TITLE

Internal Fixation of Type-C Distal Femoral Fractures in Osteoporotic Bone

AUTHOR(S)
Wähnert, Dirk; Hoffmeier, Konrad L.; von Oldenburg, Geert; Fräber, Rosemarie; Hofmann, Gunther O.; Mückley, Thomas
PUB. DATE
June 2010
SOURCE
Journal of Bone & Joint Surgery, American Volume;Jun2010, Vol. 92-A Issue 6, p1442
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Fixation of distal femoral fractures remains a challenge, especially in osteoporotic bone. This study was performed to investigate the biomechanical stability of four different fixation devices for the treatment of comminuted distal femoral fractures in osteoporotic bone. Methods: Four fixation devices were investigated biomechanically under torsional and axial loading. Three intramedullary nails, differing in the mechanism of distal locking (with two lateral–to–medial screws in one construct, one screw and one spiral blade in another construct, and four screws [two oblique and two lateral–to–medial with medial nuts] in the third), and one angular stable plate were used. All constructs were tested in an osteoporotic synthetic bone model of an AO/ASIF type 33–C2 fracture. Two nail constructs (the one–screw and spiral blade construct and the four–screw construct) were also compared under axial loading in eight pairs of fresh–frozen human cadaveric femora. Results: The angular stable plate constructs had significantly higher torsional stiffness than the other constructs; the intramedullary nail with four–screw distal locking achieved nearly comparable results. Furthermore, the four–screw distal locking construct had the greatest torsional strength. Axial stiffness was also the highest for the four–screw distal locking device; the lowest values were achieved with the angular stable plate. The ranking of the constructs for axial cycles to failure was the four–screw locking construct, with the highest number of cycles, followed by the angular stable plate, the spiral blade construct, and two–screw fixation. The findings in the human cadaveric bone were comparable with those in the synthetic bone model. Failure modes under cyclic axial load were comparable for the synthetic and human bone models. Conclusions: The findings of this study support the concept that, for intramedullary nails, the kind of distal interlocking pattern affects the stabilization of distal femoral fractures. Four–screw distal locking provides the highest axial stability and nearly comparable torsional stability to that of the angular stable plate; the four–screw distal interlocking construct was found to have the best combined (torsional and axial) biomechanical stability. Clinical Relevance: The enhanced distal interlocking stability of four–screw distal locking construct may be beneficial to the stabilization of complex distal femoral fractures, especially in osteoporotic bone.
ACCESSION #
51403998

 

Related Articles

  • Advancing a guide wire for intramedullary nail across an obliterated medullary canal during femoral diaphyseal osteotomy: a technical trick. Singh, A.K.; Livingstone, J.A.; Jackson, M. // European Journal of Orthopaedic Surgery & Traumatology;Apr2004, Vol. 14 Issue 1, p55 

    The use of a reamed intramedullary nail allows the immediate correction and stabilisation of deformity in diaphysis of the femur. Passing a guide wire after a femoral diaphyseal osteotomy can prove to be difficult, particularly if the medullary canal has been narrowed or obliterated by bone...

  • Hoffa fracture: fixation using headless compression screws. Borse, V.; Hahnel, J.; Cohen, A. // European Journal of Trauma & Emergency Surgery;Oct2010, Vol. 36 Issue 5, p477 

    Introduction: Hoffa fractures are uni- or bicondylar fractures of the distal femur in a coronal tangential plane. Case Presentation: We report the case of an isolated, low energy, closed, displaced, lateral femoral condyle Hoffa fracture in a 54 year old Caucasian man. This was treated by open...

  • Use of 2.0 mini plate system as reduction plate. Jong-Keon Oh; Sahu, Dipit; Jong-Woong Park; Chang-Wug Oh; Jin-Ho Hwang // Archives of Orthopaedic & Trauma Surgery;Oct2010, Vol. 130 Issue 10, p1239 

    Fracture stabilization and reduction using temporary plates during intramedullary tibial nailing was introduced as a novel concept in fracture surgery by Benirschke et al. (Orthop Trans 18:1055–1056, ). The concept of temporary reduction using one-third tubular plates proved useful in...

  • The Sliding Hip Screw Is Better Than Short Femoral Nails for Extracapsular Femoral Fracture.  // Journal of Bone & Joint Surgery, American Volume;Aug2004, Vol. 86-A Issue 8, p1836 

    This article compares the efficacy of cephalocondylic intramedullary nails with that of extramedullary fixation implants, in patients with extracapsular proximal femoral fractures. Studies were identified by searching the Cochrane Musculoskeletal Injuries Group trials register. Pooling the...

  • Management of a neglected femoral neck fracture in a limb affected by poliomyelitis -- a case report. Mootha, Aditya K.; Sen, Ramesh K.; Aggarwal, Sameer; Bali, Kamal; Saini, Raghav // Hip International;Apr-Jun2011, Vol. 21 Issue 2, p267 

    Neglected femoral neck fractures are difficult to treat successfully without resorting to total hip arthroplasty. Baksi described a tensor fascia lata muscle pedicle bone graft procedure for such cases. Management of such fractures following poliomyelitis presents additional challenges. We...

  • THE INSTRUMENTS KIT USED FOR DYNAMIC STABILIZED ELASTIC OSTEOSYNTHESIS IN TROCHANTERIC FRACTURES OF THE FEMUR. RĂDULESCU, Radu; BĂDILĂ, Adrian; FIRICĂ, Andrei; MOLDOVAN, Laurenţiu; MANOLESCU, Robert // Metalurgia International;Jun2013, Vol. 18 Issue 6, p243 

    The aim of the study was to design, construct and test the prototype of a device for dynamic stabilization used in elastic and mixed osteosynthesis, as well as to design and develop the instrument kit needed for its implantation. Mixed osteosynthesis is a combination between the well-known...

  • Sistemas osso-implante ex vivo utilizando haste intramedular polimérica para imobilização de fraturas femorais em bovinos jovens. Junior, Odael Spadeto; Rodrigues, Luciano Brito; Vilela Carvalho, Wellington Tadeu; de Oliveira Moreira, Deliene; de Marval, Cyril Alexandre; Gomes da Costa, Cláudio; Silveira Alves, Geraldo Eleno; de Las Casas, Estevam Barbosa; Faleiros, Rafael Resende // Ciência Rural;fev2011, Vol. 41 Issue 2, p301 

    The development of new devices using available and low cost materials may be an useful alternative for the treatment of long bone fractures in large animals. The aim of this study was to evaluate the mechanical strength of young bovine femur with diaphyseal fracture fixed with different...

  • Is distal locking with IMHN necessary in every pertrochanteric fracture? Skála-Rosenbaum, Jiří; Bartoníček, Jan; Bartoška, Radek // International Orthopaedics;Oct2010, Vol. 34 Issue 7, p1041 

    Two groups of patients were treated for pertrochanteric fractures (AO/ASIF 31A1+A2) with an intramedullary hip nail. In the first group of 44 patients distal dynamic locking was used, and in the second group of 74 patients the nail was not distally locked. Comparison of the two groups of...

  • Biomechanical analysis of a synthetic femoral spiral fracture model: Do end caps improve retrograde flexible intramedullary nail fixation?  // Journal of Orthopaedic Surgery & Research;2011, Vol. 6 Issue 1, p46 

    The article reports on a research related to the study of treatments of for femoral shaft fractures. It states that Elastic Stable intramedullary Nailing (ESIN) is an accepted method for the treatment of femur fractures. It also informs that the stability of simulated spiral femoral fractures is...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics