Biomechanical Study of Pins in Cementing of Contained Proximal Tibia Defect

Weiner, Marsha M.; Damron, Timothy A.; Patterson, Francis; Werner, Frederick W.; Mann, Kenneth A.

doi:10.1097/00003086-200402000-00038

Cited by 15 publications

(15 citation statements)

References 10 publications

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“…The use of intramedullary pins in the cement demonstrated a mechanical advantage compared with the use of cement alone. Three similar biomechanical studies [10][11][12] , however, concluded that the addition of intramedullary Steinmann pins to the cement did not significantly improve the strength of the reconstruction for contained defects.…”

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confidence: 99%

Reconstruction of Noncontained Distal Femoral Defects with Polymethylmethacrylate and Crossed-Screw Augmentation: A Biomechanical Study

Toy

Randall

Neel

et al. 2006

J Bone Joint Surg Am

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mentioning

confidence: 99%

Reconstruction of Noncontained Distal Femoral Defects with Polymethylmethacrylate and Crossed-Screw Augmentation: A Biomechanical Study

Toy

Randall

Neel

et al. 2006

J Bone Joint Surg Am

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“…They found no difference in the stiffness, peak load to failure, and energy to failure between femurs treated with PMMA only, and femurs treated with PMMA and intramedullary Steinmann pins. In a similar study, Weiner et al looked at the effect of intramedullary Steinmann pins to reconstruct proximal tibia defects [12]. This study also showed no difference in stiffness, peak load to failure, and energy to failure between tibias fixed with PMMA and PMMA with Steinmann pin constructs.…”

Section: Discussionmentioning

confidence: 91%

Steinmann pin augmentation versus locking plate constructs

Ruskin

Caravaggi

Beebe

et al. 2016

J Orthopaed Traumatol

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BackgroundAggressive bone neoplasms, such as giant cell tumors, often affect the proximal tibia warranting bony resection via curettage leaving behind massive defects that require extensive reconstruction. Reconstruction is usually accomplished with poly(methyl methacrylate) (PMMA) packing supplemented with an internal fixation construct. The purpose of this study is to compare Steinmann pin augmentation to locking plate constructs to determine which offers the stiffer reconstruction option.Materials and methodsLarge defects were created below the lateral condyle of fresh frozen tibias. The defects extended for an average of 35 mm beneath the lateral plateau in the frontal plane, and from the anterior to posterior cortex in the sagittal plane. Distally the defect extended for an average of 35 mm to the metadiaphyseal junction. In the Pin group, the tibias were reconstructed with three 4-mm diameter Steinmann pins placed in the medullary canal and PMMA packing. In the Plate group, the tibias were reconstructed with a 6-hole 3.5-mm LCP Proximal locking plate fixed to the proximal−lateral tibia utilizing seven 3.5-mm screws and PMMA packing. The tibias were tested for stiffness on a MTS machine by applying up to 400 N to the tibial plateau in force control at 5 N/s. Fatigue properties were tested by applying a haversine loading waveform between 200 N and 1,200 N at 3 Hz simulating walking upstairs/downstairs.ResultsLocking plate constructs (801.8 ± 78 N/mm) had greater (p = 0.041) stiffness than tibial constructs fixed with Steinmann pins (646.5 ± 206.3 N/mm).ConclusionsPermanent deformation was similar between the Pin and Plate group; however, two tibia from the Pin group exhibited displacements >5 mm which we considered failure.Level of evidencen/a.

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“…1,11 Biomechanical studies, however, suggest this technique does very little to improve the strength of the construct. 7,11,15 We recently examined the use of crossed screws that engaged intact bone to augment construct strength for a defect in the distal femur. 13 The addition of crossed screws to the cement mantle improved the strength and stiffness compared to constructs with cement alone and cement augmented with intramedullary Steinmann pins.…”

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confidence: 99%

“…Toy et al ies, 7,11,13,15 the method and direction of loading were based upon major forces across the knee during ambulation and likely represent the best cadaver model for this type of study. We observed a mechanical advantage to a construct by adding diverging screws to augment the acrylic cement mantle in noncontained defects of the proximal tibia.…”

mentioning

confidence: 99%

“…Other studies suggest no mechanical advantage with the incorporation of Steinmann pins in the cement mantle in contained defects about the distal femur and proximal tibia. 7,15 We recently examined the effect of augmenting a cement mantle with crossed screws in a noncontained defect of the distal femur. 13 The study design compared the strength and stiffness of distal femoral defects reconstructed in one of three ways: (1) cement alone, (2) cement augmented with crossed screws that engaged the opposite cortex, and (3) cement augmented with intramedullary Steinmann pins.…”

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confidence: 99%

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Reconstruction of Noncontained Proximal Tibial Defects with Divergent Screws and Cement

Toy

Scott

Brown

et al. 2007

Clinical Orthopaedics &Amp; Related Research

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Postoperative fracture is a well described complication following curettage and cementation of aggressive benign bone tumors. We asked whether: (1) the addition of diverging screws that engage the opposite cortex increase the strength and rigidity of the construct in the proximal tibia compared with (a) cement alone and (b) would cement with intramedullary Steinmann pins; and (2) the modes of failure be different for those constructs. The average load to failure for tibias reconstructed with cement augmented with diverging screws (6321 +/- 681 N) was higher than for tibias reconstructed with cement alone (2343 +/- 222 N). The average load to failure for tibias reconstructed with cement augmented with diverging screws (6885 +/- 445 N) was higher than for tibias reconstructed with cement and intramedullary Steinmann pins (5218 +/- 941 N). Furthermore, constructs with cement augmented with diverging screws were less likely to fail by an intraarticular fracture than other types of constructs. Our data support the use of diverging screws that engage the opposite cortex to augment the strength of the construct when using acrylic cement to fill noncontained defects after curettage of the proximal tibia. This more stable, stronger construct might allow earlier mobilization and rehabilitation after curettage, with a decreased risk of fracture.

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Biomechanical Study of Pins in Cementing of Contained Proximal Tibia Defect

Cited by 15 publications

References 10 publications

Reconstruction of Noncontained Distal Femoral Defects with Polymethylmethacrylate and Crossed-Screw Augmentation: A Biomechanical Study

Reconstruction of Noncontained Distal Femoral Defects with Polymethylmethacrylate and Crossed-Screw Augmentation: A Biomechanical Study

Steinmann pin augmentation versus locking plate constructs

Reconstruction of Noncontained Proximal Tibial Defects with Divergent Screws and Cement

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