Implant Material, Type of Fixation at the Shaft, and Position of Plate Modify Biomechanics of Distal Femur Plate Osteosynthesis

Kandemir, Utku; Augat, Peter; Konowalczyk, Stefanie; Wipf, Felix; Oldenburg, Geert von; Schmidt, Ulf

doi:10.1097/bot.0000000000000860

Cited by 38 publications

(24 citation statements)

References 41 publications

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“…Creating appropriate fracture site strain environments conducive to bone healing in comminuted distal femoral fractures can be difficult and relies on many factors, including plate length, screw and plate characteristics, and fracture morphology 1 . The ideal diaphyseal screw type, working length, and construct configuration for distal femoral locking plates remain unknown despite ample literature on the biomechanical properties of distal femoral plate constructs varying in plate material, plate and working lengths, diaphyseal screw type used, and plate distance from bone 1‐21 . Many surgeons advocate for long plate constructs when using nonlocking or locking screws in the diaphysis in an attempt to distribute strain over a greater working length and avoid condensing the strain at the fracture site 19 …”

Section: Introductionmentioning

confidence: 99%

Biomechanical comparison of distal femoral fracture fixation: Analysis of non‐locked, locked, and far‐cortical locked constructs

Riedel

Oppizzi

O’Hara

et al. 2020

Journal Orthopaedic Research

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To assess whether far‐cortical locking (FCL) screws alter the fracture site strain environment and allow shorter bridge plate constructs for supracondylar femoral fractures, we tested the fracture site displacement under force of synthetic left femora with a 5‐cm metaphyseal fracture gap, modeling comminution. Five models of nine constructs were tested (three types of diaphyseal screws [nonlocking, locking, and FCL] and two plate lengths [13 holes and 5 holes]). Long plate models using three or four diaphyseal screws (working length 13.5 or 7.5 cm, respectively) were compared with short plates with three diaphyseal screws (working length 7.5 cm). Models were loaded axially and torsionally; 100 cycles in random order. Primary outcome measures were axial and torsional fracture site stiffness. FCL screws decreased rotational stiffness 19% (P < .01) compared with baseline nonlocking screws in the same plate and working length construct, mirroring the effect (20% decrease in stiffness, P < .01) of nearly doubling the nonlocking construct working length (7.5‐13.5 cm). Similarly, FCL screws decreased axial stiffness 23% (P < .01) in the same baseline comparison. Fracture site displacement under loading comparable to a long working length nonlocked plate construct was achieved using a shorter FCL plate construct. By closely replicating the biomechanical properties of a long plate construct, a fracture site strain environment considered favorable in promoting fracture healing might still be achievable using a shorter plate length. Clinical Significance: It might be possible to optimize fracture site strain environment and displacement under loading using shorter FCL plate constructs. Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 00:00–00, 2020.

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Section: Introductionmentioning

confidence: 99%

Biomechanical comparison of distal femoral fracture fixation: Analysis of non‐locked, locked, and far‐cortical locked constructs

Riedel

Oppizzi

O’Hara

et al. 2020

Journal Orthopaedic Research

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“…However, excessive interfragmentary motion may lead to the hypertrophy-induced nonunion of a fracture, and too little interfragmentary motion may cause bone atrophy [ 11 ]. Although the ideal stiffness and motion cannot be determined, overall structural stiffness can be modified by choosing different implants, screw types, and positions of the screw or plate [ 12 , 13 ]. When the stability is too high (in other words, the strain is too low), it may result in nonunion [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Micromotion-based balanced drilling technology to increase near cortical strain

et al. 2022

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Objective A micromotion-based balanced drilling system was designed based on a locking plate (LP) and far cortical locking (FCL) concept to maintain the balance of micromotions of the cortex on both sides of a fracture region. The system was tested by axial compression test. Methods The fracture gap was set to 2 cm, and locking screws with a diameter of 5 mm and a locking plate were used to fix it. The diameters of the two sections of the stepping drill were 3.5 mm and 5.0 mm, respectively. One of the matching drilling sleeves was a standard sleeve (eccentricity, 0 mm) and the other was an eccentric sleeve (proximal eccentricity, 1 mm). A model of the fixed locking plate (AO/ASIF 33-A3) for distal femoral fractures with a gap of 2 cm was established based on data from 42 artificial femurs (SAWBONE). According to the shape of the screw holes on the cortex, the fixed fracture models were divided into a control group (standard screw hole group X126, six cases) and an experimental group (elliptical screw hole group N, 36 cases). The experimental group was further divided into six subgroups with six cases in each (N126, N136, N1256, N1356, N12356, N123456), based on the number and distribution of the screws on the proximal fracture segment. The control, N126, and N136 groups were subjected to an axial load of 500 N, and the other groups were subjected to an axial load of 1000 N. The displacements of the kinetic head, far cortex, and near cortex were measured. The integral structural stiffness of the model and the near cortical strain were calculated. The data of each group were analyzed by using a paired t-test. Results When the far cortical strains were 2%, 5%, and 10%, the near cortical strains in group N126 were 0.96%, 2.35%, and 4.62%, respectively, significantly higher than those in the control group (X126) (p < 0.05). For a different distribution of the screws, when the far cortical strains were 2%, 5%, and 10%, the near cortical strains in group N126 were significantly higher than those in group N136 (p < 0.05). However, there was no significant difference between the near cortical strains in the two groups with four screws (p > 0.05). For different numbers of screws, the near cortical strains in the three-screw groups were significantly higher than those in the four-screw groups (p < 0.05), and there was no significant difference in near cortical strains among the four-, five-, and six-screw groups (p > 0.05). Conclusion The proposed drill and matching sleeves enabled a conventional locking compression plate to be transformed into an internal fixation system to improve the balanced motion of the near and far cortices. Thus, strain on a fracture site could be controlled by adjusting the diameter of the drill and the eccentricity of the sleeve.

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“…As anyone might expect, a significant clinical disappointment situation in regular plating is screw disappointment because of screw slackening or haul out (Fig. 2) [10] . The strength of crack obsession in traditional plating can be additionally upgraded if the break closes are packed.…”

Section: Customary Platingmentioning

confidence: 99%

Materials evolution of bone plates for internal fixation of bone fractures: A review

Jirjees¹

2019

Int. J. Adv. Res. Med.

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Bone breaks are the most widely recognized horrendous wounds in people. At present, hardened steels and titanium-based bone plates stay prevailing in bone crack inward obsession. In spite of the fact that these composites are sufficiently unbending to guarantee the obsession unwavering quality for the crack sections, the undesired pressure protecting impact and second activity for embed expulsion are unavoidable. As inward obsession inserts for bone crack, the top need of the bone plates is to give basic mechanical obsession to the break closes, which is the reason for break recuperating. Neither as of now known degradable biomaterials nor permeable metallic biomaterials do well in mechanical execution. The plate must give a parity of biomechanical execution and bio function so as to make crack mending progress through satisfactory structure plan and material choice.

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Implant Material, Type of Fixation at the Shaft, and Position of Plate Modify Biomechanics of Distal Femur Plate Osteosynthesis

Cited by 38 publications

References 41 publications

Biomechanical comparison of distal femoral fracture fixation: Analysis of non‐locked, locked, and far‐cortical locked constructs

Biomechanical comparison of distal femoral fracture fixation: Analysis of non‐locked, locked, and far‐cortical locked constructs

Micromotion-based balanced drilling technology to increase near cortical strain

Materials evolution of bone plates for internal fixation of bone fractures: A review

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