Biomechanical comparison of locked plating and spiral blade retrograde nailing of supracondylar femur fractures

Assari, Soroush; Kaufmann, Alan; Darvish, Kurosh; Park, Jung; Haw, Jonathan; Safadi, Fayez F.; Rehman, Saqib

doi:10.1016/j.injury.2013.04.016

Cited by 22 publications

(21 citation statements)

References 19 publications

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“…2,[6][7][8] Although distal femur replacing total knee replacement, angled blade plates, and other methods have been successfully used to treat distal femur fractures in the elderly patients, locked plating and intramedullary nailing remain the current standards of operative care. [9][10][11][12] Nevertheless, high rates of complications and mortalities continue to be reported in all methods of internal fixation for distal femur fractures in the elderly patients. 1,2,8,13 Although multiple studies have assessed the biomechanical properties, functional scores, and complication rates of surgical treatment for distal femur fractures in the elderly patients, few studies have investigated the patient's quality of life.…”

Section: Introductionmentioning

confidence: 99%

Do Elderly Patients Fare Worse Following Operative Treatment of Distal Femur Fractures Using Modern Techniques?

Shulman

Patsalos-Fox

Lopez

et al. 2014

Geriatr Orthop Surg Rehabil

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Background: The purpose of this study was to compare the functional outcomes and quality of life of older and younger patients with similarly treated distal femur fractures. Methods: We conducted an assessment of 57 patients who sustained distal femur fractures (Orthopaedic Trauma Association Type 33B, C) and underwent surgical treatment at our academic medical center. Patients were divided into 2 groups for analysis: an elderly cohort of patients aged 65 or older and a comparison cohort of patients younger than age of 65. A retrospective review of demographics, preoperative ambulatory status, radiographic data, and physical examination data was collected from the medical records. Follow-up functional data were collected via telephone at a mean of 2.5 years (range 6 months-8 years) using a Short Musculoskeletal Functional Assessment (SMFA). All patients underwent standard operative treatment of either nail or plate fixation. Results: There was no statistical difference in gender, fracture type, surgical technique, surgeon, or institution where the surgery was performed. The percentage of patients with healed fractures at 6-months follow-up was not significantly different between the cohorts. The elderly cohort had slightly worse knee range of motion at 3, 6, and 12 months postoperatively but there was not a statistically significant difference between the groups. The SMFA Daily Activity, Functional, and Bother indices were significantly worse in the older cohort (P < .01, P ¼ .01, P ¼ .02, respectively). However, there was no significant difference in the SMFA Emotional or Mobility indices. Conclusion: Despite lower quality of life and functional scores, this study suggests that relatively good clinical outcomes can be achieved with surgical fixation of distal femoral fractures in the elderly patients. Age should not be used as a determinate in deciding against operative treatment of distal femur fractures in the elderly patients.

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Section: Introductionmentioning

confidence: 99%

Do Elderly Patients Fare Worse Following Operative Treatment of Distal Femur Fractures Using Modern Techniques?

Shulman

Patsalos-Fox

Lopez

et al. 2014

Geriatr Orthop Surg Rehabil

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“…In our study, to simulate the real‐life situation, we chose to use anti‐corrosion cadaver bone instead of artificial bone. As a well‐established modeling technique for biomechanical study of the distal femur, a 1‐cm transverse osteotomy was created 6 cm from the intercondylar fossa. Generally, this kind of absolute bone defect is rarely encountered in the clinic, and fracture fragments fill the gap, so the stress stiffness of the implants inside the body would be greater than that in our biomechanical study.…”

Section: Discussionmentioning

confidence: 96%

Comparison of Less Invasive Stabilization System Plate and Retrograde Intramedullary Nail in the Fixation of Femoral Supracondylar Fractures in the Elderly: A Biomechanical Study

Wang³

et al. 2019

Orthopaedic Surgery

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Objective To compare the biomechanical stabilities of less invasive stabilization system (LISS) plate and retrograde intramedullary nail (IMN) for the comminuted femoral supracondylar fracture fractures in the elderly. Methods Sixteen pairs of embalmed cadaver femurs were obtained to simulate a comminuted supracondylar femur fracture (AO/OTA33‐A3) gap model. All left‐side specimens were fixed with LISS plate, and retrograde IMN were applied to the right‐side specimens. All specimens were tested in torsional, axial and cyclic load mode on an Instron testing machine. Results The mean torsional stiffness for LISS plate group was 34.1% greater than retrograde IMN group (2.90 vs. 1.91 Nm/degree, P = 0.002), but the mean axial stiffness was greater for the retrograde IMN (199.16 vs. 303.93 N/mm, P < 0.001). The total deformation of LISS plate caused by cyclic axial loading was greater than retrograde IMN (4.17 vs. 3.57 mm, P = 0.014). Significantly less mean irreversible deformation was detected in LISS plate than in retrograde IMN (1.64 vs. 1.69 mm, P = 0.699). Failure loads of the constructs were significantly different between the two groups (LISS plate: 2941±128 N; retrograde IMN: 4022±176 N, P < 0.001). Conclusion For comminuted femoral supracondylar fractures in the elderly, the tested instruments can both maintain sufficient biomechanical stabilities, but retrograde IMN is superior to LISS plate in deformation of fracture site.

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“…1,2 Internal fixation needs to provide enough rigidity, compression, and have adequate durability (fatigue life) to promote bone healing. 2,3 Intramedullary rods are implanted along the axis of the center of mass and provide better durability than plates, but are not as rigid.…”

Section: Introductionmentioning

confidence: 99%

“…The differences between these two fixation methods have different biomechanical and clinical outcome considerations. [1][2][3][4][5] Intramedullary rods have become the preferred clinical choice for femoral shaft non-union. 2,3 A rod with improved durability might be useful for situations with prolonged healing such as bulk allografts, and severe bone defects as is seen with high-energy trauma and metastatic bone disease.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8][9][10]14 In both models, previous biomechanical testing of plates and intramedullary rods provided a suitable predicate. 1,4,5,10,[12][13][14][15][16][17][18][19][20] An osteotomy model was chosen for both models because of the biomechanical demand such a defect places on a fixation system. 5 Understanding the biomechanical performance of these two implant systems could be beneficial in directing clinical decisions when the two systems might be considered for the same indication.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Biomechanical Comparison of a Novel Expandable Photodynamic Intramedullary System to a Metal Plate and Screw System in Humerus and Femur Osteotomy Models

Johnston

Biercevicz²,

Koruprolu³

et al. 2016

Orthop Res Traumatol Open J

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Biomechanical comparison of locked plating and spiral blade retrograde nailing of supracondylar femur fractures

Abstract: The RAFN constructs experienced greater subsidence and reduced axial stiffness compared to the LCP constructs. In Low BMD specimens, the RAFN constructs had a higher risk of failure.

Cited by 22 publications

References 19 publications

Do Elderly Patients Fare Worse Following Operative Treatment of Distal Femur Fractures Using Modern Techniques?

Do Elderly Patients Fare Worse Following Operative Treatment of Distal Femur Fractures Using Modern Techniques?

Comparison of Less Invasive Stabilization System Plate and Retrograde Intramedullary Nail in the Fixation of Femoral Supracondylar Fractures in the Elderly: A Biomechanical Study

A Biomechanical Comparison of a Novel Expandable Photodynamic Intramedullary System to a Metal Plate and Screw System in Humerus and Femur Osteotomy Models

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