Biomechanical Analysis of Augmented Plate Fixation for the Treatment of Vertical Shear Femoral Neck Fractures

Kunapuli, Sarat C.; Schramski, Matthew J.; Lee, Angela S.; Popovich, John M.; Cholewicki, Jacek; Reeves, N. Peter; Crichlow, Renn J

doi:10.1097/bot.0000000000000205

Cited by 82 publications

(69 citation statements)

References 16 publications

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“…[19–23] Pauwels grade-3 femoral neck fracture treatment should be based on the individual characteristics of patient and fracture feature. Factors including fracture displacement, comminution, invasion of operation, meanwhile, surgeon's experience should also be taken into consideration.…”

Section: Discussionmentioning

confidence: 99%

Osteonecrosis of the femoral head, nonunion and potential risk factors in Pauwels grade-3 femoral neck fractures

Zhang

Chen

et al. 2016

Medicine

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The present study was to analyze clinical outcome of Pauwels grade-3 femoral neck fractures treated by different surgical techniques. Potential risk factors associated with nonunion and osteonecrosis of the femoral head (ONFH) were investigated as well. The retrospective study comprised of 67 sequential patients treated between January 2008 and December 2011. Patients with Pauwels grade-3 femoral neck fractures were treated by operative reduction and internal fixation. Cannulated screws (CS) were used in 46 patients, dynamic hip screw plus CS (DHS+CS) in 14, and locking compression plate (LCP) for proximal femur in 7. Reduction quality was assessed according to Haidukewych criteria. Postoperative radiographic examinations were conducted to observe fracture healing. Fracture displacement, comminution, fashion of internal fixation, and the sliding effect were analyzed, regarding the incidence of nonunion and ONFH. All patients had a follow-up of 21.6 ± 6.0 months on average. The phenomenon of sliding effect was observed in 16 cases (23.9%). In terms of reduction quality, 64 cases were graded as excellent, 2 were good, and 1 was poor. ONFH was presented in 15 cases (22.4%) and nonunion was found in 8 (11.9%), with 1 patient had ONFH and nonunion concomitantly. Profound hip contour was preserved in 45 cases (67.2%). The fashion of internal fixation yielded different results regarding ONFH and nonunion, whereas the effects of fracture displacement, comminution, and the sliding effect were not significant. ONFH and nonunion were common complications following Pauwels grade-3 femoral neck fractures. Higher incidence of ONFH in DHS+CS and of nonunion in the LCP group should be noted.

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Section: Discussionmentioning

confidence: 99%

Osteonecrosis of the femoral head, nonunion and potential risk factors in Pauwels grade-3 femoral neck fractures

Zhang

Chen

et al. 2016

Medicine

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“…Buttress plates placed against the medial cortical bone have been previously reported. Sarat C. Kunapuli et al [29] introduced an augmenting fixation with a 2.7-mm limited contact dynamic compression (LCDC) plate, contoured to fit along the anterior. Subsequently, Hak et al [17] reported a novel procedure that combines cannulated screws with a medialbuttress 1/3 tubular plate, which is contoured during surgery based on the patients' anatomical structure.…”

Section: Discussionmentioning

confidence: 99%

Medial anatomical buttress plate in treating displaced femoral neck fracture a finite element analysis

Li¹,

Yin²,

Zhang

et al. 2019

Injury

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Keywords:Displaced femoral neck fractures Finite element analysis (FEA) Tubular plate (TP) Medial anatomical buttress plate (MABP) A B S T R A C TBackground: Displaced femoral neck fractures in young adults are most likely to result from high energy trauma that causes a vertically-oriented shearing injury through the femoral neck. The optimal strategy for treatment of displaced femoral neck fractures remains an unsolved challenge in orthopedic surgery. Methods: our group has previously designed a medial anatomical buttress plate (MABP) based on the analysis of the computed tomography (CT) data of anatomical structures derived from a large sample population. In this study, finite element analyses (FEA) were carried out to compare the outcomes of the combination of our MABP with cannulated screws to those of the combination of tubular plate with cannulated screws, and to those of using cannulated screws alone. Results: MABP resulted in a more stable fixation as compared to the other two approaches, with respect to the femur and the stress distributions, stress peaks, and Z axis displacements. Conclusions: The FEA encouraged us that addition of a medial buttress plate not only achieved superior medial buttress stability but also achieves superior performance because it perfectly fits with the existing anatomic structure of medial femoral neck. The results from our study may provide references for clinical decision making in dealing with such patients.

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“…72 The plate augmentation increased the energy absorbed to failure by an average of 187%. Buttress plates are applied over the apex of fractures and act by resisting shear forces and converting them into compressive forces.…”

Section: Augmentation Technique: Buttress Plating Of the Femoral Neckmentioning

confidence: 99%

Displaced Femoral Neck Fracture in Young Adults

Collinge

Mir

McAndrew

2015

Techniques in Orthopaedics

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Femoral neck fractures undergoing repair in young adult patients are at high risk for failure: reasons include powerful local forces acting across the hip, fracture pattern, associated injury, inadequate reduction, and imperfect available implants. In an effort to maximize fixation to minimize the risks for failure, accessory fixation along with more traditional fracture constructs can be used. Use of a buttress plate for achieving improved fixation in treating displaced femoral neck fractures is described.

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Biomechanical Analysis of Augmented Plate Fixation for the Treatment of Vertical Shear Femoral Neck Fractures

Abstract: The strength of surgical repairs of the vertical shear femoral neck fractures can be significantly augmented with the 2.7-mm locking plate. The construct with the cannulated screws was significantly stronger than the DHS construct.

Cited by 82 publications

References 16 publications

Osteonecrosis of the femoral head, nonunion and potential risk factors in Pauwels grade-3 femoral neck fractures

Osteonecrosis of the femoral head, nonunion and potential risk factors in Pauwels grade-3 femoral neck fractures

Medial anatomical buttress plate in treating displaced femoral neck fracture a finite element analysis

Displaced Femoral Neck Fracture in Young Adults

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