nach oben

Archives of Orthopaedic and Trauma Surgery

Erschienen in:

06.11.2019 | Trauma Surgery

A novel method for intraoperative osseomechanical strength measurements: a biomechanical ex vivo evaluation on proximal femora

verfasst von: Alexander Maslaris, Olaf Brinkmann, Frank Layher, Georg Matziolis, Matthias Bungartz

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 6/2020

Einloggen, um Zugang zu erhalten

Abstract

Introduction

The increasing number of geriatric traumatology cases has intensified the need to reliably and objectively evaluate local bone quality, the latter poses a decisive factor for the choice of an optimal approach to treat osteoporotic fractures. Osteodensitometry imaging techniques are not routinely available in acute operative settings, nor do they provide objective information on local bone properties specifically needed for the prognosis of implant stability.

Materials and methods

This study sought to verify ex vivo the feasibility and sensitivity of a novel method for the determination of local bone strength in the acute operative setting (intraoperative osseomechanical strength measurement; IOSM) that is based on the principle of material displacement resistance against the force of a rotary indenter. Samples consisted of human femoral heads obtained after total hip replacement. Comparisons were made with results obtained via conventional dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (qCT).

Results

Regression analyses of the results showed a highly significant correlation between the IOSM and the control methods (r = 0.61 and r = 0.56; p < 0.01), indicating that this new approach qualifies as a reliable tool for the intraoperative evaluation of the intrinsic local bone strength.

Conclusions

The intraoperative integration of this method may support surgeon on taking proper decisions in terms of optimal surgical approaches and prevention of complications inherent to osteoporotic bone.

Czerwiński E, Badurski JE, Marcinowska-Suchowierska E, Osieleniec J (2007) Current understanding of osteoporosis according to the position of the World Health Organization (WHO) and International Osteoporosis Foundation. Ortop Traumatol Rehabil 9:337–356PubMed

Eisenmenger M, Pötzsch O, Sommer B et al (2007) Bevölkerung Deutschlands bis 2050—11. koordinierte Bevölkerungsvorausberechnung. Statistisches Bundesamt, Wiesbaden

Papaioannou A, Kennedy CC, Ioannidis G et al (2009) The impact of incident fractures on health-related quality of life: 5 years of data from the Canadian Multicentre Osteoporosis Study. Osteoporos Int 20:703–714. https://doi.org/10.1007/s00198-008-0743-7 CrossRefPubMed

Adachi JD, Loannidis G, Berger C et al (2001) The influence of osteoporotic fractures on health-related quality of life in community-dwelling men and women across Canada. Osteoporos Int 12:903–908CrossRef

Davis TR, Sher JL, Horsman A et al (1990) Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br 72:26–31CrossRef

Barrios C, Broström LA, Stark A, Walheim G (1993) Healing complications after internal fixation of trochanteric hip fractures: the prognostic value of osteoporosis. J Orthop Trauma 7:438–442CrossRef

Bonnaire F, Zenker H, Lill C et al (2005) Treatment strategies for proximal femur fractures in osteoporotic patients. Osteoporos Int 16:S93–S102. https://doi.org/10.1007/s00198-004-1746-7 CrossRefPubMed

Bonnaire F, Weber A, Bösl O et al (2007) “Cutting out” bei pertrochantären frakturen—ein problem der osteoporose? Unfallchirurg 110:425–432. https://doi.org/10.1007/s00113-007-1248-0 CrossRefPubMed

Bartucci EJ, Gonzalez MH, Cooperman DR et al (1985) The effect of adjunctive methylmethacrylate on failures of fixation and function in patients with intertrochanteric fractures and osteoporosis. J Bone Joint Surg Am 67:1094–1107CrossRef

10.

Kammerlander C, Gebhard F, Meier C et al (2011) Standardised cement augmentation of the PFNA using a perforated blade: a new technique and preliminary clinical results. a prospective multicentre trial. Injury 42:1484–1490. https://doi.org/10.1016/j.injury.2011.07.010 CrossRefPubMed

11.

Baruffaldi F, Barbanti Brodano G, Testoni M et al (1996) Femoral densitometry as potential preoperative indicator for cementation of hip prosthesis. Radiol Med 92:193–198PubMed

12.

Ammann P, Rizzoli R (2003) Bone strength and its determinants. Osteoporos Int 14:13–18. https://doi.org/10.1007/s00198-002-1345-4 CrossRef

13.

Atsumi M, Park S-H, Wang H-L (2007) Methods used to assess implant stability: current status. Int J Oral Maxillofac Implants 22:743–754

14.

