Cement augmentation of the proximal femoral nail antirotation for the treatment of osteoporotic pertrochanteric fractures—A biomechanical cadaver study

Fensky, Florian; Nüchtern, Jakob; Kolb, Jan Philipp; Huber, S.; Rupprecht, Martin; Jauch, S.Y.; Sellenschloh, Kay; Püschel, Klaus; Morlock, Michael M.; Rueger, Johannes M.; Lehmann, Wolfgang

doi:10.1016/j.injury.2013.03.003

Cited by 65 publications

(45 citation statements)

References 28 publications

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“…Realistic test conditions for an elderly patient population were simulated using specimens with compromised structural bone quality. Unlike other biomechanical examinations of osteoporotic bones, in this experimental setup, failing specimens showed no significant difference in BMD as compared to surviving constructs (p = 0.467) [9]. A larger number of samples might have helped to reach statistical significance regarding this point.…”

Section: Load In Newton (N) Deformation In Milimeter (Mm)mentioning

confidence: 58%

Distal femoral fractures in the elderly: biomechanical analysis of a polyaxial angle-stable locking plate versus a retrograde intramedullary nail in a human cadaveric bone model

Bliemel

Buecking

Mueller

et al. 2014

Arch Orthop Trauma Surg

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Based on our results, no statements regarding the superiority of either of the devices can be made. Even though the load to failure values for both osteosyntheses were much higher than the loads experienced during normal walking; however, because only axial loading was applied, it remains unclear whether both osteosyntheses meet the estimated requirements for postoperative full weight-bearing for an average heavy patient with a distal femoral fracture.

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Section: Load In Newton (N) Deformation In Milimeter (Mm)mentioning

confidence: 58%

Distal femoral fractures in the elderly: biomechanical analysis of a polyaxial angle-stable locking plate versus a retrograde intramedullary nail in a human cadaveric bone model

Bliemel

Buecking

Mueller

et al. 2014

Arch Orthop Trauma Surg

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“…Even though the number of cycles needed to provoke failure of the constructs was not different among the three groups, the energy absorbed was greater in the cemented than in the transsacral group. Other biomechanical studies using cyclic loading protocols have shown comparable results with improved implant anchorage in osteoporotic bone in the distal radius [18], proximal humerus [35], the proximal [11] and distal femur [44], and the spine [9]. Grechenig et al [16] recently reported higher pullout forces of sacroiliac screws after cement augmentation, even though pullout strength may not be a well-chosen parameter for assessment of construct stability after pelvic fracture stabilization.…”

Section: Discussionmentioning

confidence: 99%

Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model

Osterhoff

Dodd

Unno

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Sacroiliac screw fixation in elderly patients with pelvic fractures is prone to failure owing to impaired bone quality. Cement augmentation has been proposed as a possible solution, because in other anatomic areas this has been shown to reduce screw loosening. However, to our knowledge, this has not been evaluated for sacroiliac screws. Questions/purposes We investigated the potential biomechanical benefit of cement augmentation of sacroiliac screw fixation in a cadaver model of osteoporotic bone, specifically with respect to screw loosening, construct survival, and fracture-site motion. Methods Standardized complete sacral ala fractures with intact posterior ligaments in combination with ipsilateral upper and lower pubic rami fractures were created in osteoporotic cadaver pelves and stabilized by three fixation techniques: sacroiliac (n = 5) with sacroiliac screws in S1 and S2, cemented (n = 5) with addition of cement augmentation, and transsacral (n = 5) with a single transsacral screw in S1. A cyclic loading protocol was applied with torque (1.5 Nm) and increasing axial force (250-750 N). Screw loosening, construct survival, and sacral fracture-site motion were measured by optoelectric motion tracking. A sample-size calculation revealed five samples per group to be required to achieve a power of 0.80 to detect 50% reduction in screw loosening. Results Screw motion in relation to the sacrum during loading with 250 N/1.5 Nm was not different among the three groups (sacroiliac: 1.2 mm, range, 0.6-1.9; cemented: 0.7 mm, range, 0.5-1.3; transsacral: 1.1 mm, range, 0.6-2.3) (p = 0.940). Screw subsidence was less in the cemented group (3.0 mm, range, 1.2-3.7) compared with the sacroiliac (5.7 mm, range, 4.7-10

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“…Ebenso zeigten biomechanische Untersuchungen eine höhere Belastbarkeit des zementaugmentierten PFNA zur Versorgung osteoporoseassoziierter AO31-A2.3-Frakturen gegenüber der nicht zementierten Kontrolle [6].…”

Section: Pfna-marknagelosteosyntheseunclassified

Augmentationstechnik am proximalen Femur

Neuerburg

Gosch

Blauth³

et al. 2015

Unfallchirurg

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In addition to the optimal surgical treatment, secondary prevention such as osteoporosis management to avoid further fractures is crucial in the treatment of these patients. This article is based on the current literature and provides an overview of the possible applications of cement augmentation for the treatment of proximal femoral fractures. In addition the surgical approach as well as previous scientific data on an established osteosynthesis using cement-augmented PFNA for the treatment of pertrochanteric frailty fractures are presented.

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Cement augmentation of the proximal femoral nail antirotation for the treatment of osteoporotic pertrochanteric fractures—A biomechanical cadaver study

Cited by 65 publications

References 28 publications

Distal femoral fractures in the elderly: biomechanical analysis of a polyaxial angle-stable locking plate versus a retrograde intramedullary nail in a human cadaveric bone model

Distal femoral fractures in the elderly: biomechanical analysis of a polyaxial angle-stable locking plate versus a retrograde intramedullary nail in a human cadaveric bone model

Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model

Augmentationstechnik am proximalen Femur

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