The Effect of Strut Allograft and Its Position on Vancouver Type B1 Periprosthetic Femoral Fractures: A Biomechanical Study

Sariyilmaz, Kerim; Dikici, Fatih; Dikmen, Göksel; Bozdağ, Ergün; Sünbüloğlu, Emin; Bekler, Bugra; Yazıcıoğlu, Önder

doi:10.1016/j.arth.2014.02.017

Cited by 27 publications

(34 citation statements)

References 32 publications

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“…Confirming that when unstable injuries are managed in clinical practice and absolute stability is not achieved by fixation with a LCP, the stiffness of the construct is decreased. It may therefore be wise to use additional fixations such as anterior allografts or at least strongly recommend partial weight bearing for patients with unstable injuries, until union is achieved [14,15,18,19]. If the plate is considered inadequate for achieving safe fixation then a long stem revision is recommended to address both bone healing and stem survival [20][21].…”

Section: Discussionmentioning

confidence: 99%

Periprosthetic femoral fracture fixation: A biomechanical comparison between proximal locking screws and cables

Graham

Mak

Moazen

et al. 2015

Journal of Orthopaedic Science

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Background: The incidence of periprosthetic femoral fractures (PFF) around a stable stem is increasing. The aim of this biomechanical study is to examine how three different methods of fixation, for Vancouver type B1 PFF, alter the stiffness and strain of a construct under various configurations in order to gain a better insight into the optimal fixation method. Methods:Three different combinations of proximal screws and Dall-Miles cables were used: (A) proximal unicortical locking screws alone; (B) proximal cables and unicortical locking screws; (C) proximal cable alone, each in combination with distal bicortical locking screws, to fix a stainless steel locking compression plate to five synthetic femora with simulated Vancouver type B1 PFFs. In one synthetic femora there was a 10mm fracture gap, in order to simulate a comminuted injury. The other four femora had no fracture gap, to simulate a stable injury. An axial load was applied to the constructs, at varying degrees of adduction and the overall construct stiffness and surface strain were measured.Results: With regards to the stiffness, in both the gap and no gap models, method of fixation A was the stiffest form of fixation. The inclusion of the fracture gap reduced the stiffness of the construct quite considerably for all methods of fixation. The strain, across both the femur and the plate, was considerably less for method of fixation C, compared to A and B at the locations considered in this study. Conclusion:This study highlights that the inclusion of cables appears to damage the screw fixations and does not aid in the construct stability. Furthermore, the degree of fracture reduction affects the whole construct stability and the bending behaviour of the fixation.

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Section: Discussionmentioning

confidence: 99%

Periprosthetic femoral fracture fixation: A biomechanical comparison between proximal locking screws and cables

Graham

Mak

Moazen

et al. 2015

Journal of Orthopaedic Science

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“…As for mechanical criteria, these are already well known. Characteristics of the fracture and type of hardware have been evaluated, with biomechanical studies [60,[62][63][64][65][66][67][68][69] con rming clinical remarks. The use of bicortical screws around the stem is preferable over cerclages alone or cerclages plus monocortical screws, even if a recent clinical study showed no differences in results when only proximal cables where used with a non-locking plate [70].…”

Section: Discussionmentioning

confidence: 98%

Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

Mondanelli

Colasanti

Cataldi

et al. 2020

Preprint

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Background: There is lack of consensus regarding best operative fixation strategy for periprosthetic femoral fractures (PFFs) around a stable stem. Based on our experience in the treatment of nonunions after PFFs and other challenging cases and on Literature, we propose an algorithm that can guide in choosing the ideal surgical technique even for first-time PFFs with a stable stem.Methods: We retrospectively reviewed data on patients who failed to heal after a surgically treated Vancouver type B1 or C PFF. All patients were treated with locking plate, double structural allograft and autologous bone marrow concentrate (BMC) over a platelet-rich plasma (PRP)-based membrane at fracture site. All patients were also pharmacologically treated with Teriparatide in the postoperative period. We studied patients with radiograms, histological evaluation of the nonunion area, and phosphocalcic metabolism. Patients were assessed subjectively, clinically and radiographically until healing and then annually.Results: All nonunions healed over a six months period, and functional recovery appeared to be good. Retrospective evaluation of the proposed algorithm showed that none of the patients met biological or mechanical criteria such as to make valid the treatment with locking plate alone.Conclusion: Mechanical factors are not the only issues that should be taken into account when choosing the surgical approach to PFFs over a stable stem. Systemic and local biological conditions are factors that should drive to a rigid fixation with absolute stability (using a plate and structural allograft) plus local biological support (structural allograft and autologous BMC in a PRP-based scaffold) and systemic anabolic treatment (Teriparatide) in the first instance. A therapeutic algorithm is proposed, given the prosthetic stem to be stable, taking into account mechanical and biological criteria.

