Mechanical evaluation of a carbonated apatite cement in the fixation of unstable intertrochanteric fractures

Yetkinler, Duran N.; Goodman, Stuart B.; Reindel, E S; Carter, Dennis; Poser, Robert D.; Constantz, Brent R.

doi:10.1080/000164702753671731

Cited by 28 publications

(14 citation statements)

References 18 publications

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“…Almost every study used large amounts of bone cement to ensure distribution around the whole implant, but did not account for potential nonunion due to cement leakage into the fracture gap or to blocking of the sliding mechanism of the dynamic screw. 18,27,42 In the present study, this complication could be avoided by placing cement only around the screw thread by injecting it through the implanted and Figure 2. Load application curve, adapted from the findings of Bergmann and colleagues.…”

Section: Discussionmentioning

confidence: 88%

“…[12][13][14] The application of different bone cements, mostly based on polymethylmethacrylate (PMMA) or calcium phosphates (CaP), is a promising approach for further reducing implant cut-out. [15][16][17][18][19][20][21][22][23][24][25][26][27] However, no standardized technique has so far been developed that achieves safe and reproducible augmentation. Furthermore, infiltration of the trabecular network with viscous bone cements is difficult.…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical evaluation of a new augmentation method for enhanced screw fixation in osteoporotic proximal femoral fractures

et al. 2006

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A biomechanical investigation on eight pairs of human cadaver proximal femurs was performed to evaluate the impact of a new augmentation method on the internal fixation of osteoporotic proximal femur fractures. The study focused on enhancing implant purchase to reduce the incidence of implant cut-out in osteoporotic bone. In a left-right comparison, a conventional hip screw fixation (control) was compared to the new cement augmentation method. After bone bed preparation through high pressure irrigation to remove fat, blood, and bone debris, the bones were augmented with low viscosity polymethylmethacrylate (PMMA) cement.Step-wise fatigue testing was performed by cyclically loading the femoral heads in a physiological manner, beginning at 1,500 N and increasing 500 N every 5,000 cycles to 4,000 N, and continuously monitoring head displacement. Failure was defined as >5.0 mm head displacement. The head displacement at 2,000 N was significantly smaller (p ¼ 0.018) for the augmented group as compared to the conventionally treated bones (0.09 AE 0.01 mm vs. 0.90 AE 0.32 mm; mean AE SEM). The displacement rate at the second load step was significantly higher (p ¼ 0.018) for the conventionally treated bones as compared to the augmented ones. All of the nonaugmented specimens failed during testing, where 50% of the augmented specimens did not fail. The promising results of these experiments suggest that this new standardized irrigation/augmentation method enhances the implant anchorage and offers a potential solution to the problem of implant cut-out in osteoporotic metaphyseal bone. ß

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of a new augmentation method for enhanced screw fixation in osteoporotic proximal femoral fractures

et al. 2006

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“…[53][54][55][56][58][59][60][61][62][63] Two different cements were examined, namely, polymethylmethacrylate (PMMA) cement 56,58,59,[61][62][63] and calciumphosphate degradable cement. 55,56,60,62 Only one study used a composite. 52 Additionally the study settings differed in terms of the characteristics of the fracture, the implants used, the technique and the location of application of cement (Fig.…”

Section: Resultsmentioning

confidence: 99%

Fractures of the hip and osteoporosis

Lindner

Kanakaris

Marx

et al. 2009

The Journal of Bone and Joint Surgery. British volume

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Failure of fixation is a common problem in the treatment of osteoporotic fractures around the hip. The reinforcement of bone stock or of fixation of the implant may be a solution. Our study assesses the existing evidence for the use of bone substitutes in the management of these fractures in osteoporotic patients. Relevant publications were retrieved through Medline research and further scrutinised. Of 411 studies identified, 22 met the inclusion criteria, comprising 12 experimental and ten clinical reports. The clinical studies were evaluated with regard to their level of evidence. Only four were prospective and randomised.Polymethylmethacrylate and calcium-phosphate cements increased the primary stability of the implant-bone construct in all experimental and clinical studies, although there was considerable variation in the design of the studies. In randomised, controlled studies, augmentation of intracapsular fractures of the neck of the femur with calcium-phosphate cement was associated with poor long-term results. There was a lack of data on the longterm outcome for trochanteric fractures. Because there were only a few, randomised, controlled studies, there is currently poor evidence for the use of bone cement in the treatment of fractures of the hip.With the steadily increasing proportion of elderly people in the population, osteoporosis, a disease process characterised by compromised bone strength predisposing to an increased risk of fracture, will become epidemic. By 2012, 25% of people living in Europe will be older than 65 years 1 and more than 40% of women and 14% of men over the age of 50 years will sustain osteoporotic fractures.2 Common sites affected by osteoporotic fractures include the wrist, spine, ribs, humerus and the proximal femur.

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“…However, the effects of neutral sodium hydrogen phosphate on the initial setting time, the ensuing apatite formation, and the development of mechanical strength were found to be somewhat limited when Changes in DTS of Biopex ® pre-hardened in an incubator kept at 37°C and 100％ relative humidity for 1,4,8,24, and 168 hours after mixing with various liquid phases: distilled water (A), neutral sodium hydrogen phosphate solution (B), or succinic acid sodium salt solution (C). compared to those of TTCP-DCPA-based cement.…”

Section: Discussionmentioning

confidence: 99%

“…This is largely because of its twofold benefits: AC paste can set in situ and the final product after complete setting is apatite [1][2][3][4][5][6][7][8][9][10][11] . Due to the formation of apatitic structure, set AC shows excellent tissue response and good osteoconductivity.…”

Section: Introductionmentioning

confidence: 99%

Effects of liquid phase on basic properties of .ALPHA.-tricalcium phosphate-based apatite cement

et al. 2008

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Effects of liquid phase on the basic properties of α-tricalcuim phosphate (α-TCP)-based cement, BIOPEX ® , were investigated by employing three liquid phases: distilled water, neutral sodium hydrogen phosphate solution, and succinic acid disodium salt solution containing sodium salt of chondroitin sulfate. When mixed with neutral sodium hydrogen phosphate or succinic acid disodium salt solution, the initial setting times of the cement were 19.4±0.55 and 11.8±0.45 minutes respectively. These setting times were much shorter than that of distilled water, 88.4±0.55 minutes. Formation of needle-like crystals typical of apatite was much faster when neutral sodium hydrogen phosphate solution was used, as compared to distilled water or succinic acid disodium salt solution. Moreover, at 24 hours after mixing, the largest amount of apatite was formed when neutral sodium hydrogen phosphate solution was used, whereas use of succinic acid resulted in the least. On the final mechanical strength of the cement, that yielded with neutral sodium hydrogen phosphate solution was the highest. In contrast, lower mechanical strength was observed -especially at the initial stage -when succinic acid sodium salt was used. It was thus concluded thatα-TCP-based cement allowed accelerated transformation to apatite, and that higher mechanical strength since the initial stage was achieved when neutral sodium hydrogen phosphate solution was used as the liquid phase.

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Mechanical evaluation of a carbonated apatite cement in the fixation of unstable intertrochanteric fractures

Cited by 28 publications

References 18 publications

Biomechanical evaluation of a new augmentation method for enhanced screw fixation in osteoporotic proximal femoral fractures

Biomechanical evaluation of a new augmentation method for enhanced screw fixation in osteoporotic proximal femoral fractures

Fractures of the hip and osteoporosis

Effects of liquid phase on basic properties of .ALPHA.-tricalcium phosphate-based apatite cement

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