nach oben

Erschienen in:

01.09.2012 | Original Paper

The locking attachment plate for proximal fixation of periprosthetic femur fractures—a biomechanical comparison of two techniques

verfasst von: Mark Lenz, Markus Windolf, Thomas Mückley, Gunther O. Hofmann, Michael Wagner, Robert G. Richards, Karsten Schwieger, Boyko Gueorguiev

Erschienen in: International Orthopaedics | Ausgabe 9/2012

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Mechanical properties of a locking attachment plate construct (LAP-LCP), allowing bicortical screw placement laterally to the prosthesis stem, are compared to a cerclage-LCP construct.

Methods

Eight right synthetic femora with implanted uncemented hip endoprosthesis were cut distally and fixed with LCP, monocortical locking screws and either LAP (n = 4) or cerclage (n = 4). Cyclic testing was performed with monotonically increasing sinusoidal load until failure. Relative movements at the plate–femur interface were registered by motion tracking. Statistical differences were detected by unpaired t-test and general linear model repeated measures.

Results

Stiffness of the LAP-LCP was significantly higher at the beginning (875.4 N/mm ± 29.8) and after 5000 cycles (1213.0 N/mm ± 101.1) compared to the cerclage-LCP (644.96 N/mm ± 50.1 and 851.9 N/mm ± 81.9), with p = 0.013. Relative movements for AP-bending (B) and axial translation (T) of the LAP-LCP at the beginning (0.07° ± 0.02, 0.20 mm ± 0.08), after 500 cycles (0.16° ± 0.10, 0.26 mm ± 0.07) and after 5000 cycles (0.26° ± 0.11, 0.31 mm ± 0.07) differed significantly from the cerclage-LCP (beg.: 0.26° ± 0.04, 0.28 mm ± 0.05; 500 cyc: 0.47° ± 0.03, 0.53 mm ± 0.07; 5000 cyc.: 0.63° ± 0.18, 0.79 mm ± 0.13), with B: p = 0.02, T: p = 0.04. Relative movements for medial bending were not significantly different between the two constructs. Cycles to failure (criterion 1 mm axial translation) differed significantly between LAP-LCP (19,519 ± 1,758) and cerclage-LCP (11,265 ± 2,472), with p = 0.035.

Conclusions

Biomechanically, the LAP-LCP construct improves proximal fixation of periprosthetic fractures compared to the cerclage-LCP construct.

Duncan CP, Masri BA (1995) Fractures of the femur after hip replacement. Instr Course Lect 44:293–304PubMed

Lindahl H, Garellick G, Regner H, Herberts P, Malchau H (2006) Three hundred and twenty-one periprosthetic femoral fractures. J Bone Joint Surg Am 88:1215–1222PubMedCrossRef

Pike J, Davidson D, Garbuz D, Duncan CP, O’Brien PJ, Masri BA (2009) Principles of treatment for periprosthetic femoral shaft fractures around well-fixed total hip arthroplasty. J Am Acad Orthop Surg 17:677–688PubMed

Ricci WM, Bolhofner BR, Loftus T, Cox C, Mitchell S, Borrelli J Jr (2005) Indirect reduction and plate fixation, without grafting, for periprosthetic femoral shaft fractures about a stable intramedullary implant. J Bone Joint Surg Am 87:2240–2245PubMedCrossRef

Virolainen P, Mokka J, Seppanen M, Makela K (2010) Up to 10 years follow up of the use of 71 cortical allografts (strut-grafts) for the treatment of periprosthetic fractures. Scand J Surg 99:240–243PubMed

Kamineni S, Ware HE (1999) The Mennen plate: unsuitable for elderly femoral peri-prosthetic fractures. Injury 30:257–260PubMedCrossRef

Dennis MG, Simon JA, Kummer FJ, Koval KJ, DiCesare PE (2000) Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem: a biomechanical study of 5 techniques. J Arthroplast 15:523–528CrossRef

Fulkerson E, Koval K, Preston CF, Iesaka K, Kummer FJ, Egol KA (2006) Fixation of periprosthetic femoral shaft fractures associated with cemented femoral stems: a biomechanical comparison of locked plating and conventional cable plates. J Orthop Trauma 20:89–93PubMedCrossRef

Lever JP, Zdero R, Nousiainen MT, Waddell JP, Schemitsch EH (2010) The biomechanical analysis of three plating fixation systems for periprosthetic femoral fracture near the tip of a total hip arthroplasty. J Orthop Surg Res 5:45PubMedCrossRef

10.

