Additional fixation of medial plate over the unstable lateral locked plating of distal femur fractures: A biomechanical study

Park, Kyeong-Hyeon; Park, Il-Hyung; Kim, Joon‐Woo; Lee, Jin-Han; Kim, Hee-June

doi:10.1016/j.injury.2019.06.032

Cited by 52 publications

(37 citation statements)

References 30 publications

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“…However, when we tested the flexural resistance, no significant differences were observed, and although without significant statistical changes, there was an increase in the resistance of the plate with the new conformation obtained by molding [5]. Another important observation, in contrast to the literature, we noticed that this plate had higher resistance and a lower stiffness than the compression plate and the polyaxial locking plate [5,7].…”

Section: Discussioncontrasting

confidence: 62%

“…Orthopedic implants are commonly used for different types of surgical procedures to gain optimal function and to provide stability to both born and tendon structures [3,7]. When inserting these implants, the characteristics of the material are important for surgical success, and the ideal implant must be biocompatible, nontoxic, noncarcinogenic, nonpyrogenic and nonallergenic [1,6].…”

Section: Introductionmentioning

confidence: 99%

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Femoral Orthopedic Implants in Dogs with Titanium - Mechanical Evaluation

Souza¹,

Morales²,

Denevitz³

et al. 2022

Acta Scientiae. Vet.

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Background: Orthopedic implants are commonly used for different types of surgical procedures to gain optimal function and to provide stability to both bones and tendon structures. When inserting these implants, the characteristics of the material are important for surgical success, and the ideal implant must be biocompatible and nonallergenic. However, when molding an implant to the bone structure, its resistance can change significantly. Implants can be temporary or permanent in the body, and metal possesses properties that make it acceptable for bone repair. In biomedical implants, 2 types are most common, commercially pure (CP)-Ti and Ti-6A1-4V. They both provide stable fixation and low risk of loosening. Implants made with the same material and composition can perform differently if the material has been altered by processing techniques for different scenarios. Stress, strain and elastic modulus are the primary metrics used in the description of implant materials. They can be calculated based on mechanical tests of specimens with defined geometry, most commonly tensile, bending and torsional tests. In order to better evaluate those changes, we compared the mechanical characteristics of titanium bone plates, before and after they were molded to the bone, to verify and quantify the loss of stiffness and resistance after molding the plate.Materials, Methods & Results: The study was prospective. Orthopedic implant made of commercially pure titanium (CP-Ti) were divided into 2 groups, one group without plate molding and the other with plate molding to a dog femora bone. Thirty-six plates of different sizes (5.0, 6.5, 8.0, 9.0, 10.0 and 11.0-mm diameter) were divided into 6 groups containing 6 plates of each size and submitted to the 4-point flexion test of resistance, using a piece of dog femur (weights of 5, 10, 15, 20 and 25 kg) as the bone in which the molding was performed. The evaluations were tabulated and analyzed using the program GraphPad Prism version 5.0. Corrections of the normal distribution curve were made using the Bartlett test. After the corrections, one-way analysis of variance (ANOVA) was performed with P < 0.05. Assessments were made within the group and between groups. Subsequently, the Newman-Keuls test was performed, adopting P < 0.05. For analyses in 2 groups, Student's t-test was performed as a post-test, also with P < 0.05. When the plates were compared between equal sizes of groups 1 and 2, the non-molded plate group (G1) obtained the best results in the flexural stiffness and structural flexion tests. However, in the flexural resistance test, most plates obtained similar results and the plates with diameters of 8 mm, 9 mm and 10 mm of the molded plate group (G2) obtained the best results.Discussion: Our results show that the implants had adequate mechanical characteristics, but the unmolded plates had greater flexural and structural stiffness than the molded plates. This difference was significant, thus demonstrating a large loss of stiffness in relation to the original conformation. However, when we tested the flexural resistance, no significant differences were observed, and although without significant statistical changes, there was an increase in the resistance of the plate with the new conformation obtained by molding. In the results of the mechanical tests, we observed that after the molding, the implants gained greater resistance, although the difference was not statistically significant. This suggests that the architecture of the implants should have slight curvature in the medial direction of the bone, since this would lead to a better adaptation to the anatomy of the bone, and possibly greater resistance, as indicated by the new configuration after molding.Keywords: bone implants, titanium, orthopedic implants, femur, dogs.

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Section: Discussioncontrasting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Femoral Orthopedic Implants in Dogs with Titanium - Mechanical Evaluation

Souza¹,

Morales²,

Denevitz³

et al. 2022

Acta Scientiae. Vet.

