When is the stability of a fracture fixation limited by osteoporotic bone?

Konstantinidis, Lukas; Helwig, Peter; Hirschmüller, Anja; Langenmair, Elia; Südkamp, Norbert P.; Augat, Peter

doi:10.1016/s0020-1383(16)47005-1

Cited by 43 publications

(25 citation statements)

References 48 publications

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“…The chance of mobilisation is probably exacerbated by the poor bone quality in the region surrounding the lag screw postoperatively, and patients who have significantly multi-fragmented intertrochanteric fractures may be more prone to mobilisation [ 39 ]. We are conscious of the fact that we did not evaluate the bone mineral density (BMD) in our patients, but we point out that there is no agreement regarding values of BMD that may be used to indicate a higher risk of mobilisation in osteoporotic bone [ 40 ] Furthermore, the TAD has been shown to be an independent predictor risk factor of cephalic screw mobilisation after internal fixation [ 9 , 41 ], while the Singh Osteoporosis Index does not exhibit any significant relationship with the rate of cutout [ 22 ]. If revision surgery becomes necessary, a high mortality, or at the very least a high rate of in-hospital morbidity, and increasing costs are likely [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Greater rate of cephalic screw mobilisation following proximal femoral nailing in hip fractures with a tip–apex distance (TAD) and a calcar referenced TAD greater than 25 mm

Aicale

Maffulli

2018

J Orthop Surg Res

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BackgroundTo ascertain whether the tip–apex distance (TAD), calcar referenced TAD (CalTAD), and the sum of both (TADcalTAD) are predictive measurements of mobilisation of the cephalic screw in patients with trochanteric hip fractures.MethodsBetween 2014 and 2015, 68 patients (mean age 86 years, 45 females, 23 males) with a trochanteric hip fracture underwent intramedullary nailing. The TAD and CalTAD were measured, and for each parameter, we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).ResultsThere is evidence of a statistically significant association between a TAD and CalTAD greater than 25 mm and a TADcalTAD greater than 50 mm and mobilisation of the cephalic screw. All measurements have similar sensitivity, but the TAD presents the highest specificity (p < 0.01).ConclusionTo avoid the risk of mobilisation of the cephalic screw and possible subsequent failure of the construct, surgeons should strive for a TAD and CalTAD less than 25 mm and a TADcalTAD less than 50 mm when using intramedullary fixation.

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Section: Discussionmentioning

confidence: 99%

Greater rate of cephalic screw mobilisation following proximal femoral nailing in hip fractures with a tip–apex distance (TAD) and a calcar referenced TAD greater than 25 mm

Aicale

Maffulli

2018

J Orthop Surg Res

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“…The typical range of apparent density in cancellous bone is 1.0-1.4 g/cm 3 , compared to about 1.8-2.0 g/cm 3 , for compact bone [6]. Values of  lower than 0.25 g/cm 3 correspond to the fracture of osteoporotic bone [35].…”

Section: Fig 5 Stress-strain Diagram Of Cortical Bone Under Cyclic mentioning

confidence: 98%

Biomechanical analysis of tension-compression asymmetry, anisotropy and heterogeneity of bone reconstruction in response to periprosthetic fracture repair

2019

The Journal of v. N. Karazin Kharkiv National University, Series "Medicine"

