A biomechanical evaluation of cortical onlay allograft struts in the treatment of periprosthetic femoral fractures

2003 ◽  
Vol 13 (3) ◽  
pp. 148-158 ◽  
Author(s):  
F.S. Haddad ◽  
M.N. Dehaan ◽  
O. Brady ◽  
B.A. Masri ◽  
D.S. Garbuz ◽  
...  
Keyword(s):  
Testing Machine ◽  
Femoral Stem ◽  
Femoral Fractures ◽  
Fracture Site ◽  
Camera System ◽  
Cable Tension ◽  
Periprosthetic Femoral Fractures ◽  
Significant Difference ◽  
Fracture Stability ◽  
Fracture Motion

Periprosthetic femoral fractures are increasingly addressed through the use of cortical onlay allografting. This study was designed to determine the effect of allograft cortical strut length, configuration, cable number, cable tension and the use of wire or cable on the fixation of periprosthetic femoral fractures. Ten cadaveric femora-strut constructs were tested using anteroposterior and axial loads to simulate the forces at the hip during gait. A transverse fracture at the level of the tip of the femoral stem was simulated. A biaxial servohydraulic testing machine was used to apply one hundred cycles of craniocau-dal load of 1.53 × bodyweight at a frequency of one Hz, along with an anteroposterior load of 0.15 × bodyweight at one half Hz. Variables for different constructs included the strut length (twelve cm, sixteen cm, or twenty cm), the number of cables (two, three, or four above and below the fracture site), cable tension, strut configurations and orientation (single strut or two struts, adjacent or opposite), and the use of wires instead of cables. Cable tension was measured using a calibrated tensioner. Movement at the fracture site was measured using a precision optoelectronic camera system. There was significantly less motion when cables were used rather than wires (p<0.05). Increasing the number of cables decreased fracture motion in some directions (p<0.05) and increasing cable tension showed a trend towards decreased fracture motion. We observed strut fractures in four cases when a single strut alone was used to stabilise the fracture. There was a significant decrease in fracture motion if two struts were used rather than one (p<0.01), but there was no significant difference between the anterior and lateral, and the medial and lateral strut configurations. Decreasing the strut length from twenty cm to twelve cm led to a significant decrease in axial rotation (p<0.05). Our data strongly favour the use of two struts, rather than a single strut alone. Cables enhance fracture stability compared to wires, presumably due to increased tension and to different surface characteristics. Increasing the cable tension gave greater stability although this may not fully translate to the clinical situation because the cable may garrotte or fracture the strut. Increased cable number and decreased strut length also enhanced fracture stability. The cortical struts essentially represent biological bone plates. If appropriately selected and prepared they can be customised to fit any femur. Our improved understanding of this technique should contribute to high rates of fracture union with an increase in bone stock and overall bone strength.

Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

2020 ◽  
Author(s):  
Nicola Mondanelli ◽  
Giovanni Battista Colasanti ◽  
Carlo Cataldi ◽  
Fabio Moreschini ◽  
Vanna Bottai ◽  
...  
Keyword(s):  
Locking Plate ◽  
Platelet Rich Plasma ◽  
Femoral Fractures ◽  
Autologous Bone Marrow ◽  
Fracture Site ◽  
Histological Evaluation ◽  
Rigid Fixation ◽  
Structural Allograft ◽  
Periprosthetic Femoral Fractures ◽  
Therapeutic Algorithm

Abstract Background: There is lack of consensus regarding best operative fixation strategy for periprosthetic femoral fractures (PFFs) around a stable stem. Based on our experience in the treatment of nonunions after PFFs and other challenging cases and on Literature, we propose an algorithm that can guide in choosing the ideal surgical technique even for first-time PFFs with a stable stem.Methods: We retrospectively reviewed data on patients who failed to heal after a surgically treated Vancouver type B1 or C PFF. All patients were treated with locking plate, double structural allograft and autologous bone marrow concentrate (BMC) over a platelet-rich plasma (PRP)-based membrane at fracture site. All patients were also pharmacologically treated with Teriparatide in the postoperative period. We studied patients with radiograms, histological evaluation of the nonunion area, and phosphocalcic metabolism. Patients were assessed subjectively, clinically and radiographically until healing and then annually.Results: All nonunions healed over a six months period, and functional recovery appeared to be good. Retrospective evaluation of the proposed algorithm showed that none of the patients met biological or mechanical criteria such as to make valid the treatment with locking plate alone.Conclusion: Mechanical factors are not the only issues that should be taken into account when choosing the surgical approach to PFFs over a stable stem. Systemic and local biological conditions are factors that should drive to a rigid fixation with absolute stability (using a plate and structural allograft) plus local biological support (structural allograft and autologous BMC in a PRP-based scaffold) and systemic anabolic treatment (Teriparatide) in the first instance. A therapeutic algorithm is proposed, given the prosthetic stem to be stable, taking into account mechanical and biological criteria.

scholarly journals Atypical periprosthetic femoral fracture associated with long-term bisphosphonate therapy

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Dávid Dózsai ◽  
Tamás Ecseri ◽  
István Csonka ◽  
István Gárgyán ◽  
Péter Doró ◽  
...  
Keyword(s):  
Femoral Fracture ◽  
Case Reports ◽  
Femoral Stem ◽  
Femoral Fractures ◽  
Atypical Femoral Fracture ◽  
Periprosthetic Fractures ◽  
Periprosthetic Femoral Fracture ◽  
Mineral Research ◽  
Periprosthetic Femoral Fractures

