Cemented Internal Fixation for Supracondylar Femur Fractures in Osteoporotic Patients

Struhl, Steven; Szporn, Monroe; Cobelli, Neil J.; Sadler, Arthur H.

doi:10.1097/00005131-199004020-00008

Cited by 63 publications

(22 citation statements)

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“…In letzterer Verletzungsgruppe fanden sich neben einem Patienten mit erheblicher Beugeeinschränkung (0-0-60°) auch die 3 Patientinnen mit einem Streckdefizit >10°. Bei der Versorgung distaler Femurfrakturen durch Standardverfahren [3,6,14,26,27] finden nur Giles et al [7] nach Kondylenplattenosteosynthese mit einer durchschnittlich erreichten Kniebeugung von 120° nach 1,5 Jahren ähnlich gute Funktionswerte.…”

Section: Infekt Pseudarthrose Klinisches Ergebnisunclassified

Klinische Erprobung des distalen Femurnagels

Grass¹,

Biewener²,

Endres³

et al. 2002

Unfallchirurg

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Section: Infekt Pseudarthrose Klinisches Ergebnisunclassified

Klinische Erprobung des distalen Femurnagels

Grass¹,

Biewener²,

Endres³

et al. 2002

Unfallchirurg

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“…Although it is still uncertain whether the mechanical effect obtained by augmentation with PMMA is optimum, the successful clinical use of PMMA has already been confirmed despite its lesser biocompatible properties. [8][9][10][11] This study showed that the mean values of the pullout force and energy absorption with CAP were higher than those of PMMA, although the differences were not statistically significant. An augmenting cement should be resorbed and replaced with bone, especially in young patients.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,6 Since Mueller described the use of acrylic cement as an adjunct to internal fixation in 1962, 7 polymethylmethacrylate (PMMA) cement has been used to stabilize fractures. 8,9 In 1979, Muhr reported that 231 patients older than 65 years with a comminuted trochanteric fracture of the femur were treated with an angled blade-plate and PMMA cement. 10 He concluded that this method provided the stability necessary for immediate weight-bearing and subsequent bone union.…”

Section: Introductionmentioning

confidence: 99%

“…Although PMMA cement may be useful for elderly patients with osteoporosis, both to maintain the stability of a fracture-implant construct and to enhance screw fixation, [8][9][10][11][12][13][14] some of its properties are not biocompatible, for example, the thermal damage that occurs to the surrounding bone during polymerization and the impedance of the fracture-healing process. Leeson reported that the average peak curing temperature of PMMA is 86.9°C; thus, thermal necrosis extended to the surgical margins, including cartilage cells and osteocytes.…”

Section: Introductionmentioning

confidence: 99%

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Augmentation of cancellous screw fixation with hydroxyapatite composite resin (CAP)in vivo

