Use of Locking Plate and Strut Onlay Allografts for Periprosthetic Fracture Around Well-Fixed Femoral Components

Kim, Young-Hoo; Mansukhani, Sameer Ajit; Kim, Jun-Shik; Park, Jang Won

doi:10.1016/j.arth.2016.05.064

Cited by 22 publications

(17 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The papers included in the review are reported by category in Table 2. (15)(16)(17)25,26,(29)(30)(31)(32)(33) 205 Bone substitutes (41,42,45,46,48) 331 Growth factors (53,(55)(56)(57)(58) 615 Cell therapies (66,69,73) 69 Pharmacological therapy (97)** (98)(99)(100)(101)(102)(103)(104)(105)(107)(108)(109)(110)(111)(112)(113)(114) 110 ** Systematic review including case series and case reports.…”

Section: Resultsmentioning

confidence: 99%

The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence

et al. 2020

View full text Add to dashboard Cite

Background: The healing of long bones diaphyseal fractures can be often impaired and eventually end into delayed union and non-union. A number of therapeutic strategies have been proposed in combination with surgical treatment in order to enhance the healing process, such as scaffolds, growth factors, cell therapies and systemic pharmacological treatments. Our aim was to investigate the current evidence of bone healing enhancement of acute long bone diaphyseal fractures. Methods: A systematic review was conducted by using Pubmed/MEDLINE; Embase and Ovid databases. The combination of the search terms “long-bones; diaphyseal fracture; bone healing; growth factors; cell therapies; scaffolds; graft; bone substitutes; orthobiologics; teriparatide”. Results: The initial search resulted in 4156 articles of which 37 papers fulfilled the inclusion criteria and were the subject of this review. The studies included 1350 patients (837 males and 513 females) with a mean age of 65.3 years old. Conclusions: General lack of high-quality studies exists on the use of adjuvant strategies for bone healing enhancement in acute shaft fractures. Strong evidence supports the use of bone grafts, while only moderate evidence demineralized bone matrix and synthetic ceramics. Conflicting results partially supported the use of growth factors and cell therapies in acute fractures. Teriparatide showed promising results, particularly for atypical femoral fractures and periprosthetic femoral fractures.

show abstract

Section: Resultsmentioning

confidence: 99%

The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The variety of methods and implants used, and their combinations implies that no "gold standard" exists. Elastic xation (relative stability) with minimal soft-tissue damage seems to be preferred [24,40,57,58], relying on biological potentiality of the fracture, while a rigid xation (absolute stability) is advocate in some other cases [6,41,59]. Anyway, all Authors focused their attention over mechanical issues of the PFF [60,61], without taking into account patient's biological criteria.…”

Section: Discussionmentioning

confidence: 99%

“…A PFF around or at the tip of a cemented stem [20,75,76] or over an osteoporotic bone are known to have higher complication rate than other cases [77]. Conditions such as osteoporosis and rheumatoid arthritis or other autoimmune or endocrinological diseases, long lasting CCSs or BPs assumption, AFFs or previous surgeries are indicators of a local and systemic biological impairment that suggest the use of structural allograft even if mechanically it would be unnecessary [6,9,31,78]. Also, smoking is known to be a negative prognostic factor for bone healing, and it has been found in a systematic review as the only biological patientdepending risk factor for nonunion [79].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

Mondanelli

Colasanti

Cataldi

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: There is lack of consensus regarding best operative fixation strategy for periprosthetic femoral fractures (PFFs) around a stable stem. Based on our experience in the treatment of nonunions after PFFs and other challenging cases and on Literature, we propose an algorithm that can guide in choosing the ideal surgical technique even for first-time PFFs with a stable stem.Methods: We retrospectively reviewed data on patients who failed to heal after a surgically treated Vancouver type B1 or C PFF. All patients were treated with locking plate, double structural allograft and autologous bone marrow concentrate (BMC) over a platelet-rich plasma (PRP)-based membrane at fracture site. All patients were also pharmacologically treated with Teriparatide in the postoperative period. We studied patients with radiograms, histological evaluation of the nonunion area, and phosphocalcic metabolism. Patients were assessed subjectively, clinically and radiographically until healing and then annually.Results: All nonunions healed over a six months period, and functional recovery appeared to be good. Retrospective evaluation of the proposed algorithm showed that none of the patients met biological or mechanical criteria such as to make valid the treatment with locking plate alone.Conclusion: Mechanical factors are not the only issues that should be taken into account when choosing the surgical approach to PFFs over a stable stem. Systemic and local biological conditions are factors that should drive to a rigid fixation with absolute stability (using a plate and structural allograft) plus local biological support (structural allograft and autologous BMC in a PRP-based scaffold) and systemic anabolic treatment (Teriparatide) in the first instance. A therapeutic algorithm is proposed, given the prosthetic stem to be stable, taking into account mechanical and biological criteria.

show abstract

“…This is in place of the introduction and increase in testing the biomechanical performance of double plating and the use of a LAP or similar construct. Clinically, there is not much data regarding the use of the LAP, however, there have been some reports of acceptable outcomes from using an LAP to manage PFF with a well-fixed stem (Kim et al, 2017a(Kim et al, , 2017b or when stability of plate is insufficient (Kammerlander et al, 2013). Despite the significant decrease in the use of struts in biomechanical testing; clinically struts in conjunction with plate fixation are still widely used for PFF fixation treatment, with some studies showing positive clinical outcomes (Barden et al, 2003;Khashan et al, 2013;Kim et al, 2017aKim et al, , 2017b.…”

Section: Discussionmentioning

confidence: 99%

Periprosthetic fracture fixation of the femur following total hip arthroplasty: A review of biomechanical testing – Part II

Wang

Kenanidis

Miodownik

et al. 2019

Clinical Biomechanics

View full text Add to dashboard Cite

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.

show abstract

Use of Locking Plate and Strut Onlay Allografts for Periprosthetic Fracture Around Well-Fixed Femoral Components

Cited by 22 publications

References 32 publications

The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence

The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence

Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

Periprosthetic fracture fixation of the femur following total hip arthroplasty: A review of biomechanical testing – Part II

Contact Info

Product

Resources

About