Salvage procedures for trochanteric femoral fractures after internal fixation failure: Biomechanical comparison of a plate fixator and the dynamic condylar screw

Abstract

The aim of this study was the biomechanical evaluation of the reversed less invasive stabilization system (LISS) internal fixation as a joint-preserving salvage procedure for trochanteric fractures. Five LISS plates and five dynamic condylar screws (DCS) were tested using synthetic femora (Sawbones) with an osteotomy model similar to a type-A2.3 pertrochanteric fracture. The constructs were subjected to axial loading up to 1000 N for five cycles. Then, the force was continuously increased until fixation failure. For the evaluation of the biomechanical behaviour, the stiffness levels were recorded and the osteotomy gap displacement was mapped three-dimensionally. The average stiffness for the constructs with LISS plates was 412 N/mm (with a standard deviation (SD) of 103N/mm) and 572N/mm (SD of 116 N/mm) for the DCS constructs (p=0.051). Local displacement at the osteotomy gap did not yield any significant differences. The LISS constructs failed at a mean axial compression of 2103N (SD of 519N) and the DCS constructs at a mean of 2572N (SD of 372N) (p=0.14). It is concluded that the LISS plate offers a reliable fixation alternative for salvage procedures.

Comparison of proximal femoral nail antirotation (PFNA) with AO dynamic condylar screws (DCS) for the treatment for unstable peritrochanteric femoral fractures

“…However, it is obvious that many complications have been observed after surgeries. The most important of these complications are devascularization, seen as a result of over-dissection, union delay, failure to unify, and infection [26, 27]. The deficiency and fatigue of the implant should also be considered [17, 28, 29].…”

Sliding of the load carrier in third-generation intramedullary nails for proximal femur fractures: An in vitro mechanical comparison study

“…13 Despite this lack of evidence, every effort should be made to prevent complications of these types because the salvage procedure options after fixation failure are very limited. 14,15 This issue has been addressed experimentally in the past by Loch et al 8 They worked with an experimental setup very similar to the one we described here (especially using a similar perpendicular force) and found that the DHS possessed the best dynamization properties compared to the other intramedullary load carriers under testing (Recon, ZMS, and Gamma). Assuming that the Targon PFT in our study has a similar geometry to the DHS, our results are substantiated by the conclusions of Loch et al…”

Curative effect of artificial femoral head replacement and its effect on hip joint function and complications of senile patients with femoral intertrochanteric fracture

“…At the same time, the plate and screw can be fixed through the thread, making the locking plate a whole part, so that the fracture could be fixed on the ‘surface’, which could avoid stress concentration and enhance the capacity of anti-rotation and internal fixation. It is applied to the senile intertrochanteric fracture combined with osteoporosis ( 13 ). The PFLP surgery does not require shaping to make the large intertrochanteric fractures and the small intertrochanteric fractures to be well fixed.…”