Kawagoe

Saito

Shibuya³

et al. 2000

J. Biomed. Mater. Res.

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The fixation of fractured bone with screws is important for orthopedic surgery, however, rigid fixation often cannot be attained in elderly patients with osteoporosis. Recently, we developed a new injectable, nonresorbable bone cement (CAP) that possesses mechanical and biological properties superior to those of polymethylmethacrylate (PMMA) cement. CAP can directly bond with bone without intervening fibrous tissue, and the peak curing temperature is 46 degrees C. In this study, we assessed the effects of CAP and PMMA cement on the augmentation of screw fixation in vivo. A cancellous screw was placed in the proximal metaphysis of rabbit tibiae. One side of each tibia was randomly selected to be augmented with CAP or PMMA. The contralateral side received a screw without cement (control). Of the 36 rabbits included in this study, 9 rabbits from each group were sacrificed and the tibial constructs retrieved 1 or 3 months after the initial operation. The screws were then pulled out to failure. The values of the pullout force of the screws augmented with CAP and PMMA were higher than those of the control specimens at both 1 month (319 +/- 58 N for CAP vs. 105 +/- 41 N for control; p < 0.05, 284 +/- 100 N for PMMA vs. 132 +/- 71 N for control; p < 0.05) and 3 months (387 +/- 109 N for CAP vs. 196 +/- 107 N for control; p < 0.05, 372 +/- 145 N for PMMA vs. 242 +/- 100 N for control; p > 0.05) after the operation. However, the average increase in the pullout force between CAP and PMMA augmentation was not statistically significant at either time. The values of energy absorption augmented with CAP and PMMA were also higher than those of the control specimens at both 1 month (129 +/- 54 N*mm for CAP vs. 19 +/- 10 N*mm for control; p < 0.05, 145 +/- 95 N*mm for PMMA vs. 28 +/- 21 N*mm for control; p < 0.05) and 3 months (172 +/- 58 N*mm for CAP vs. 44 +/- 41N*mm for control; p < 0.05, 185 +/- 198 N*mm for PMMA vs. 67 +/- 49N*mm for control; p > 0.05) after the operation. However, there were also no significant differences in energy absorption between the two types of cement augmentation. On the other hand, a significant increase was not observed in stiffness among the CAP, PMMA, and respective control groups at either 1 month (626 +/- 133 N/mm for CAP vs. 441 +/- 180 N/mm for control; p < 0.05, 577 +/- 87 N/mm for PMMA vs. 450 +/- 121 N/mm for control; p > 0.05) or 3 months (622 +/- 144 N/mm for CAP vs. 600 +/- 204 N/mm for control; p > 0.05, 633 +/- 175 N/mm for PMMA vs. 630 +/- 168 N/mm for control; p > 0.05) after the operation, except in the average increase between CAP augmentation and its control 1 month after the operation. These results suggested that a cancellous screw fixation augmented with CAP, as well as PMMA, was effective compared with the unaugmented control in vivo. Because of its biocompatibility and low curing temperature, CAP can be used clinically to augment cancellous screw fixation.

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“…geschlechtsspezifischer Osteoporose, die sich beim einfachen Sturz in der Häuslichkeit oder im Altersheim ("low velocity incident") mehrheitlich eine extraartikuläre Schräg-oder Torsionsfraktur [36,37,38] ohne nennenswerten Weichteilschaden zuziehen.Wegen der geringen Festigkeit des osteoporotischen Knochens und der damit verknüpften mangelhaften Implantatverankerung wird die Stabilisierung dieser "osteoporotischen Frakturen" (nicht nur am körperfernen Oberschenkel) als derzeit noch ungelöstes Problem der Unfallchirurgie angesehen [19,24,55,67]. Dies wird durch eine Arbeit von Karpmann und Del Mar [29] eindrucksvoll belegt, die bei diesen Problemfrakturen, im Falle des Versagens einer Kondylenplattenosteosynthese und/oder eines Infektes, eine Oberschenkelamputationsrate von 9% konstatierten.…”

Section: Epidemiologie Und äTiologieunclassified

Die retrograde Verriegelungsnagelosteosynthese distaler Femurfrakturen mit dem distalen Femurnagel DFN

et al. 2002

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Non-operative treatment with immobilization or isometric traction has been abandoned as treatment for fractures of the distal femur at the end of the 1960ies. The technique of open reduction and internal fixation with a condylar plate as suggested by the AO has been the golden standard since the 1970ies. However, anatomic reconstruction of the condylar region with interfragmentary screw fixation and axial realignment of the femur shaft with a plate are challenging procedures especially in the presence of severely compromised soft tissues and put periosteal blood supply at risk. Soft tissue complications, axial malalignment and delayed fracture healing times led to the consideration of alternative techniques, such as intramedullary nailing which has been practiced with success since the 1940ies by Gerhard Küntscher and colleagues for femoral shaft fractures with minimal complication rates and improved results after closed reduction. The era of retrograde femoral nailing began with the systematic approach through the intercondylar notch by Green. This paper reviews the biomechanical properties, indication, technique as well as potential hazards and pitfalls of fracture management with the AO "distal femoral nail" (DFN). With appropriate application this technique is suitable for all fractures of the distal third of the femoral shaft including highly instable bicondylar fractures without damage to the soft tissues and the knee joint.

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Cemented Internal Fixation for Supracondylar Femur Fractures in Osteoporotic Patients

Cited by 63 publications

References 0 publications

Klinische Erprobung des distalen Femurnagels

Klinische Erprobung des distalen Femurnagels

Augmentation of cancellous screw fixation with hydroxyapatite composite resin (CAP)in vivo

Die retrograde Verriegelungsnagelosteosynthese distaler Femurfrakturen mit dem distalen Femurnagel DFN

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