Suhm N, Hengg C, Schwyn R et al (2007) Mechanical torque measurement predicts load to implant cut-out: a biomechanical study investigating DHS® anchorage in femoral heads. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-006-0265-8 CrossRefPubMed

15.

Grote S, Noeldeke T, Blauth M et al (2013) Mechanical torque measurement in the proximal femur correlates to failure load and bone mineral density ex vivo. Orthop Rev 5:77–81. https://doi.org/10.4081/or.2013.e16 CrossRef

16.

Mueller MA, Hengg C, Hirschmann M et al (2012) Mechanical torque measurement for in vivo quantification of bone strength in the proximal femur. Injury 43:1712–1717CrossRef

17.

Taylor WR, Szwedowski TD, Heller MO et al (2012) The difference between stretching and splitting muscle trauma during THA seems not to play a dominant role in influencing periprosthetic BMD changes. Clin Biomech 27:813–818. https://doi.org/10.1016/j.clinbiomech.2012.05.004 CrossRef

18.

Müller MA, Hengg C, Krettek C et al (2015) Trabecular bone strength is not an independent predictive factor for dynamic hip screw migration—a prospective multicenter cohort study. J Orthop Res 33:1680–1686. https://doi.org/10.1002/jor.22934 CrossRefPubMed

19.

Trudel G, Koike Y, Dinh L, Uhthoff HK (2005) Thawing of frozen calcaneus bone specimens has no effect on the bone mineral density using dual energy X-ray absorptiometry: a study in rabbits and humans. Physiol Meas 26:769–777. https://doi.org/10.1088/0967-3334/26/5/015 CrossRefPubMed

20.

Whitehouse RW, Economou G, Adams JE (1993) Influence of temperature on QCT: implications for mineral densitometry. J Comput Assist Tomogr 17:945–951CrossRef

21.

Lenich A (2005) Der trochantäre Fixationsnagel (TFN) im biomechanischen Test. In: DGU-DGOT Tagung. p 670

22.

Bonnaire FA, Buitrago-Tellez C, Schmal H et al (2002) Correlation of bone density and geometric parameters to the mechanical strength of the femoral neck. Injury 33(Suppl 3):C47–53CrossRef

23.

Ahrengart L, Tornkvist H, Fornander P et al (2002) A randomized study of the compression hip screw and gamma nail in 426 fractures. Clin Orthop Relat Res 401:209–222CrossRef

24.

Brammar TJ, Kendrew J, Khan RJK, Parker MJ (2005) Reverse obliquity and transverse fractures of the trochanteric region of the femur; a review of 101 cases. Injury 36:851–857. https://doi.org/10.1016/j.injury.2005.02.004 CrossRefPubMed

25.

Herrera A, Domingo L, Calvo A et al (2002) A comparative study of trochanteric fractures treated with the Gamma nail or the proximal femoral nail. Int Orthop 26:365–369. https://doi.org/10.1007/s00264-002-0389-6 CrossRefPubMedPubMedCentral

26.

Hohendorff B, Meyer P, Menezes D et al (2005) Behandlungsergebnisse und Komplikationen nach PFN-osteosynthese. Unfallchirurgie 108:938–953. https://doi.org/10.1007/s00113-005-0962-8 CrossRef

27.

Werner-Tutschku W, Lajtai G, Schmiedhuber G et al (2002) Intra- und perioperative Komplikationen bei der Stabilisierung von per- und subtrochantären Femurfrakturen mittels PFN ®. Unfallchirurgie 105:881–885. https://doi.org/10.1007/s00113-002-0416-5 CrossRef

28.

Schipper IB, Marti RK, van der Werken C (2004) Unstable trochanteric femoral fractures: extramedullary or intramedullary fixation. Review of literature. Injury 35:142–151CrossRef

29.

Parker MJ, Handoll HH (2010) Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD000093.pub5 CrossRefPubMed

30.

Parker M, Handoll H (2005) Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. In: Parker M (ed) Cochrane Database Syst Rev Wiley, Chichester, p CD000093

31.

Center JR, Nguyen TV, Pocock NA, Eisman JA (2004) Volumetric bone density at the femoral neck as a common measure of hip fracture risk for men and women. J Clin Endocrinol Metab 89:2776–2782. https://doi.org/10.1210/jc.2003-030551 CrossRefPubMed

32.

Black DM, Cummings SR, Karpf DB et al (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet (Lond, Engl) 348:1535–1541CrossRef

33.

