A biomechanical study on proximal plate fixation techniques in periprosthetic femur fractures

Injury. 2014 Jan:45 Suppl 1:S71-5. doi: 10.1016/j.injury.2013.10.027. Epub 2013 Oct 29.

Abstract

Introduction: Proximal plate fixation is a crucial factor in osteosynthesis of periprosthetic femur fractures. Stability and strength of different fixation concepts for proximal plate fixation were compared.

Materials and methods: Twelve fresh frozen, bone mineral density matched human femora, instrumented with cemented hip endoprosthesis were osteotomized simulating a Vancouver B1 fracture. Specimens were instrumented with locking compression plates, fixed proximally with either locking attachment plate (LAP), monocortical screws, cerclage plus monocortical screws (1cerclage) or cerclages only (4cerclages). Cyclic testing was performed with monotonically increasing load until failure. Relative movements at the proximal plate-femur interface were registered by motion tracking.

Results: The LAP construct exhibited a significantly longer cumulative survival (failure criterion 1mm separation at the proximal plate fixation) compared to the monocortical (p=0.048) and 4cerclages constructs (p=0.012) but not to 1cerclage constructs.

Conclusion: Bicortical screw anchorage improves proximal plate fixation in periprosthetic fractures. The cerclage-screw combination is a valuable alternative especially in osteoporotic bone.

Keywords: Cerclage; Hip arthroplasty; Locking attachment plate; Periprosthetic fracture.

Publication types

  • Evaluation Study

MeSH terms

  • Biomechanical Phenomena
  • Bone Plates*
  • Bone Screws*
  • Cadaver
  • Female
  • Femoral Fractures / surgery*
  • Fracture Fixation, Internal*
  • Humans
  • Male
  • Materials Testing
  • Osteotomy
  • Periprosthetic Fractures / surgery*
  • Weight-Bearing