Schmotzer H, Tchejeyan GH, Dall DM (1996) Surgical management of intra- and postoperative fractures of the femur about the tip of the stem in total hip arthroplasty. J Arthroplast 11:709–717CrossRef

11.

Zdero R, Walker R, Waddell JP, Schemitsch EH (2008) Biomechanical evaluation of periprosthetic femoral fracture fixation. J Bone Joint Surg Am 90:1068–1077PubMedCrossRef

12.

Konstantinidis L, Hauschild O, Beckmann NA, Hirschmuller A, Sudkamp NP, Helwig P (2010) Treatment of periprosthetic femoral fractures with two different minimal invasive angle-stable plates: biomechanical comparison studies on cadaveric bones. Injury 41:1256–1261PubMedCrossRef

13.

Duda GN, Schneider E, Chao EY (1997) Internal forces and moments in the femur during walking. J Biomech 30:933–941PubMedCrossRef

14.

Windolf M, Muths R, Braunstein V, Gueorguiev B, Hanni M, Schwieger K (2009) Quantification of cancellous bone-compaction due to DHS Blade insertion and influence upon cut-out resistance. Clin Biomech (Bristol, Avon) 24:53–58CrossRef

15.

Gueorguiev B, Wähnert D, Albrecht D, Ockert B, Windolf M, Schwieger K (2010) Effect on dynamic mechanical stability and interfragmentary movement of angle-stable locking of intramedullary nails in unstable distal tibia fractures: a biomechanical study. J Trauma 70:358–365CrossRef

16.

Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191PubMedCrossRef

17.

Dennis MG, Simon JA, Kummer FJ, Koval KJ, Di Cesare PE (2001) Fixation of periprosthetic femoral shaft fractures: a biomechanical comparison of two techniques. J Orthop Trauma 15:177–180PubMedCrossRef

18.

Kligman M, Rotem A, Roffman M (2003) Cancellous and cortical morselized allograft in revision total hip replacement: a biomechanical study of implant stability. J Biomech 36:797–802PubMedCrossRef

19.

McConnell A, Zdero R, Syed K, Peskun C, Schemitsch E (2008) The biomechanics of ipsilateral intertrochanteric and femoral shaft fractures: a comparison of 5 fracture fixation techniques. J Orthop Trauma 22:517–524PubMedCrossRef

20.

Talbot M, Zdero R, Schemitsch EH (2008) Cyclic loading of periprosthetic fracture fixation constructs. J Trauma 64:1308–1312PubMedCrossRef

21.

Kobbe P, Klemm R, Reilmann H, Hockertz TJ (2008) Less invasive stabilisation system (LISS) for the treatment of periprosthetic femoral fractures: a 3-year follow-up. Injury 39:472–479PubMedCrossRef

22.

Kääb MJ, Stöckle U, Schütz M, Stefansky J, Perka C, Haas NP (2006) Stabilisation of periprosthetic fractures with angular stable internal fixation: a report of 13 cases. Arch Orthop Trauma Surg 126:105–110PubMedCrossRef

Titel: The locking attachment plate for proximal fixation of periprosthetic femur fractures—a biomechanical comparison of two techniques
verfasst von: Mark Lenz
Markus Windolf
Thomas Mückley
Gunther O. Hofmann
Michael Wagner
Robert G. Richards
Karsten Schwieger
Boyko Gueorguiev
Publikationsdatum: 01.09.2012
Verlag: Springer-Verlag
Erschienen in: International Orthopaedics / Ausgabe 9/2012
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-012-1574-x

Update Orthopädie und Unfallchirurgie

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

Newsletter bestellen

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

The locking attachment plate for proximal fixation of periprosthetic femur fractures—a biomechanical comparison of two techniques