 10.1016/j.injury.2019.10.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 10/03/2019] [Accepted: 10/14/2019] [Indexed: 02/02/2023]
Abstract
AIM To investigate demographics and outcomes of Vancouver type C periprosthetic femoral fractures (PPFF) treated with open reduction and internal fixation. METHODS Patient data were obtained from medical charts of cases reported to the Swedish Hip Arthroplasty Register and/or from the National Patient Register. Vancouver type C fractures undergoing surgery between 2001 and 2011, in patients who had received their primary THR between 1979 and 2011, were included. Any further reoperation performed between 2001 and 2013 and related to the PPFF constituted the primary outcome. RESULTS A total of 632 patients with 639 Vancouver type C fractures were identified. The majority of the patients were women (84%) and they had a fracture distal to a cemented stem (95%). The mean age at the time of fracture was 72 years. Treatment was performed with a locking plate (363 cases), a conventional plate (184 cases), an intramedullary nail (62 cases), or with double plating (30 cases). The overall reoperation rate was 17%, and mortality within one year of the operation was 16%. Locking plates had a significantly lower reoperation rate than conventional plates (p<0.001) and intramedullary nailing (p = 0.005). Interprosthetic femoral fractures did not have a statistically different outcome compared with non-IPFFs. CONCLUSIONS The lowest reoperation rate was observed using locking plates in Vancouver type C fractures when compared with conventional plates or intramedullary nailing. The presence of an ipsilateral knee prosthesis did not influence the outcome of the surgical treatment.
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Affiliation(s)
- Georgios Chatziagorou
- The Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, SE-413 45 Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, R-huset, plan 4, Mölndals sjukhus, Göteborgsvägen 31, 431 80 Mölndal, Sweden.
| | - Hans Lindahl
- The Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, SE-413 45 Gothenburg, Sweden; Lidköping Hospital, Sweden. Department of Orthopaedics, Mellbygatan 11-15, 531 85 Lidköping, Sweden
| | - Johan Kärrholm
- The Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, SE-413 45 Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, R-huset, plan 4, Mölndals sjukhus, Göteborgsvägen 31, 431 80 Mölndal, Sweden
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18
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Yang TC, Tzeng YH, Wang CS, Lin CC, Chang MC, Chiang CC. Are proximal screws necessary for osteosynthesis of stable-stem periprosthetic femoral fractures fixed with non-locking plate and cable? Injury 2019; 50:1739-1744. [PMID: 31182231 DOI: 10.1016/j.injury.2019.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/25/2019] [Accepted: 06/03/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study was to assess the effectiveness of the cable-plate-cable technique which comprises fixation of the proximal fragment using cable loops without additional proximal screws on the plate for the treatment of stable-stem periprosthetic femoral fractures around hip prostheses. METHODS We retrospectively reviewed Vancouver types B1 and C periprosthetic femoral fractures treated with a dynamic compression plate combined with Dall-Miles cable between 2010 and 2016 at a single institution and followed for at least 12 months. Patients were treated with proximal fragment fixation using cable combined with screws (Group I) or with proximal fragment fixation using cable alone (Group II). Demographic data, fracture types, and clinical and radiological outcomes were analyzed. RESULTS A total of 50 patients were included (Group I, n = 23 patients; Group II, n = 27). Fracture union was achieved in 49 patients with one case of non-union in Group I and no cases of non-union in Group II. Mean time to union was 5.4 months in Group I and 5.1 months in Group II (P = 0.624). Mean Harris hip score at latest assessment was 69.5 in Group I and 69.4 in Group II (P = 0.919). Regarding complications, there was one deep wound infection, one stem subsidence, and one loss of reduction in Group I, and one stem subsidence in Group II. No significant difference in clinical and radiological outcomes between groups was observed. CONCLUSIONS The cable-plate-cable technique sufficiently treats Vancouver types B1 and C periprosthetic femoral fractures without use of additional screws in the proximal fragment.
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Affiliation(s)
- Tzu-Cheng Yang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital; Department of Surgery, School of Medicine, National Yang-Ming University, Taiwan.
| | - Yun-Hsuan Tzeng
- Division of Medical Imaging for Health Management, Cheng-Hsin General Hospital, 45, Cheng-Hsin St., Peitou, Taipei 112, Taiwan.
| | - Chien-Shun Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital; Department of Surgery, School of Medicine, National Yang-Ming University, Taiwan.
| | - Chun-Cheng Lin
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital; Department of Surgery, School of Medicine, National Yang-Ming University, Taiwan.
| | - Ming-Chau Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital; Department of Surgery, School of Medicine, National Yang-Ming University, Taiwan.
| | - Chao-Ching Chiang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital; Department of Surgery, School of Medicine, National Yang-Ming University, Taiwan.
