Abstract
Introduction
The introduction of fixed-angle plate osteosynthesis techniques has provided us a
further means to treat periprosthetic femoral fractures. The goal of this experimental
study is to evaluate the biomechanical properties and stability of treated periprosthetic
fractures when using two different plate systems, which vary in the locking mechanism
and the screw placement (monocortical or bicortical) with respect to the prosthesis
stem.
Materials and methods
Using five pairs of formalin-fixed femora, a Vancouver B1 periprosthetic fracture
was treated either with a 13-hole LISS® titanium plate using four monocortical periprosthetic screws or with a non-contact
bridging plate (NCB) DF® plate using bicortical angle-stable blocked screws positioned ventrally or dorsally
to the prosthesis stem. Bones were loaded under axial and cyclic compression with
a progressively increased load until failure. Displacement at the osteotomy gap was
measured during loading using an ultra-sound measuring system.
Results
The mean displacement in the region of the fracture gap was not significantly different
at any time during the experiments for the two models. The mean force resulting in
subsequent model failure was similar in both models; the failure morphology varied
slightly between the models, however. Four of the five LISS® models exhibited either a tear-out of the monocortical screws or a decortication
from the bony shaft of the cortical lamella surrounding the screws. On the other side,
two of the NCB models showed macroscopically visible fissures along the osteosynthesis
plates at the height of the osteotomy gap, and were hence considered implant failures.
Only one NCB model showed tear-out of the bicortically placed screws.
Conclusion
Bicortical screw placement provides more stable anchoring when compared to monocortical
screw fixation. However, in relation to the amount of motion at the osteotomy gap
and to failure loads, stabilisation of periprosthetic femoral fractures can be equally
well achieved using either the LISS® plate with periprosthetic monocortical screws or the NCB plate with poly-axially
placed bicortical screws.
Keywords
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Article info
Publication history
Accepted:
May 3,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
