Periprosthetic femoral fracture fixation: a biomechanical comparison between proximal locking screws and cables View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2015-09

AUTHORS

Simon M. Graham, Jonathan H. Mak, Mehran Moazen, Andreas Leonidou, Alison C. Jones, Ruth K. Wilcox, Eleftherios Tsiridis

ABSTRACT

BACKGROUND: The incidence of periprosthetic femoral fractures (PFF) around a stable stem is increasing. The aim of this biomechanical study was to examine how three different methods of fixation, for Vancouver type B1 PFF, alter the stiffness and strain of a construct under various configurations, in order to gain a better insight into the optimal fixation method. METHODS: Three different combinations of proximal screws and Dall-Miles cables were used: (A) proximal unicortical locking screws alone; (B) proximal cables and unicortical locking screws; (C) proximal cable alone, each in combination with distal bicortical locking screws, to fix a stainless steel locking compression plate to five synthetic femora with simulated Vancouver type B1 PFFs. In one synthetic femora, there was a 10-mm fracture gap, in order to simulate a comminuted injury. The other four femora had no fracture gap, to simulate a stable injury. An axial load was applied to the constructs at varying degrees of adduction, and the overall construct stiffness and surface strain were measured. RESULTS: With regards to stiffness, in both the gap and no gap models, method of fixation A was the stiffest form of fixation. The inclusion of the fracture gap reduced the stiffness of the construct quite considerably for all methods of fixation. The strain across both the femur and the plate was considerably less for method of fixation C, compared to A and B, at the locations considered in this study. CONCLUSION: This study highlights that the inclusion of cables appears to damage the screw fixations and does not aid in construct stability. Furthermore, the degree of fracture reduction affects the whole construct stability and the bending behaviour of the fixation. More... »

PAGES

875-880

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00776-015-0735-3

DOI

http://dx.doi.org/10.1007/s00776-015-0735-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1020294199

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25968896


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40 schema:description BACKGROUND: The incidence of periprosthetic femoral fractures (PFF) around a stable stem is increasing. The aim of this biomechanical study was to examine how three different methods of fixation, for Vancouver type B1 PFF, alter the stiffness and strain of a construct under various configurations, in order to gain a better insight into the optimal fixation method. METHODS: Three different combinations of proximal screws and Dall-Miles cables were used: (A) proximal unicortical locking screws alone; (B) proximal cables and unicortical locking screws; (C) proximal cable alone, each in combination with distal bicortical locking screws, to fix a stainless steel locking compression plate to five synthetic femora with simulated Vancouver type B1 PFFs. In one synthetic femora, there was a 10-mm fracture gap, in order to simulate a comminuted injury. The other four femora had no fracture gap, to simulate a stable injury. An axial load was applied to the constructs at varying degrees of adduction, and the overall construct stiffness and surface strain were measured. RESULTS: With regards to stiffness, in both the gap and no gap models, method of fixation A was the stiffest form of fixation. The inclusion of the fracture gap reduced the stiffness of the construct quite considerably for all methods of fixation. The strain across both the femur and the plate was considerably less for method of fixation C, compared to A and B, at the locations considered in this study. CONCLUSION: This study highlights that the inclusion of cables appears to damage the screw fixations and does not aid in construct stability. Furthermore, the degree of fracture reduction affects the whole construct stability and the bending behaviour of the fixation.
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