View full text Add to dashboard Cite

show abstract

“…Studies demonstrated that adding a medial plate after lateral plating led to good radiological and clinical results (6,23). The biomechanical study proved that the medial plate opposed varus stress of the lower limb, shared part of stresses from the lateral plating (20), and thus increased the fracture stability (18). Rollick et al (24) reported that an addition of a plate to the medial side of the distal femur after a laterally based plate did not further influence the vascularization of the femur.…”

Section: Discussionmentioning

confidence: 99%

“…In type C fractures, the distance from the lower border of the fracture line hot zone to the joint line was approximately 5 cm, and the perpendicular length of the hot zone was about 4 cm. Although the distance of the hot zone measured on the femur template can only be used as a reference, osteotomy gaps created in the former studies (18)(19)(20)(21)(22) were not long enough to accurately simulate the fracture morphology, which may underpower the results drawn from those studies. According to the scale of the template model, we suggest that for type A fracture model, the osteotomy gap should be made approximately 4 cm and the supracondylar osteotomy at 4 cm proximal to the joint line.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional computed tomography mapping and analysis of distal femur fractures (AO/OTA types 33A, 33B, and 33C)

Li¹,

Zhuge²,

Zhan³

et al. 2022

Ann Transl Med

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Background: Distal femur fractures are complex injuries with a high rate of fracture healing problems.Since the widespread of computed tomographic imaging in the diagnosis of distal femur fractures, many fracture characteristics have been discovered. This study aimed to depict the location and frequency of distal femur fracture lines and further analyze the morphological characteristics using the 3-dimensional computed tomography (CT) mapping technique, thus providing more information to solve this challenging clinical problem.Methods: In total, 217 distal femur fractures in 216 patients were retrospectively reviewed. Fracture fragments on CT were digitally reconstructed and virtually reduced to match a template model. The contour of every fracture fragment was then marked with smooth curves, and the overlap of all fracture lines allowed for the creation of 3-dimensional fracture maps and heat maps. Fracture characteristics were summarized based on these maps.Results: This study included 114 left knee injuries, 101 right knee injuries, and 1 case with bilateral injury.Distal femur fractures were most likely to occur among patients aged 61 to 70 years. On the heat map of all 217 fractures, fracture line hot zones were mainly concentrated around the metaphysis, the lateral part of the intercondylar notch, and the patellofemoral joint. Distal femur fractures with three Arbeitsgemeinschaft für Osteosynthesefragen Foundation/Orthopaedic Trauma Association (AO/OTA) types demonstrated distinct fracture characteristics. In total, there were 58 coronal plane fractures (41.1%) in 141 intercondylar fractures. Conclusions:The intercondylar fracture patterns in AO/OTA type B and type C fractures were similar, while the supracondylar characteristics in AO/OTA type A and type C were different. The findings in this study can help orthopaedic surgeons better understand the fracture morphology on the basis of AO/OTA classification. Further studies are needed to establish a standard biomechanical fracture model and new fixation strategy for better clinical outcomes.

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“…A persistent medial cortical gap leads to inadequate support with progressive varus malalignment resulting in collapse and hardware failure [8][9][10]. Literature suggests salvage with addition of a medial plate if single lateral plating is insufficient, but there is no consensus on which plate type to use [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Modified use of the proximal humeral internal locking system (PHILOS) plate for distal femoral nonunions

Poelmann

Kloen

2022

Eur J Orthop Surg Traumatol

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Purpose Nonunion is a common complication after a distal femoral fracture (DFF). Standard treatment consists of revision plating and/or bone grafting. Single lateral plating for a distal femoral nonunion can be insufficient in case of a persistent medial gap and compromised bone stock. Alternatively, dual plating can be used to treat a distal femoral nonunion, but to date there is no Gold standard. The aim of our study was to report our results after use of a minimally invasively placed proximal humeral internal locking system (Philos) plate as a medial buttress in the treatment of a distal femoral nonunion. Methods Fifteen adult patients with a distal femoral nonunion were prospectively entered in a trauma database and retrospectively assessed. All patients underwent a similar operation, which included removal of failed hardware, nonunion debridement, fixation with a lateral plate, and a medial Philos plate combined with bone grafting. Data collected included union rate, time to union, complications and functional outcome. Results In twelve out of fifteen patients (80%), the fracture united after our index operation. Median time to union was 4.8 months (range 1.6–15). Three patients (20%) needed additional bone grafting surgery. One patient underwent a Judet quadricepsplasty. Conclusion This study suggests that the Philos plate is a safe and effective adjunct as a medial buttress plate for distal femoral nonunions.

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Additional fixation of medial plate over the unstable lateral locked plating of distal femur fractures: A biomechanical study

Cited by 52 publications

References 30 publications

Femoral Orthopedic Implants in Dogs with Titanium - Mechanical Evaluation

Femoral Orthopedic Implants in Dogs with Titanium - Mechanical Evaluation

Three-dimensional computed tomography mapping and analysis of distal femur fractures (AO/OTA types 33A, 33B, and 33C)

Modified use of the proximal humeral internal locking system (PHILOS) plate for distal femoral nonunions

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