Finite element analysis of double‐plate fixation using reversed locking compression‐distal femoral plates for Vancouver B1 periprosthetic femoral fractures

Abstract

Background Internal fixation is recommended for treating Vancouver B1 periprosthetic femoral fractures. Although several fixation procedures have been developed with high fixation stability and union rates, long-term weight-bearing constructs are still lacking. Therefore, the aim of the present study was to evaluate the stability of a double-plate procedure using reversed contralateral locking compression-distal femoral plates for fixation of Vancouver B1 periprosthetic femoral fractures under full weight-bearing. Methods Single- and double-plate fixation procedures for locking compression-distal femoral plates were analysed under an axial load of 1,500 N by finite element analysis and biomechanical loading tests. A vertical loading test was performed to the prosthetic head, and the displacements and strains were calculated based on load-displacement and load-strain curves generated by the static compression tests. Results The finite element analysis revealed that double-plate fixation significantly reduced stress concentration at the lateral plate place on the fracture site. Under full weight-bearing, the maximum von Mises stress in the lateral plate was 268 MPa. On the other hand, the maximum stress in the single-plating method occurred at the defect level of the femur with a maximum stress value of 1,303 MPa. The principal strains of single- and double-plate fixation were 0.63 % and 0.058 %, respectively. Consistently, in the axial loading test, the strain values at a 1,500 N loading of the single- and double-plate fixation methods were 1,274.60 ± 11.53 and 317.33 ± 8.03 (× 10− 6), respectively. Conclusions The present study suggests that dual-plate fixation with reversed locking compression-distal femoral plates may be an excellent treatment procedure for patients with Vancouver B1 fractures, allowing for full weight-bearing in the early postoperative period.

Use of the Locking Attachment Plate for Internal Fixation of Periprosthetic Femur Fractures

“…This is a frequent location of implant failure and/ or nonunion after the treatment of Vancouver B1 fractures and therefore authors concluded double plating a potential solution for such fractures. 17 An additional biomechanical study comparing the use of a LCP/LAP construct to double plating with lateral and anterior plates demonstrated significantly superior values in axial stiffness and cycles to failure for the double plate construct. 18 A review article of double-plating outcomes reported from 5 studies of PPFFx reported that healing was achieved in 85/96 (88.5%) cases with an overall complication rate of 21.9%.…”

A Rare Case of Open 3A VTB2W Periprosthetic Fracture around a Total Hip Arthroplasty

“…Double plating for PPF has been shown to provide superior outcomes in terms of union, functional outcomes, and lower complication rates [ 22 ]. It allows immediate post-operative full weight-bearing after ORIF post-PPF [ 23 ]. In a biomechanical study, double plating was shown to increase stiffness, stability, and the number of cycles to failure was significantly higher than a single plate [ 24 ].…”

Identification of screw spacing on pediatric hip locking plate in proximal femoral osteotomy

“…Coquim et al evaluated the biomechanical performance of a metal plate and bone strut in correcting stubborn nonunions of mid-shaft segmental femur defects, which had not previously been systematically performed [ 19 ]. Takahashi et al investigated the stability of a double-plate technique employing reversed contralateral locked compression-distal femoral plates for periprosthetic femoral fracture repairs while bearing full weight [ 20 ]. Samsami et al proposed cannulated screws, dynamic hip screws with derotational screws, and proximal femoral locking plates as the most stable fixation for vertical femoral fractures [ 21 ].…”