Kanis JA, Glüer CC (2000) An update on the diagnosis and assessment of osteoporosis with densitometry: Committee of Scientific Advisors, International Osteoporosis Foundation. Osteoporos Int 11:192–202CrossRef

34.

Goulet RW, Goldstein SA, Ciarelli MJ et al (1994) The relationship between the structural and orthogonal compressive properties of trabecular bone. J Biomech 27:375–389CrossRef

35.

Beck TJ, Ruff CB, Warden KE et al (1990) Predicting femoral neck strength from bone mineral data: A structural approach. Invest Radiol 25:6–18CrossRef

36.

Cummings SR, Black DM, Nevitt MC et al (1993) Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet 341:72–75CrossRef

37.

Lotz JC, Gerhart TN, Hayes WC (1990) Mechanical properties of trabecular bone from the proximal femur: a quantitative CT study. J Comput Assist Tomogr 14:107–114CrossRef

38.

Lotz JC, Hayes WC (1990) The use of quantitative computed tomography to estimate risk of fracture of the hip from falls. J Bone Joint Surg Am 72:689–700CrossRef

39.

Bonnaire FA, Weber AT (2002) Analysis of fracture gap changes, dynamic and static stability of different osteosynthetic procedures in the femoral neck. Injury 33(Suppl 3):C24–32CrossRef

Titel: A novel method for intraoperative osseomechanical strength measurements: a biomechanical ex vivo evaluation on proximal femora
verfasst von: Alexander Maslaris
Olaf Brinkmann
Frank Layher
Georg Matziolis
Matthias Bungartz
Publikationsdatum: 06.11.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 6/2020
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-019-03284-7

Clinical and radiological results of the vascularized medial femoral condyle graft for scaphoid non-union

Open Access
Handsurgery

Conventional instruments are more accurate for measuring the depth of the tibial cut than computer-assisted surgery in total knee arthroplasty: a prospective study

Knee Arthroplasty

The learning curves of a validated virtual reality hip arthroscopy simulator

Open Access
Arthroscopy and Sports Medicine

Accuracy of tibial positioning in the frontal plane: a prospective study comparing conventional and innovative techniques in total knee arthroplasty

Open Access
Knee Arthroplasty

Three-dimensional templating in hip arthroplasty: the basis for template-directed instrumentation?

Open Access
Hip Arthroplasty

Joint line convergence angle predicts outliers of coronal alignment in navigated open-wedge high tibial osteotomy

Orthopaedic Surgery

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie erweitert durch Fallbeispiele, Videos und Abbildungen. Zur Fortbildung und Wissenserweiterung, verfasst und geprüft von Expertinnen und Experten der Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA).

Jetzt entdecken!

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Positive Daten für supraskapulären Nervenblock bei Schultersteife

20.01.2025
Schultersteife
Nachrichten

Daten einer aktuellen Metaanalyse sprechen dafür, dass eine Blockade des Nervus suprascapularis bei Schultersteife mit Blick auf Funktion und Schmerzlinderung mindestens so effektiv ist wie eine Physiotherapie oder intraartikulär injizierte Steroide.

Wirbelgleiten: Dem persönlichen Drang zum Versteifen widerstehen!

17.01.2025
Spondylolisthese
Nachrichten

In einer norwegischen Studie schnitt die alleinige Dekompressions-Op. bei Personen mit Wirbelgleiten auch dann nicht schlechter ab, wenn erfahrene Chirurgen/ Chirurginnen eigentlich für eine zusätzliche Versteifung plädiert hätten.

Nackenschmerzen nach Bandscheibenvorfall: Muskeltraining hilft!

15.01.2025
Nackenschmerzen
Nachrichten

Bei hartnäckigen Schmerzen aufgrund einer zervikalen Radikulopathie schlägt ein Team der Universität Istanbul vor, lokale Steroidinjektionen mit einem speziellen Trainingsprogramm zur Stabilisierung der Nackenmuskulatur zu kombinieren.

Die elektronische Patientenakte kommt: Das sollten Sie jetzt wissen

12.01.2025
Elektronische Patientenakte
Nachrichten

Am 15. Januar geht die „ePA für alle“ zunächst in den Modellregionen an den Start. Doch schon bald soll sie in allen Praxen zum Einsatz kommen. Was ist jetzt zu tun? Was müssen Sie wissen? Wir geben in einem FAQ Antworten auf 21 Fragen.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

A novel method for intraoperative osseomechanical strength measurements: a biomechanical ex vivo evaluation on proximal femora