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Carvajal JL, Kim SE, Pozzi A. Use of a cerclage cable‐plate system to stabilize a periprosthetic femoral fracture after total hip replacement in a dog. Vet Surg 2019; 48:437-443. [DOI: 10.1111/vsu.13185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/15/2019] [Accepted: 02/02/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jose L. Carvajal
- Department of Clinical Sciences, College of Veterinary MedicineUniversity of Florida Gainesville Florida
| | - Stanley E. Kim
- Department of Clinical Sciences, College of Veterinary MedicineUniversity of Florida Gainesville Florida
| | - Antonio Pozzi
- Clinic for Small Animal Surgery, Small Animal Department, Vetsuisse FacultyUniversity of Zurich Zurich Switzerland
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20
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Wang K, Kenanidis E, Miodownik M, Tsiridis E, Moazen M. Periprosthetic fracture fixation of the femur following total hip arthroplasty: A review of biomechanical testing - Part II. Clin Biomech (Bristol, Avon) 2019; 61:144-162. [PMID: 30579137 DOI: 10.1016/j.clinbiomech.2018.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/21/2018] [Accepted: 12/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Periprosthetic femoral fracture is a severe complication of total hip arthroplasty. A previous review published in 2011 summarised the biomechanical studies regarding periprosthetic femoral fracture and its fixation techniques. Since then, there have been several commercially available fracture plates designed specifically for the treatment of these fractures. However, several clinical studies still report failure of fixation treatments used for these fractures. METHODS The current literature on biomechanical models of periprosthetic femoral fracture fixation since 2010 to present is reviewed. The methodologies involved in the experimental and computational studies of periprosthetic femoral fracture fixation are described and compared with particular focus on the recent developments. FINDINGS Several issues raised in the previous review paper have been addressed by current studies; such as validating computational results with experimental data. Current experimental studies are more sophisticated in design. Computational studies have been useful in studying fixation methods or conditions (such as bone healing) that are difficult to study in vivo or in vitro. However, a few issues still remain and are highlighted. INTERPRETATION The increased use of computational studies in investigating periprosthetic femoral fracture fixation techniques has proven valuable. Existing protocols for testing periprosthetic femoral fracture fixation need to be standardised in order to make more direct and conclusive comparisons between studies. A consensus on the 'optimum' treatment method for periprosthetic femoral fracture fixation needs to be achieved.
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Affiliation(s)
- Katherine Wang
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Eustathios Kenanidis
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK; Academic Orthopaedics Department, Papageorgiou General Hospital & CORE Lab at CIRI AUTH, Aristotle University Medical School, University Campus 54 124, Thessaloniki, Greece
| | - Mark Miodownik
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Eleftherios Tsiridis
- Academic Orthopaedics Department, Papageorgiou General Hospital & CORE Lab at CIRI AUTH, Aristotle University Medical School, University Campus 54 124, Thessaloniki, Greece
| | - Mehran Moazen
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK.
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Abstract
Locking plates have led to important changes in bone fracture management, allowing flexible biological fracture fixation based on the principle of an internal fixator. The technique has its indications and limitations. Most of the typical failure patterns arise from basic technical errors. Types of locking plates, material properties and the general principles of locking plate applications are reviewed together with their misapplication.
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Affiliation(s)
| | - Mark Lenz
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
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Shaat M. Reporting the Fatigue Life of 316L Stainless Steel Locking Compression Plate Implants: The Role of the Femoral and Tibial Biomechanics During the Gait. J Biomech Eng 2017; 139:2648718. [DOI: 10.1115/1.4037561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Indexed: 01/02/2023]
Abstract
In this study, the fatigue characteristics of femoral and tibial locking compression plate (LCP) implants are determined accounting for the knee biomechanics during the gait. A biomechanical model for the kinematics and kinetics of the knee joint during the complete gait cycle is proposed. The rotations of the femur, tibia, and patella about the knee joint during the gait are determined. Moreover, the patellar-tendon force (PT), quadriceps-tendon force (QT), the tibiofemoral joint force (TFJ), and the patellofemoral joint force (PFJ) through the standard gait cycle are obtained as functions of the body weight (BW). On the basis of the derived biomechanics of the knee joint, the fatigue factors of safety along with the fatigue life of 316L stainless steel femoral and tibial LCP implants are reported as functions of the BW and bone fracture location, for the first time. The reported results reveal that 316L stainless steel LCP implants for femoral surgeries are preferred for conditions in which the bone fracture is close to the knee joint and the BW is less than 80 kg. For tibial surgeries, 316L stainless steel LCP implants can be used for conditions in which the bone fracture is close to the knee joint and the BW is less than 100 kg. This study presents a critical guide for the determination of the fatigue characteristics of LCP implants. The obtained results reveal that the fatigue analyses should be performed on the basis of the body biomechanics to guarantee accurate designs of LCP implants for femoral and tibial orthopedic surgeries.
