Nail diameter significantly impacts stability in combined plate-nail constructs used for fixation of supracondylar distal femur fractures

Wright, David J.; DeSanto, Donald J.; McGarry, Michelle H.; Lee, Thay Q.; Scolaro, John A.

doi:10.1097/oi9.0000000000000174

Cited by 6 publications

(1 citation statement)

References 30 publications

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“…[10][11][12] NPC constructs have increased resistance to axial and torsional forces compared with LLP alone, and the addition of a nail to an LLP construct combat fatigue failure by serving as an endosteal substitute for the incompetent medial cortex. 17,18,22,[26][27][28] We believe this is most beneficial in distal femur fractures with medialsided comminution and to obese patients who submit their fracture fixation to supraphysiologic loads, because these patients are known to have a high rate of nonunion and implant failure.…”

Section: Discussionmentioning

confidence: 99%

Nail Plate Constructs are Associated with Decreased Rates of Reoperation in Complex Distal Femur Fractures

Roszman,

Cone,

Chodaba

et al. 2023

Journal of Orthopaedic Trauma

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Objectives: To determine if nail plate constructs have lower rates of reoperation to promote bone healing than lateral locking plates in the treatment of distal femur fractures. Design: Retrospective Cohort Setting: Single Level 1 trauma center Patients/Participants: 312 consecutive patients treated operatively for native distal femur fractures (OTA/AO 33A or 33C) Intervention: Reduction and fixation of distal femur fractures with either a lateral locked plate (LLP) or a nail plus plate construct (NPC) Main Outcome Measures: reoperation to promote bone healing at any time after definitive fixation Results: 279 fractures were treated with LLP and were compared with and 33 fractures treated with NPC constructs. Patient demographics, injury severity score (ISS), and frequency utilization of each construct between different types of OTA/AO classified distal femur fractures were similar. The reoperation rate to promote bone healing was 18.7% (51/273) for LLPs, and 3% (1/33) for NPC constructs. There was no significant difference in surgical site infection (SSI) (p = 0.67). Conclusions: Utilization of NPC technique demonstrated a significant decrease in rates of reoperation to promote bone healing compared to LLP alone in the treatment of OTA/AO 33A and 33C distal femur fractures. Augmented fixation with NPCs should be considered to treat complex distal femur fractures as it is associated with lower rates of reoperation to promote bone healing in comparison to LLP. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Nail Plate Constructs are Associated with Decreased Rates of Reoperation in Complex Distal Femur Fractures

Roszman,

Cone,

Chodaba

et al. 2023

Journal of Orthopaedic Trauma

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Relative contribution of the nail and plate to a nail‐plate construct for comminuted distal femoral fractures

Lin,

Parody,

Anil

et al. 2024

Journal Orthopaedic Research

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The purpose of this study was to assess the biomechanical contributions of the nail and the plate individually to a complete nail‐plate construct in the setting of comminuted distal femur fractures. For this biomechanical study, comminuted extra‐articular distal femur fractures were created in 24 synthetic osteoporotic femur models. These were then split into three groups: the nail‐only group, the plate‐only group, and the nail‐plate group. After fixation, each specimen underwent sequential axial and torsional loading, and axial and torsional stiffness were calculated and compared. The addition of a nail to a plate‐only construct increased axial stiffness by 19.7% and torsional stiffness by 59.4%. The plate‐only group and nail‐plate group both demonstrated significantly greater axial and torsional stiffness than the nail‐only group at all levels of axial and torsional load. (p < 0.001) At 1000 and 2000 N of cyclic loading, the nail‐plate group demonstrated significantly greater axial stiffness than the plate‐only group (p ≤ 0.018). The nail‐plate group demonstrated greater torsional stiffness than the plate‐only groups at all levels of torsional loading (p < 0.001). In osteoporotic comminuted distal femur fracture models, most of the axial stiffness in a nail‐plate construct comes from the plate. While the combination of the two constructs is not fully additive, the plate contributes the majority of the axial and torsional stiffness in a nail‐plate construct. The supplementation of the plate with a nail primarily helps to increase resistance to rotational forces. Level of Evidence: III.

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What is the stable internal fixation for the unstable and osteoporotic supracondylar femoral fractures: a finite element analysis

Rao,

Zhang,

et al. 2023

J Orthop Surg Res

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Background Osteoporotic supracondylar femoral fractures (OSFF) have historically been managed by the lateral anatomical locking plate with reasonable success. However, for some kinds of unstable and osteoporotic supracondylar femoral fractures (UOSFF), especially with bone defects, unilateral locking plate (ULLP) fixation failed or resulted in implant breakage. This paper is going to explore what is the stable internal fixation for UOSFF by adding the bilateral locking plate (BLLP) fixation. Methods OSFF models were divided into two groups according to the fracture line type, which would be further subdivided according to their angle of fracture line, presence of bone defect, location, and degree of bone defect. Thereafter, kinds of locking plate fixation were constructed. A 2010-N load was applied to the femoral head, and a 1086-N load was applied to the greater trochanter. In this condition, the maximum von Mises stress distribution of models were investigated. Results Firstly, it was obviously found that the stress concentration in the BLLP group was more dispersed than that in the ULLP group. Secondly, according to the fracture line analysis, the stress value of fracture line type in “\” model group was higher than that of “/” model group. Moreover, with the increase in fracture line angle, the stress value of the model increased. Thirdly, from the bone defect analysis, the stress value of the medial bone defect (MBD) model group was higher than that of the lateral bone defect (LBD) model group. And as the degree of bone defect increased, the stress value increased gradually in the model group. Conclusion In the following four cases, lateral unilateral locking plate fixation cannot effectively stabilize the fracture end, and double locking plate internal fixation is a necessary choice. First, when the angle of the fracture line is large (30, 45). Second, when the fracture line type is “/.” Third, when the bone defect is large. Fourth, when the bone defect is medial.

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Nail diameter significantly impacts stability in combined plate-nail constructs used for fixation of supracondylar distal femur fractures

Cited by 6 publications

References 30 publications

Nail Plate Constructs are Associated with Decreased Rates of Reoperation in Complex Distal Femur Fractures

Nail Plate Constructs are Associated with Decreased Rates of Reoperation in Complex Distal Femur Fractures

Relative contribution of the nail and plate to a nail‐plate construct for comminuted distal femoral fractures

What is the stable internal fixation for the unstable and osteoporotic supracondylar femoral fractures: a finite element analysis

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