The stability of fixation of proximal femoral fractures

Embden, Daphne van; Stollenwerck, Guido; Koster, Lennard A; Kaptein, Bart L; Nelissen, Rob G H H; Schipper, I.B.

doi:10.1302/0301-620x.97b3.35077

Cited by 27 publications

(18 citation statements)

References 24 publications

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“…Unexpectedly, but in line with the results of a recent study, we encountered technical difficulties in the implantation of RSA markers into the femoral head. The original RSA technique described for femoral neck fractures involved the use of predrilled bone channels .…”

Section: Discussionsupporting

confidence: 64%

“…RSA is applicable for the three-dimensional (3D) measurement of the displacement in femoral neck fractures. [16][17][18] Differentially loaded RSA (DL-RSA) allows for the measurement of inducible micromotion under physiologic loading 19,20 but has not yet been applied in hip fracture patients. Because of its high accuracy and precision, RSA permits the minimization of sample size.…”

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confidence: 99%

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Radiostereometric analysis of the initial stability of internally fixed femoral neck fractures under differential loading

Finnilä

Moritz

Strandberg

et al. 2018

Journal Orthopaedic Research

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We examined the feasibility of radiostereometric analysis (RSA) in the assessment of the initial stability of internally fixed femoral neck fractures. The study included 16 patients (mean age 73 years). During surgery, multiple RSA‐beads were inserted on both sides of the fracture. Radiographs for RSA were taken in the supine position within the first 3 days and 6, 12, 24, and 52 weeks after surgery. To detect any inducible motion at the fracture‐site, radiographs for RSA were taken with the patient resting or applying a load through the fracture. Fracture loading was achieved by the patient pressing the ipsilateral foot as much as tolerated on a force plate while providing a counterforce through both hands. Micromotion exceeding the precision values of RSA (≥0.3 mm for the translation vector and/or ≥1.2 degrees for the rotation vector) was considered significant. Permanent three‐dimensional fracture‐site displacement was also recorded. Voluntary loading induced fracture‐site micromotion, which exhibited a dichotomous distribution. In patients with uncomplicated fracture union, inducible micromotion was detectable only at baseline—if at all. Conversely, fractures that developed a nonunion were characterized by the continuation of inducible micromotion beyond baseline. Permanent fracture‐site displacement was, on average, nearly an order of magnitude greater than the inducible micromotion. Fracture unions were characterized by the cessation of permanent fracture‐site displacement by 12 weeks. Nonunions presented as outliers in permanent fracture‐site displacement. Large‐scale studies are warranted to evaluate whether the detection of inducible micromotion beyond baseline could serve as an indicator of insufficient fixation stability. © 2018 The Authors. Journal of Orthopaedic Research ® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society.

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Section: Discussionsupporting

confidence: 64%

mentioning

confidence: 99%

Radiostereometric analysis of the initial stability of internally fixed femoral neck fractures under differential loading

Finnilä

Moritz

Strandberg

et al. 2018

Journal Orthopaedic Research

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“…10 A recent clinical study using radiostereometric analysis (RSA) to quantify the stability of an undisplaced femoral neck fracture post fixation, has shown a mean rotation of 5.5° (-3.6° to 14.0°) at four months follow-up, when using a DHS or three cannulated hip screws. 11 Torsional instability of an implant system is a predictor of the most common failure modes, including cut-out. 12 …”

Section: Introductionmentioning

confidence: 99%

The efficacy of rotational control designs in promoting torsional stability of hip fracture fixation

Gosiewski

Holsgrove

Gill

2017

Bone & Joint Research

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ObjectivesFractures of the proximal femur are a common clinical problem, and a number of orthopaedic devices are available for the treatment of such fractures. The objective of this study was to assess the rotational stability, a common failure predictor, of three different rotational control design philosophies: a screw, a helical blade and a deployable crucifix.MethodsDevices were compared in terms of the mechanical work (W) required to rotate the implant by 6° in a bone substitute material. The substitute material used was Sawbones polyurethane foam of three different densities (0.08 g/cm3, 0.16 g/cm3 and 0.24 g/cm3). Each torsion test comprised a steady ramp of 1°/minute up to an angular displacement of 10°.ResultsThe deployable crucifix design (X-Bolt), was more torsionally stable, compared to both the dynamic hip screw (DHS, p = 0.008) and helical blade (DHS Blade, p= 0.008) designs in bone substitute material representative of osteoporotic bone (0.16 g/cm3 polyurethane foam). In 0.08 g/cm3 density substrate, the crucifix design (X-Bolt) had a higher resistance to torsion than the screw (DHS, p = 0.008). There were no significant differences (p = 0.101) between the implants in 0.24 g/cm3 density bone substitute.ConclusionsOur findings indicate that the clinical standard proximal fracture fixator design, the screw (DHS), was the least effective at resisting torsional load, and a novel crucifix design (X-Bolt), was the most effective design in resisting torsional load in bone substitute material with density representative of osteoporotic bone. At other densities the torsional stability was also higher for the X-Bolt, although not consistently significant by statistical analysis.Cite this article: J. D. Gosiewski, T. P. Holsgrove, H. S. Gill. The efficacy of rotational control designs in promoting torsional stability of hip fracture fixation. Bone Joint Res 2017;6:270–276. DOI: 10.1302/2046-3758.65.BJR-2017-0287.R1.

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“…While repaired fracture fragments move slightly during the first few postoperative months, partially due to the desired compression mechanism, only few patients actually suffer from symptoms related to fixation failures that lead to revision surgery [ 12 , 21 ]. A few researchers studied structural changes in the bone-device construct and found expected movement during the first 6 weeks following surgery.…”

Section: Discussionmentioning

confidence: 99%

Routine early post-operative X-ray following internal fixation of intertrochanteric femoral fractures is unjustified: a quality improvement study

et al. 2018

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BackgroundThere is no consensus regarding the proper radiographic protocol following closed or open reduction and internal fixation for intertrochanteric femoral fractures. The objective of this study was to assess the role of early postoperative imaging studies when deciding about weight bear limitations and reoperations.MethodsA prospective cohort study of 100 patients (26 men and 74 women, at a mean age of 79.8 years) treated by closed or open reduction and internal fixation for AO31A fractures was conducted. According to the AO classification, there were 25 cases of 31A1, 54 cases of 31A2, and 21 cases of 31A3. For every patient, the intraoperative fluoroscopy studies were recorded and post-operative radiograms were taken during the first week. Excluded were patients for whom the early X-rays were clinically indicated. The intraoperative AP and axial fluoroscopy studies were compared with the radiograms taken during the first post-operative week. The investigators compared the decisions regarding weight-bearing limitations and the need for re-operation before and after conducting the radiograms.ResultsThe early post-operative imaging studies did not change weight-bearing limitations nor did they lead to consecutive surgical treatments.ConclusionsUnless indicated by physical examination, there is no value to routine post-operative radiograms within the first few days after closed reduction and internal fixation of intertrochanteric femoral fractures with regard to weight-bearing limitations and re-operation decisions.Trial registrationIdentifier: NCT02868125.

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The stability of fixation of proximal femoral fractures

Cited by 27 publications

References 24 publications

Radiostereometric analysis of the initial stability of internally fixed femoral neck fractures under differential loading

Radiostereometric analysis of the initial stability of internally fixed femoral neck fractures under differential loading

The efficacy of rotational control designs in promoting torsional stability of hip fracture fixation

Routine early post-operative X-ray following internal fixation of intertrochanteric femoral fractures is unjustified: a quality improvement study

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