Do Transcortical Screws in a Locking Plate Construct Improve the Stiffness in the Fixation of Vancouver B1 Periprosthetic Femur Fractures? A Biomechanical Analysis of 2 Different Plating Constructs

Lochab, Jasjit; Carrothers, Andrew; Wong, E.; McLachlin, Stewart D.; Aldebeyan, Wassim; Jenkinson, Richard; Whyne, Cari; Nousiainen, Markku

doi:10.1097/bot.0000000000000704

Cited by 15 publications

(20 citation statements)

References 25 publications

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“…Median surgical time seems higher for patients treated with RA, although only a trend toward significance can be seen (P ¼ .051). Median time of hospital stay was similar in both groups with 16 days (IQR: [12][13][14][15][16][17][18][19][20][21][22] in the LCP group compared to 15 days (IQR: [12][13][14][15][16][17][18][19][20][21][22] in the RA group (P ¼ .621). A total of 19 of 24 patients in the LCP group versus 24 of 35 patients in the RA group received blood units (P ¼ .548).…”

Section: Surgical Time Blood Transfusion Hospital Stay and Time Tomentioning

confidence: 85%

“…8,11,12 According to the Vancouver algorithm, open reduction and internal fixation (ORIF) using LCP is a widely accepted and established treatment option for VTB1 fractures. 13,14 For the more technically challenging VTB2 fractures, RA with a long stem that bypasses the fracture remains the recommended procedure. 15,16 However, ORIF using LCP is a less complex and a less invasive procedure, especially in the management of polymorbid elderly patients.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Periprosthetic Femoral Fractures Vancouver Type B2: Revision Arthroplasty Versus Open Reduction and Internal Fixation With Locking Compression Plate

Baum

Leimbacher

Kriechling

et al. 2019

Geriatr Orthop Surg Rehabil

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Introduction:The Vancouver algorithm recommends revision arthroplasty (RA) for Vancouver type B2 (VTB2) fractures. However, open reduction and internal fixation (ORIF) using locking compression plates (LCP) may be a valid and less invasive alternative treatment.Materials and Methods:Between January 2007 and March 2017, we retrospectively recruited all patients treated with either ORIF with LCP or RA for VTB2 fractures in our clinic. All of the following were reviewed: the length of hospital stay, the operating time, the need for blood transfusions during and/or after surgery, implant-related and patient-related complications, need for revision surgery, and the radiological outcome. Additionally, the functional outcome was investigated.Results:Fifty-nine patients were recruited. Thirty-five (59.3%) patients underwent RA, while 24 (40.7%) patients received ORIF with LCP. The median surgical time was 137.50 minutes in the LCP group compared to 160.00 minutes in the RA group ( P = .051). Three (12.5%) patients in the LCP group and 10 (28.6%) patients in the RA group experienced an implant-associated complication ( P = .131). Patient-related complications occurred in 3 (12.5%) patients in the LCP group versus 6 (17.1%) patients in the RA group ( P = .628). The mean preoperative Parker mobility score was 9 points in both groups and decreased in both groups to a mean of 5 points in the LCP and 7 points in the RA group.Discussion:Open reduction and internal fixation with LCP seems to be a less invasive procedure for VTB2 fractures in comparison to RA. It is a bone-sparing procedure that can be advantageous for further revision operations. Moreover, some fractures can only be anatomically reduced by ORIF with LCP, whereas for proximal fractures with a radiologically unambiguously loosened stem RA might be advantageous.Conclusion:In line with previously published studies, our data suggest that ORIF using LCP is a valid treatment option for VTB2 fractures.

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Section: Surgical Time Blood Transfusion Hospital Stay and Time Tomentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Treatment of Periprosthetic Femoral Fractures Vancouver Type B2: Revision Arthroplasty Versus Open Reduction and Internal Fixation With Locking Compression Plate

Baum

Leimbacher

Kriechling

et al. 2019

Geriatr Orthop Surg Rehabil

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“…The classification of type B fractures depends on the status of the prosthesis: in type B1, the prosthesis is well-fixed, whereas in type B2, the prosthesis is loose, and in type B3, the prosthesis is loose with the addition of poor bone stock [98]. Type B fractures are reported to make up approximately 75% of all cases [99,100].…”