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Affiliation(s)
- Mohamed Shaat
- Department of Mechanical and Aerospace Engineering, New Mexico State University, Las Cruces, NM 88003 e-mails:
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Simons P, Sommerer T, Zderic I, Wahl D, Lenz M, Skulev H, Knobe M, Gueorguiev B, Richards RG, Klos K. Biomechanical investigation of two plating systems for medial column fusion in foot. PLoS One 2017; 12:e0172563. [PMID: 28222170 PMCID: PMC5319781 DOI: 10.1371/journal.pone.0172563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 02/07/2017] [Indexed: 01/30/2023] Open
Abstract
Background Arthrodesis of the medial column (navicular, cuneiform I and metatarsal I) is performed for reasons such as Charcot arthropathy, arthritis, posttraumatic reconstruction or severe pes planus. However, the complication rate is still high and mainly resulting from inadequate fixation. Special plates, designed for medial column arthrodesis, seem to offer potential to reduce the complication rate. The aim of this study was to investigate biomechanically plantar and dorsomedial fusion of the medial column using two new plating systems. Methods Eight matched pairs of human cadaveric lower legs were randomized in two groups and medial column fusion was performed using either plantar or dorsomedial variable-angle locking compression plates. The specimens were biomechanically tested under cyclic progressively increasing axial loading with physiological profile of each cycle. In addition to the machine data, mediolateral x-rays were taken every 250 cycles and motion tracking was performed to determine movements at the arthrodesis site. Statistical analysis of the parameters of interest was performed at a level of significance p = 0.05. Results Displacement of the talo-navicular joint after 1000, 2000 and 4000 cycles was significantly lower for plantar plating (p≤0.039) while there was significantly less movement in the naviculo-cuneiform I joint for dorsal plating post these cycle numbers (p<0.001). Displacements in all three joints of the medial column, as well as angular and torsional deformations between the navicular and metatarsal I increased significantly for each plating technique between 1000, 2000 and 4000 cycles (p≤0.021). The two plating systems did not differ significantly with regard to stiffness and cycles to failure (p≥0.171). Conclusion From biomechanical point of view, although dorsomedial plating showed less movement than plantar plating in the current setup under dynamic loading, there was no significant difference between the two plating systems with regard to stiffness and cycles to failure. Both tested techniques for dorsomedial and plantar plating appear to be applicable for arthrodesis of the medial column of the foot and other considerations, such as access morbidity, associated deformities or surgeon's preference, may also guide the choice of plating pattern. Further clinical studies are necessary before definitive recommendations can be given.
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Affiliation(s)
- Paul Simons
- Department of Foot and Ankle Surgery, Catholic Clinic Mainz, Mainz, Germany
| | | | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | - Dieter Wahl
- AO Research Institute Davos, Davos, Switzerland
| | - Mark Lenz
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
| | | | - Matthias Knobe
- Department of Trauma and Reconstructive Surgery, University Hospital Aachen, Aachen, Germany
| | | | | | - Kajetan Klos
- Department of Foot and Ankle Surgery, Catholic Clinic Mainz, Mainz, Germany
- * E-mail:
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Wähnert D, Grüneweller N, Gehweiler D, Brunn B, Raschke MJ, Stange R. Double plating in Vancouver type B1 periprosthetic proximal femur fractures: A biomechanical study. J Orthop Res 2017; 35:234-239. [PMID: 27061941 DOI: 10.1002/jor.23259] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/04/2016] [Indexed: 02/04/2023]
Abstract
Periprosthetic hip fractures are an increasing problem in modern orthopedic and trauma surgery. Many options for the operative treatment are available to the surgeon ranging from modern variable angular systems to standard plates, screws, and cerclages. However, there is no gold standard and therefore, the aim of this study, was to investigate the biomechanical characteristics of double plating versus a lateral standard plate in a Vancouver B1 fracture model. Ten 4th generation composite femora were used to implant cementless total hip prosthesis and create Vancouver B1 periprosthetic fractures. Afterwards, the osteotomies were fixed using the locking compression plate in combination with the locking attachment plate (LCP, LAP, DePuy Synthes, Solothurn, Switzerland)-group I. Group II additionally achieved a 5-hole 4.5/5.0 mm LCP anteriorly. Each construct was cyclically loaded to failure in axial compression. Axial construct stiffness was 50.87 N/mm (SD 1.61) for group I compared to 738.68 N/mm (SD 94.8) for group II, this difference was statistically significant (p = 0.016). The number of cycles to failure was also significant higher for group II (2,375 vs. 13,000 cycles; p = 0.016). Double plating can significantly increase construct stiffness and stability, and thus, is an option in the treatment of complex periprosthetic fractures, in revision surgery and for patients with the inability to partial weight bear. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:234-239, 2017.
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Affiliation(s)
- Dirk Wähnert
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Niklas Grüneweller
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Dominic Gehweiler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Benjamin Brunn
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Richard Stange
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
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