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Introduction. Bone repair after periprosthetic fracture is a critical issue in orthopedics. Objectives. So there is a need for research to provide new medical solutions, especially in the context of population ageing in the Ukraine. The importance of biomechanics which is concerned with the application of principles, concepts and methods of mechanics of solid and fluid to the human body in motion and at rest is well recognized as a foundation for further experimental and theoretical research in the skeletal tissues. Materials and methods. Different aspects of biomechanics require different concepts and methods of mechanics of solid and fluid to be used. Remodeling occurs significantly throughout lifetime of bone that is why it can be regarded as a primary determinant of the mechanical properties of bone and implant. Biomechanical analysis given in this review has been concerned with understanding on how mechanical signals and molecular mechanisms affect the healing of Vancouver periprosthetic femoral fracture of B1 and C-type with the use of internal fixation through a less invasive stabilization system (LISS)-plate, which is screwed into the artificial hip joint. Results. Identification of such parameters as mechanical properties of bone, titanium alloys (hip prosthesis, coating, LISS-plate, screws) and implant/biomaterial interface with bone under mechanical and biochemical loading that are very essential for predicting arthroplasty outcomes were investigated experimentally considering elastoplastic deformation, creep, fatigue and ratcheting, as well as, damage development in materials under discussion. Among the basic deformation features were tension-compression asymmetry, anisotropy and heterogeneity of mechanical properties. We used the three-dimensional finite element model derived from the reconstruction of treatment and magnetic resonance (tomographic) images. Conclusions. As a result of this model analysis, it was found that treatment rate of periprosthetic femoral fractures after total hip arthroplasty with the use of LISS-plates and screws for internal fixation may be controlled by means of ABAQUS (or ANSYS) software package to reproduce the characteristic features of bone and implant in bone reconstruction in order to improve the fracture healing rate and shorten treatment duration Introduction. Bone repair after periprosthetic fracture is a critical issue in orthopedics. Objectives. So there is a need for research to provide new medical solutions, especially in the context of population ageing in the Ukraine. The importance of biomechanics which is concerned with the application of principles, concepts and methods of mechanics of solid and fluid to the human body in motion and at rest is well recognized as a foundation for further experimental and theoretical research in the skeletal tissues. Materials and methods. Different aspects of biomechanics require different concepts and methods of mechanics of solid and fluid to be used. Remodeling occurs significantly throughout lifetime of bone that is why it can be regarded as a primary determinant of the mechanical properties of bone and implant. Biomechanical analysis given in this review has been concerned with understanding on how mechanical signals and molecular mechanisms affect the healing of Vancouver periprosthetic femoral fracture of B1 and C-type with the use of internal fixation through a less invasive stabilization system (LISS)-plate, which is screwed into the artificial hip joint. Results. Identification of such parameters as mechanical properties of bone, titanium alloys (hip prosthesis, coating, LISS-plate, screws) and implant/biomaterial interface with bone under mechanical and biochemical loading that are very essential for predicting arthroplasty outcomes were investigated experimentally considering elastoplastic deformation, creep, fatigue and ratcheting, as well as, damage development in materials under discussion. Among the basic deformation features were tension-compression asymmetry, anisotropy and heterogeneity of mechanical properties. We used the three-dimensional finite element model derived from the reconstruction of treatment and magnetic resonance (tomographic) images. Conclusions. As a result of this model analysis, it was found that treatment rate of periprosthetic femoral fractures after total hip arthroplasty with the use of LISS-plates and screws for internal fixation may be controlled by means of ABAQUS (or ANSYS) software package to reproduce the characteristic features of bone and implant in bone reconstruction in order to improve the fracture healing rate and shorten treatment duration.

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“…Hierfür verwenden wir verschiedene Verfahren wie den "Tingart-Index" [36], den "Deltoid Tuberosity Index" [37] sowie die direkte Messung der lokalen Knochendichte im Q-CT [38]. Derzeit wird eine lokale Knochendichte von 95 mg/cm 3 als Grenzwert angesehen, unter dem eine hohe Gefahr für ein me-chanisches Implantatversagen durch Versagen des Knochen-Implantat-Interfaces besteht [39].…”

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Die proximale Humerusfraktur des geriatrischen Patienten

Plecko¹

2017

OP-JOURNAL

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ZusammenfassungFrakturen am proximalen Humerus stellen beim alten Patienten mit erheblicher Osteoporose auch heute noch, trotz der stark verbesserten Implantate und der verfeinerten Operationstechnik, eine große Herausforderung dar. In Abhängigkeit von den persönlichen Bedürfnissen eines geriatrischen Patienten, der Erwartungshaltung, dem Aktivitätsniveau, den kognitiven Fähigkeiten sowie der Frakturform, der Knochendurchblutung, dem Grad der Osteoporose, dem Zustand der Rotatorenmanschette und dem Grad der Arthrose ist heute ein individuell angepasstes Behandlungskonzept zu favorisieren. Dabei spielt auch die konservative Therapie eine zunehmende Rolle, da bei manchen Patienten weniger die weitgehende Wiederherstellung der Beweglichkeit als vielmehr die Schmerzfreiheit im Vordergrund steht. Es ist also eine individuelle Nutzen-Risiko-Abwägung notwendig und das Behandlungsziel und die notwendige Behandlungsstrategie mit dem Patienten bzw. seinen Angehörigen zu diskutieren und festzulegen. Die winkelstabile Plattenosteosynthese sollte im Bedarfsfall mit Zusatzmaßnahmen wie einer Zementaugmentation oder einem Knochengraft kombiniert werden, um ein sekundäres Nachsinken mit sekundärer Schraubenperforation zu vermeiden. Bei nicht sinnvoll rekonstruierbaren Frakturen hat die inverse Schulterprothese im geriatrischen Patientengut die Frakturhemiprothese weitgehend abgelöst und bietet eine gute Möglichkeit, rasch Schmerzfreiheit und eine brauchbare Alltagsfunktion zu erreichen.

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When is the stability of a fracture fixation limited by osteoporotic bone?

Cited by 43 publications

References 48 publications

Greater rate of cephalic screw mobilisation following proximal femoral nailing in hip fractures with a tip–apex distance (TAD) and a calcar referenced TAD greater than 25 mm

Greater rate of cephalic screw mobilisation following proximal femoral nailing in hip fractures with a tip–apex distance (TAD) and a calcar referenced TAD greater than 25 mm

Biomechanical analysis of tension-compression asymmetry, anisotropy and heterogeneity of bone reconstruction in response to periprosthetic fracture repair

Die proximale Humerusfraktur des geriatrischen Patienten

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