Distal femoral fractures in the elderly: biomechanical analysis of a polyaxial angle-stable locking plate versus a retrograde intramedullary nail in a human cadaveric bone model

Bliemel, Christopher; Buecking, Benjamin; Mueller, Thorben; Wack, Christina; Koutras, Christos; Beck, Tabea; Ruchholtz, Steffen; Zettl, Ralph

doi:10.1007/s00402-014-2111-8

Cited by 30 publications

(18 citation statements)

References 43 publications

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“…Moreover, the smooth placement of the intramedullary nail will be affected if there is bone end hardening or stenosis of the medullary cavity. 19,20 In recent years, the use of locking plates combined with external fixators for bone transport has achieved good results. [21][22][23] Compared with intramedullary nails, locking steel plates can allow for screwing in the transported segment, increasing its stability, and eliminating the time required to heal the anchor point.…”

Section: Discussionmentioning

confidence: 99%

Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate

Ren

et al. 2020

J Int Med Res

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Objective To evaluate the effectiveness of bone transport involving circular external fixation and locking plate application for the treatment of segmental tibial defects. Methods A retrospective review of 12 patients with segmental tibial defects who underwent bone transport with circular external fixation and locking plate application. We evaluated external fixation time, external fixation index, time to achieve union, and complications. Clinical results were assessed using the Association for the Study and Application of the Methods of Ilizarov (ASAMI) score. Generic health-related outcome was assessed using the 36-Item Short-Form Health Survey questionnaire (SF-36). Results The mean follow-up was 25.8 months, and the mean defect size was 6.7 cm. All of the patients achieved union at the distraction callus and docking site. The average external fixation time was 299.5 days. The mean external fixation index was 16.5 days/cm, and the mean healing index was 44.9 days/cm. The functional outcomes were excellent in eight cases and good in four. The average SF-36 score was 92. Conclusion Bone transport with external fixation and locking plate application may be a promising method for the treatment of segmental tibial defects.

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Section: Discussionmentioning

confidence: 99%

Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate

Ren

et al. 2020

J Int Med Res

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“…The femora were enveloped in humidified clothes using a liquid, consisting of 96% ethanol and < 2% formaldehyde. To prevent dehydration of the specimens, they were stored in a cold storage room [7].…”

Section: Specimensmentioning

confidence: 99%

Cement augmentation of an angular stable plate osteosynthesis for supracondylar femoral fractures - biomechanical investigation of a new fixation device

Bäumlein

Klasan

Klötzer

et al. 2020

BMC Musculoskelet Disord

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Background: Implant anchorage in highly osteoporotic bone is challenging, since it often leads to osteosynthesis failure in geriatric patients with supracondylar femoral fractures. Cementation of screws is presumed to prevent such osteosynthesis failure. This study aimed to investigate the effect of a newly designed, cementable fenestrated condylar screw for plate fixation in a biomechanical setting. Methods: Eight pairs of osteoporotic cadaver femora with an average age of 77 years, ranging between 62 and 88 years, were randomly assigned to either an augmented or a non-augmented group. In both groups an instable 33-A3 fracture according to the AO / OTA classification was fixed with an angular stable locking plate. All right samples received a cement augmentation of their fenestrated condylar screws with calcium phosphate bone cement (CPC). Mechanical testing was performed at a load to failure mode by cyclic axial loading, using a servohydraulic testing machine. Results: With a mean of 2475 N (95% CI: 1727-3223 N), the pressure forces resulting in osteosynthesis failure were significantly higher in specimen with cemented condylar screws as compared to non-cemented samples (1875 N (95% CI: 1320-2430 N)) (p = 0.024). In both groups the deformation of the constructs, with the distal screws cutting through the condylar bone, were the most frequent cause for failure. Analysis of axial stiffness (p = 0.889) and irreversible deformity of the specimens revealed no differences between the both groups (p = 0.161). No cement leakage through the joint line or the medial cortex was observed. Conclusion: Based on the present study results, the newly introduced, cementable condylar screw could be an encouraging feature for the fixation of supracondylar femoral fractures in patients with reduced bone quality in terms of load to failure accuracy of the cement application.

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“…19 However, although no plate was present laterally, it was still found that the main complication with retrograde nailing was the prominence of distal locking screws. 22,37 Finally, it was shown by Demirtas et al 37 that the complications, union rate, and functional results of modern intramedullary nailing are no different than that of modern plating technology for extraarticular distal femoral fractures. A recent study on the fixation of distal femoral fractures with retrograde intramedullary nailing has demonstrated that modern locked plating and nailing present no significant difference in loadto-failure and that nails undergo less plastic deformation than plates.…”

Section: Intramedullary Nailingmentioning

confidence: 99%

“…19 Intramedullary nailing does have improved axial stability to plates and did lead to good results with a quoted 2.8% nonunion rate. 22 It also has been shown that intramedullary nailing is not as good as plates at controlling fractures with significant comminution, and they can lead to an incidence of malrotation as high as 28% and can have a nonunion rate of up to 15%. 25,35,36 Another common concern with retrograde intramedullary nails is knee sepsis from the arthrotomy created; however, review of the literature did not demonstrate this to be a problem.…”

Section: Intramedullary Nailingmentioning

confidence: 99%

Osteoporotic distal femoral fractures

Hagedorn

Achor

2016

Current Orthopaedic Practice

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Osteoporotic distal femoral fractures are complex problems to treat. As the population continues to age, orthopaedic surgeons must be aware of the challenges involved in treating these injuries. Obtaining and maintaining reduction until healing is a difficult challenge when the patient has poor bone quality. Current options for treatment include fixed angle constructs, such as angled blade plates and dynamic condylar screws, locked plating, retrograde intramedullary nailing, and replacement of the distal femur. Each treatment option has benefits and drawbacks. The goal of treatment remains minimizing complications while facilitating mobilization. FIGURE 2. A 63-year-old female stepped awkwardly off a curb, sustaining a fracture of the distal femur. (A) Injury anteroposterior radiograph. (B) Axial CT scan at the joint, revealing a nondisplaced intercondylar split. (C) Intraoperative fluoroscopic view showing start site for a retrograde nail, following placement of two interfragmentary lag screws across the condylar split. (D and E) Healed radiographs at 1-

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Distal femoral fractures in the elderly: biomechanical analysis of a polyaxial angle-stable locking plate versus a retrograde intramedullary nail in a human cadaveric bone model

Cited by 30 publications

References 43 publications

Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate

Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate

Cement augmentation of an angular stable plate osteosynthesis for supracondylar femoral fractures - biomechanical investigation of a new fixation device

Osteoporotic distal femoral fractures

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