A Biomechanical Comparison of Periprosthetic Femoral Fracture Fixation in Normal and Osteoporotic Cadaveric Bone

Demos, Harry A.; Briones, Marcus S.; White, H. Peter; Hogan, Kathleen A.; Barfield, William R.

doi:10.1016/j.arth.2011.08.019

Cited by 42 publications

(33 citation statements)

References 25 publications

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“…Numerous biomechanical studies investigated different techniques of periprosthetic fracture fixation [7][8][9][10][11][12], although as yet, not all types of these fractures or fixation methods have been comprehensively evaluated and new tools for fixation are on the way.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical comparison of two angular stable plate constructions for periprosthetic femur fracture fixation

Wähnert

Schröder

Schulze

et al. 2013

International Orthopaedics (SICOT)

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Purpose Fractures of the femur associated with total hip arthroplasty are a significant concern in orthopaedic and trauma surgery. However, little is known about the different biomechanical properties of internal fixation systems in combination with periprosthetic fractures. In this study two new internal fixation systems for periprosthetic fractures are investigated using a cadaver fracture model simulating a Vancouver B1 periprosthetic femur fracture. Methods Nine pairs of fresh-frozen cadaver femurs were scanned by dual X-ray absorptiometry. Cementless total hip prostheses were implanted and a periprosthetic femur fracture was simulated. Fractures were randomly fixed either with the fixed angle locking attachment plate (LAP®, Depuy Synthes®, Solothurn, Switzerland) or the variable angle noncontact bridging plate (NCB®, Zimmer GmbH, Winterthur, Switzerland). Each construct was cyclically loaded to failure in axial compression. Results Axial stiffness and cycles to failure were significantly higher in the NCB group. Both systems were able to be fixed well around the femoral stem. Conclusion The two different internal fixation systems for periprosthetic fractures differed significantly in our setup. The non-contact bridging plate system revealed significantly higher failure load and may be the preferred option where high stability and load capacity is needed right after operation.

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Section: Introductionmentioning

confidence: 99%

Biomechanical comparison of two angular stable plate constructions for periprosthetic femur fracture fixation

Wähnert

Schröder

Schulze

et al. 2013

International Orthopaedics (SICOT)

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show abstract

“…A second cut was applied with a 45°angle from the medial cortex of the proximal fragment downwards to the centre of the shaft in order to avoid cortical support on the medial side during testing (simulation of comminuted fracture pattern Vancouver type B1, Fig. 1b) [17]. A gap of 10 mm was created and fracture fixation was performed using a left 13-hole NCB-DF (324 mm; Zimmer, Winterthur, Switzerland; Fig.…”

Section: Surgical Techniquementioning

confidence: 99%

“…The 20 samples were randomly assigned to one of two groups. In both groups distal fixation was performed using five 5-mm bicortical locking screws, according to recommendations published elsewhere [17]. The groups differed in their proximal fixation:…”

Section: Surgical Techniquementioning

confidence: 99%

“…Biomechanical studies investigated the stability of the different fixation options and concluded that stand-alone cerclage wires are insufficient [7,16,17]. Furthermore, monocortical screw application has been shown to be superior to cerclage techniques [10,16,17]. However, hardware failure remains one of the most abundant complications following osteosynthetic reconstruction of PPF [18,19].…”

Section: Introductionmentioning

confidence: 96%

“…locking attachment plate; Synthes, Umkirch, Germany) or combinations have been described in order to achieve a stable fixation next to the prosthetic stem [7,14,15]. Biomechanical studies investigated the stability of the different fixation options and concluded that stand-alone cerclage wires are insufficient [7,16,17]. Furthermore, monocortical screw application has been shown to be superior to cerclage techniques [10,16,17].…”

Section: Introductionmentioning

confidence: 96%

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Bicortical screw fixation provides superior biomechanical stability but devastating failure modes in periprosthetic femur fracture care using locking plates

Gwinner

Märdian

Dröge

et al. 2015

International Orthopaedics (SICOT)

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Cementless femoral stem revision in total hip arthroplasty: The periprosthetic clamshell fracture. A biomechanical investigation

Kastner

Gueorguiev

Richards

et al. 2022

Journal Orthopaedic Research

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To biomechanically evaluate the stability of a diaphyseal anchored, cementless stem in presence of a proximal periprosthetic femoral medial wall defect compared to the stability of the same stem in an intact femur. Twenty-two paired human cadaveric femora were pairwise assigned either to a fracture group, featuring a proximal medial wall defect involving 40% of the stems medial anchorage distance, or a control group with native specimens. The specimens were tested under a monotonically increasing cyclic axial loading protocol. Load, cycles, and multiples of the respective body weight at implant loosening was measured. Mean initial stiffness was 2243.9 ± 467.9 N/mm for the intact group and 2190.1 ± 474.8 N/mm for the fracture group. Mean load to loosening in the intact group was 3210.5 ± 1073.2 N and 2543.6 ± 576.4 N in the fracture group, with statistical significance. Mean cycles to loosening in the intact group were 27104.9 ± 10731.7 and 20431.5 ± 5763.7 in the fracture group, with statistical significance. Mean multiples of the resulting body weight at loosening in the intact group was 548.3 ± 158.5% and 441.4 ± 104% in the fracture group, with statistical significance. A medial wall defect involving 40% of the medial anchorage distance significantly decreases the axial stability of a diaphyseal anchored stem. However, mechanical failure occurred beyond physiological stress. At loosening rates of about 4 multiples of the body weight in the fracture group, a "safe zone" remains of a 0.5-fold body weight for maximum loads and twofold body weights for average loads.

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A Biomechanical Comparison of Periprosthetic Femoral Fracture Fixation in Normal and Osteoporotic Cadaveric Bone

Cited by 42 publications

References 25 publications

Biomechanical comparison of two angular stable plate constructions for periprosthetic femur fracture fixation

Biomechanical comparison of two angular stable plate constructions for periprosthetic femur fracture fixation

Bicortical screw fixation provides superior biomechanical stability but devastating failure modes in periprosthetic femur fracture care using locking plates

Cementless femoral stem revision in total hip arthroplasty: The periprosthetic clamshell fracture. A biomechanical investigation

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