Biomechanical comparison of acetabular fracture fixation with stand-alone THA or in combination with plating

Abstract

Purpose A common surgical treatment in anterior column acetabular fractures with preexisting osteoarthritis is THA, which is commonly combined with plate osteosynthesis. Implantation of a solitary revision cup cranially fixed to the os ilium is less common. The purpose of this study was to compare the stabilization of anterior column acetabular fractures fixed with a cranial socket revision cup with flange and iliac peg or with a suprapectineal plate osteosynthesis combined with an additional revision cup. Methods In 20 human hemipelves, an anterior column fracture was stabilized by either a cranial socket revision cup with integrated flange (CF = Cup with Flange) or by a suprapectineal plate combined with a revision cup (CP = Cup and Plate). Each specimen was loaded under a stepwise increasing dynamic load protocol. Initial construct stiffness, interfragmentary movements along the fracture line, as well as femoral head movement in relation to the acetabulum were analyzed. Results Both groups showed comparable initial construct stiffness (CP: 3180 ± 1162 N/mm and CF: 3754 ± 668 N/mm; p = 0.158). At an applied load of 1400 N, interfragmentary movements at the acetabular (p = 0.139) and the supraacetabular region (p = 0.051) revealed comparable displacement for both groups and remained below 1 mm. Femoral head movement in relation to the acetabulum also remained below 1 mm for both test groups (p = 0.260). Conclusion From a biomechanical point of view, both surgical approaches showed comparable fracture reduction in terms of initial construct stiffness and interfragmentary movement. The potential benefit of the less-invasive cranial socket revision cup has to be further investigated in clinical studies.

Antegrade anterior column acetabulum fracture fixation with cannulated compression headless screws—A biomechanical study on standardized osteoporotic artificial bone

“…Biomechanical testing was performed on a servohydraulic material test system (Mini Bionix II 858; MTS Systems, Eden Prairie, MN, USA) equipped with a 4 kN load cell (HUPPERT 6, HUPPERT GmbH, Herrenberg, Germany). The setup was adopted from previous biomechanical studies investigating acetabulum fractures [ 19 ] ( Fig 2 ). Each hemi-pelvic was tested and aligned in an inverted upright standing position.…”

Managing periprosthetic fractures: perspectives on periprosthetic pelvic fractures

“…Case 1: A 68-year-old woman presented after a fall following a recent THA performed using a posterior approach. Images showed an isolated fracture of the posterior wall that was classified as a type The Unified Classification System of Periprosthetic Fractures [30]…”

“…The concept of the revision cup with flange and pelvic peg involves cranial fixation of the cup into the iliac bone, and containment or press-fit of the cup is not necessary. In a biomechanical study by Wenzl et al, [30] it was shown that the treatment of an anterior column fracture using a cranial socket revision cup with a flange and iliac peg provides the same biomechanical stability as anterior plate osteosynthesis and a revision cup. The advantage of the former surgical method is the single approach and minor surgical trauma.…”

Antegrade Posterior Column Acetabulum Fracture Screw Fixation via Posterior Approach: A Biomechanical Comparative Study

“…Biomechanical testing was run on a material test system (Mini Bionix II 8 Systems, Eden Prairie, MN, USA) equipped with a 4 kN load cell (HUPPERT 6, HU GmbH, Herrenberg, Germany). The setup was implemented from previous stud ure 2) [15]. Each hemi-pelvic specimen was tested in an inverted, upright standi tion, resting on a base plate inclined at 20° to the machine base in the frontal pla the symphyseal medial aspect and the sacroiliac joint were positioned flush with plate in accordance with Morosato et al [16].…”