Double plating in Vancouver type B1 periprosthetic proximal femur fractures: A biomechanical study

Abstract

Periprosthetic hip fractures are an increasing problem in modern orthopedic and trauma surgery. Many options for the operative treatment are available to the surgeon ranging from modern variable angular systems to standard plates, screws, and cerclages. However, there is no gold standard and therefore, the aim of this study, was to investigate the biomechanical characteristics of double plating versus a lateral standard plate in a Vancouver B1 fracture model. Ten 4th generation composite femora were used to implant cementless total hip prosthesis and create Vancouver B1 periprosthetic fractures. Afterwards, the osteotomies were fixed using the locking compression plate in combination with the locking attachment plate (LCP, LAP, DePuy Synthes, Solothurn, Switzerland)-group I. Group II additionally achieved a 5-hole 4.5/5.0 mm LCP anteriorly. Each construct was cyclically loaded to failure in axial compression. Axial construct stiffness was 50.87 N/mm (SD 1.61) for group I compared to 738.68 N/mm (SD 94.8) for group II, this difference was statistically significant (p = 0.016). The number of cycles to failure was also significant higher for group II (2,375 vs. 13,000 cycles; p = 0.016). Double plating can significantly increase construct stiffness and stability, and thus, is an option in the treatment of complex periprosthetic fractures, in revision surgery and for patients with the inability to partial weight bear. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:234-239, 2017.

Biomechanical properties of plate constructs for feline ilial fracture gap stabilization

“…The high stiffness of DoubleLCPnl constructs was consistent with previous studies on double plating of long bones in veterinary and human medicine . Among those studies, orthogonal plate constructs were stiffer and resisted higher loads to failure in a canine tibial fracture gap model than plate rod constricts .…”

“…Among those studies, orthogonal plate constructs were stiffer and resisted higher loads to failure in a canine tibial fracture gap model than plate rod constricts . Similar results were also found in a biomechanical study comparing the axial construct stiffness of orthogonal plates to single lateral bone plates in periprosthetic femur fractures in humans . The effect of orthogonal plates on mechanical properties of the construct is multifold.…”

Biomechanics of Upper Extremity Double Plating

“…For lower extremity fractures, the principle of DP has already been widely used for years to treat bicondylar tibial plateau fractures or pilon fractures. Likewise, biomechanical data was able to demonstrate the advantages of DP for periprosthetic fractures of the proximal femur, which have become more prevalent in recent years [9]. At the same time, new treatment options have become available for patients with good bone quality.…”

Biomechanics of Osteoporotic Fracture Fixation

“…These constructs require a large surgical approach and seriously deteriorate the healing capacity, thus serving as a permanent mechanical stabilizer. They may be a viable rescue option, especially for patients with unstable comminuted fractures, severe osteoporosis, over-weight, or other noncompliant patients with a need for immediate post-operative full weightbearing [111]. In unstable type B3 and type C fractures, a long stem revision in combination with a long plate often provides the only option for treatment [112,113].…”