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“…27,28 Unfortunately, previous biomechanical studies of lytic lesions, as well as traumatic femur fractures, lack either control data on intact femurs or data on the residual weakness of fixated femurs compared with intact femurs. 13,15,20,21,29,30 Accordingly, we were unable to identify a comparison study reporting how much weaker a successfully fixated femur is expected to be than an intact femur in these settings.…”

Section: Discussionmentioning

confidence: 99%

“…These femurs have been frequently used in orthopedic studies of femur fractures and are manufactured to simulate the femurs of men younger than 80 years with good bone quality. 13–15 …”

Section: Methodsmentioning

confidence: 99%

Association of the Anterolateral Thigh Osteomyocutaneous Flap With Femur Structural Integrity and Assessment of Prophylactic Fixation

Worley

Patterson

Graboyes

et al. 2018

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE The chimeric anterolateral thigh osteomyocutaneous (ALTO) free flap is a recently described microvascular option for head and neck osseous defects associated with complex soft-tissue requirements. To date, the association of ALTO flap harvest with femur structural integrity and the need for routine prophylactic fixation following harvest has been incompletely described. OBJECTIVE To investigate the association of ALTO flap harvest, with and without prophylactic fixation, on femur structural integrity as measured by 4-point bend and torsional biomechanical testing. DESIGN AND SETTING At a research laboratory, 24 synthetic fourth-generation composite femurs with validated biomechanical properties underwent 10-cm-long, 30% circumferential osteotomies at the proximal middle third of the femur; 6 femurs served as controls. Osteotomized femurs with and without fixation underwent torsional and 4-point bend biomechanical testing. Femur fixation consisted of intramedullary nail and distal interlock screw placement. MAIN OUTCOMES AND MEASURES Force and torque to fracture (expressed in kilonewtons [kN] and Newton meters [N·m], respectively) were compared between controls, osteotomized femurs without fixation, and osteotomized femurs with fixation. Additional outcome measures included femur stiffness and fracture patterns. RESULTS On posterior to anterior (PA) 4-point bend testing, force to fracture of osteotomized femurs was 22% of controls (mean difference, 8.3 kN; 95% CI, 6.6–10.0 kN). On torsional testing the torque to fracture of osteotomized femurs was 12% of controls (mean difference, 351.1 N·m; 95% CI, 307.1–395.1 N·m). Following fixation there was a 67% improvement in PA force to fracture and a 37% improvement in torque to fracture. However, osteotomized femurs with fixation continued to have a reduced PA force to fracture at 37% of controls (mean difference, 6.8 kN; 95% CI, 4.5–9.2 kN) and torque to fracture at 16% of controls (mean difference, 333.7 N·m; 95% CI, 306.8–360.6 N·m). On torsional testing, all osteotomized femurs developed similar spiral fractures through a corner of the distal osteotomy site. This fracture pattern changed after prophylactic fixation with femurs developing nondisplaced fractures through the proximal osteotomy site. There were no underlying hardware failures during testing of osteotomized femurs with fixation. CONCLUSIONS AND RELEVANCE Anterolateral thigh osteomyocutaneous flap harvest results in significant changes in the structural integrity of the femur. Postoperative stabilization should be strongly considered, with future research directed at investigating the clinical significance of residual biomechanical changes following femur fixation.

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The Effect of Strut Allograft and Its Position on Vancouver Type B1 Periprosthetic Femoral Fractures: A Biomechanical Study

Cited by 27 publications

References 32 publications

Periprosthetic femoral fracture fixation: A biomechanical comparison between proximal locking screws and cables

Periprosthetic femoral fracture fixation: A biomechanical comparison between proximal locking screws and cables

Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

Association of the Anterolateral Thigh Osteomyocutaneous Flap With Femur Structural Integrity and Assessment of Prophylactic Fixation

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