NDLI: Internal fixation of type-C distal femoral fractures in osteoporotic bone.

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Internal fixation of type-C distal femoral fractures in osteoporotic bone.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Wähnert, Dirk Hoffmeier, Konrad L. Von Oldenburg, Geert Fröber, Rosemarie Hofmann, Gunther O. Mückley, Thomas
Description	Country affiliation: Germany Author Affiliation: Wähnert D ( Department of Traumatology, Hand and Reconstructive Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, Jena, Germany. Dirk.Waehnert@med.uni-jena.de)
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.
File Format	HTM / HTML
ISSN	00219355
Issue Number	6
Volume Number	92
e-ISSN	15351386
Journal	The Journal of Bone and Joint Surgery-American Volume
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2010-06-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Orthopedic surgery Femoral Fractures Surgery Fracture Fixation, Intramedullary Instrumentation Fractures, Comminuted Osteoporosis Complications Biomechanical Phenomena Bone Nails Bone Plates Bone Screws Cadaver Humans Models, Biological Journal Article Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Surgery Sports Science

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