Comparative clinical and biomechanical study of different types of osteosynthesis in the treatment of distal femur fractures

B Redondo-Trasobares; M Sarasa-Roca; J Rosell-Pradas; J Calvo-Tapies; L Gracia-Villa; J Albareda-Albareda

doi:10.1016/j.recot.2023.01.003

Comparative clinical and biomechanical study of different types of osteosynthesis in the treatment of distal femur fractures

Rev Esp Cir Ortop Traumatol. 2023 May-Jun;67(3):216-225. doi: 10.1016/j.recot.2023.01.003. Epub 2023 Jan 14.

[Article in English, Spanish]

Authors

B Redondo-Trasobares¹, M Sarasa-Roca², J Rosell-Pradas³, J Calvo-Tapies², L Gracia-Villa³, J Albareda-Albareda²

Affiliations

¹ Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España. Electronic address: beatrizredondo90@gmail.com.
² Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
³ Departamento de Ingeniería Mecánica, Universidad de Zaragoza, Zaragoza, España.

PMID: 36649756
DOI: 10.1016/j.recot.2023.01.003

Abstract

Introduction and objectives: Distal femoral fractures represent a problem due to their high number of complications. The aim was to compare the results, complications and stability achieved with retrograde intramedullary nailing and the angular stable plate in the treatment of distal femoral diaphyseal fractures.

Material and method: A clinical and experimental biomechanical study was carried out using finite elements. The results of the simulations allowed us to obtain the main results related to the stability of osteosynthesis. For clinical follow-up data, frequencies were used for qualitative variables, and Fisher's exact test and χ² test were used to evaluate the significance of the different factors, with the condition of P<.05.

Results: In the biomechanical study, the retrograde intramedullar nails demonstrated superiority, obtaining lower values in terms of global displacement, maximum tension, torsion resistance, and bending resistance. In the clinical study, the rate of consolidation of the plates was lower than nails (77% vs. 96%, P=.02). The factor that most influenced the healing of fractures treated with plate were the central cortical thickness (P=.019). The factor that most influenced the healing of nail-treated fractures was the difference between the diameter of the medullary canal and the nail.

Conclusions: Our biomechanical study shows that both osteosynthesis provide sufficient stability, but biomechanically behaves differently. Nails provide greater overall stability being preferable the use of long nails adjusted to the diameter of the canal. Plates form less rigid osteosynthesis, with little resistance to bending.

Keywords: Angular stable plate; Biomechanic; Biomecánica; Clavo; Distal femur fractures; Elementos finitos; Enclavado intramedular; Finite elements; Fractura fémur distal; Intramdullary nail; Nail; Osteosynthesis; Osteosíntesis; Placa; Placa estabilidad angular; Plate.