Section: Periprosthetic Fracturesmentioning

confidence: 99%

Biomechanics of Osteoporotic Fracture Fixation

Hollensteiner

Sandriesser

Bliven

et al. 2019

Curr Osteoporos Rep

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Purpose of Review Fractures of osteoporotic bone in elderly individuals need special attention. This manuscript reviews the current strategies to provide sufficient fracture fixation stability with a particular focus on fractures that frequently occur in elderly individuals with osteoporosis and require full load-bearing capacity, i.e., pelvis, hip, ankle, and peri-implant fractures. Recent Findings Elderly individuals benefit immensely from immediate mobilization after fracture and thus require stable fracture fixation that allows immediate post-operative weight-bearing. However, osteoporotic bone has decreased holding capacity for metallic implants and is thus associated with a considerable fracture fixation failure rate both short term and long term. Modern implant technologies with dedicated modifications provide sufficient mechanical stability to allow immediate weight-bearing for elderly individuals. Depending on fracture location and fracture severity, various options are available to reinforce or augment standard fracture fixation systems. Summary Correct application of the basic principles of fracture fixation and the use of modern implant technologies enables mechanically stable fracture fixation that allows early weight-bearing and results in timely fracture healing even in patients with osteoporosis.

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“…In previous studies (Moazen et al, 2011), only 500 N could be seen used repeatedly for non-destructive monotonic tests; in present studies, loads of 700 N (Choi et al, 2010;Graham et al, 2015) to 2500 N (Pletka et al, 2011) have been used. A loading mode not seen in previous papers is fourpoint bending (Lenz et al, 2016a(Lenz et al, , 2016bLever et al, 2010;Lochab et al, 2017) and in one case three-point bending (Choi et al, 2010); examples of these can be seen in Fig. 1.…”

Section: Representation Of Loads and Surrounding Conditionsmentioning

confidence: 80%

“…Fractures classified as Type A are fractures involving the trochanteric area. The majority (approximately 75%, − Lochab et al, 2017;Lever et al, 2010) of PFF, however, are Type B; located around and just distal to the tip of the stem, and are subdivided as B1 with the stem stable and good bone stock, B2 with the stem unstable and good bone stock, and B3 with stem unstable and significant bone loss. Type C are fractures located distal to the stem (Capone et al, 2017;Leonidou et al, 2013;Tsiridis et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Periprosthetic fracture fixation of the femur following total hip arthroplasty: A review of biomechanical testing – Part II

Wang

Kenanidis

Miodownik

et al. 2019

Clinical Biomechanics

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Background: Periprosthetic femoral fracture is a severe complication of total hip arthroplasty. A previous review published in 2011 summarised the biomechanical studies regarding periprosthetic femoral fracture and its fixation techniques. Since then, there have been several commercially available fracture plates designed specifically for the treatment of these fractures. However, several clinical studies still report failure of fixation treatments used for these fractures. Methods: The current literature on biomechanical models of periprosthetic femoral fracture fixation since 2010 to present is reviewed. The methodologies involved in the experimental and computational studies of periprosthetic femoral fracture fixation are described and compared with particular focus on the recent developments. Findings: Several issues raised in the previous review paper have been addressed by current studies; such as validating computational results with experimental data. Current experimental studies are more sophisticated in design. Computational studies have been useful in studying fixation methods or conditions (such as bone healing) that are difficult to study in vivo or in vitro. However, a few issues still remain and are highlighted. Interpretation: The increased use of computational studies in investigating periprosthetic femoral fracture fixation techniques has proven valuable. Existing protocols for testing periprosthetic femoral fracture fixation need to be standardised in order to make more direct and conclusive comparisons between studies. A consensus on the 'optimum' treatment method for periprosthetic femoral fracture fixation needs to be achieved.

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Do Transcortical Screws in a Locking Plate Construct Improve the Stiffness in the Fixation of Vancouver B1 Periprosthetic Femur Fractures? A Biomechanical Analysis of 2 Different Plating Constructs

Cited by 15 publications

References 25 publications

Treatment of Periprosthetic Femoral Fractures Vancouver Type B2: Revision Arthroplasty Versus Open Reduction and Internal Fixation With Locking Compression Plate

Treatment of Periprosthetic Femoral Fractures Vancouver Type B2: Revision Arthroplasty Versus Open Reduction and Internal Fixation With Locking Compression Plate

Biomechanics of Osteoporotic Fracture Fixation

Periprosthetic fracture fixation of the femur following total hip arthroplasty: A review of biomechanical testing – Part II

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