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A biomechanical study on proximal plate fixation techniques in periprosthetic femur fractures. 2014

Mark Lenz, and Stephan M Perren, and Boyko Gueorguiev, and Robert G Richards, and Gunther O Hofmann, and Alberto Fernandez dell'Oca, and Dankward Höntzsch, and Markus Windolf
AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos-Platz, Switzerland; Department of Trauma, Hand and Reconstructive Surgery, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07747 Jena, Germany. Electronic address: mark.lenz@med.uni-jena.de.

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

UI MeSH Term Description Entries
D008297 Male Males
D008422 Materials Testing The testing of materials and devices, especially those used for PROSTHESES AND IMPLANTS; SUTURES; TISSUE ADHESIVES; etc., for hardness, strength, durability, safety, efficacy, and biocompatibility. Biocompatibility Testing,Biocompatible Materials Testing,Hemocompatibility Testing,Testing, Biocompatible Materials,Testing, Hemocompatible Materials,Hemocompatibility Testings,Hemocompatible Materials Testing,Materials Testing, Biocompatible,Materials Testing, Hemocompatible,Testing, Biocompatibility,Testing, Hemocompatibility,Testing, Materials,Testings, Biocompatibility
D010027 Osteotomy The surgical cutting of a bone. (Dorland, 28th ed) Osteotomies
D001860 Bone Plates Implantable fracture fixation devices attached to bone fragments with screws to bridge the fracture gap and shield the fracture site from stress as bone heals. (UMDNS, 1999) Bone Plate,Plate, Bone,Plates, Bone
D001863 Bone Screws Specialized devices used in ORTHOPEDIC SURGERY to repair bone fractures. Bone Screw,Screw, Bone,Screws, Bone
D002102 Cadaver A dead body, usually a human body. Corpse,Cadavers,Corpses
D005260 Female Females
D005264 Femoral Fractures Fractures of the femur. Femoral Fracture,Fracture, Femoral,Fractures, Femoral
D005593 Fracture Fixation, Internal The use of internal devices (metal plates, nails, rods, etc.) to hold the position of a fracture in proper alignment. Osteosynthesis, Fracture,Fixation, Internal Fracture,Fixations, Internal Fracture,Fracture Fixations, Internal,Fracture Osteosyntheses,Fracture Osteosynthesis,Internal Fracture Fixation,Internal Fracture Fixations,Osteosyntheses, Fracture
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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