Abstract Background Atypical femoral fracture is one of the many complications after the long-term use of bisphosphonates. The American Society for Bone and Mineral Research has officially excluded periprosthetic femoral fractures (PFFs) from the definition of atypical femoral fractures (AFFs). Several case reports found that PFFs can occur with characteristics similar to those of AFFs. The purpose of our study was to evaluate the proportion of atypical fractures among Vancouver type B1 fractures, and to determine the association between the long-term use of bisphosphonates and the occurrence of atypical periprosthetic femoral fractures (APFFs). Methods In this retrospective study, we reviewed 41 patients with Vancouver type B1 periprosthetic fractures between January 1, 2011 and December 31, 2018. We classified them into two groups, namely atypical and typical PFFs, based on the fracture morphology. We noted the proportion of atypical periprosthetic fractures among B1 fractures and identified risk factors. Results Among the 41 PFFs, 5 (13%) fractures were classified as atypical PFF based on the radiological characteristics. The longer duration of bisphosphonate use was probably the only independent risk factor that significantly increases the occurrence of APFF (p = 0.03, 0.08 (CI 0.008 – 0.16)). There were no significant differences in age, gender, body mass index, comorbidities, corticosteroid use, positioning of the femoral stem, the method of fixation (cemented or cementless) and time lapse from before the primary prosthesis implantation to the PFF in the development of atypical fracture type. Conclusions There seems to be a correlation between the long-term intake of bisphosphonates and the atypical periprosthetic fracture. Atypical femoral fracture can also occur in the periprosthetic form. Trial registration Study number: 22/2019-SZTE, http://www.klinikaikutatas.hu/hu/kutatasetika/jovahagyott-vizsgalatok-koezerdeku-adatai/category/25-jovahagyott-vizsgalatok-kozerdeku-adatai-rkeb-2019.html?download=985:22-2019.

scholarly journals The Effect of Fracture Stability on the Performance of Locking Plate Fixation in Periprosthetic Femoral Fractures

2013 ◽  
Vol 28 (9) ◽  
pp. 1589-1595 ◽  
Author(s):  
Mehran Moazen ◽  
Jonathan H. Mak ◽  
Lee W. Etchels ◽  
Zhongmin Jin ◽  
Ruth K. Wilcox ◽  
...  
Keyword(s):  
Locking Plate ◽  
Plate Fixation ◽  
Femoral Fractures ◽  
Locking Plate Fixation ◽  
Periprosthetic Femoral Fractures ◽  
Fracture Stability

scholarly journals Periprosthetic femoral fractures in sideways fall configuration: comparative numerical analysis of the influence of femoral stem design

2020 ◽  
Vol 30 (2_suppl) ◽  
pp. 86-93
Author(s):  
Massimo Franceschini ◽  
Luigi La Barbera ◽  
Alberto Anticonome ◽  
Claudia Ottardi ◽  
Atsuki Tanaka ◽  
...  
Keyword(s):  
Stress State ◽  
Clinical Data ◽  
Numerical Models ◽  
Femoral Stem ◽  
Femoral Fractures ◽  
Progressive Increase ◽  
Fracture Site ◽  
Stem Design ◽  
Vertical Loading ◽  
Sideways Fall

Introduction: The aim of this study was to investigate the mechanisms of periprosthetic fractures occurring as a result of a sideways fall in total hip arthroplasty patients, and to compare the predictions of numerical models in terms of load distribution on the implanted femur with clinical data. Materials and methods: 3 numerical models were built: 1 for intact femur and 2 for implanted femur with a straight stem (resembling PBF, Permedica) and with an anatomical stem (resembling ABG II, Stryker). 4 loading configurations were simulated; 1 simulates a vertical load, and 3 simulate a fall with impact on the greater trochanter in different directions. Stress state calculated in the implanted femur was compared for the 2 models with reference to the intact case. These were compared with clinical data collected at a single centre (Istituto Ortopedico Gaetano Pini, Milan, Italy) where 41 patients were investigated after periprosthetic fracture: 26 patients had a straight uncemented stem and 15 an anatomical uncemented stem. Results: The maximum calculated strain in compression in the case of ABG II implanted femur was 2 times higher than in the presence of PBF stem in the vertical loading configuration. For configurations of sideways fall, in both models, there was a progressive increase of stress state in the bone with increasing angle. Simulations of sideways fall elicited results in accordance with clinical observations: due to the peculiar stem design and consequent state of stress in the bone, anatomical stems seem to induce trochanteric fractures more frequently, while for straight stems type B fractures are more likely to occur. Conclusions: Clinical findings confirmed numerical model predictions: stem design seems to highly influence distribution of stress in the bone and consequent localisation of the fracture site.

A Comparison of Acrylic and Multilithic Teeth Bond Strengths to Acrylic Denture Base Material

2009 ◽  
Vol 10 (5) ◽  
pp. 17-22 ◽  
Author(s):  
Ramin Mosharraf ◽  
Matin Abed-Haghighi
Keyword(s):  
Bond Strength ◽  
Testing Machine ◽  
Base Material ◽  
Fracture Site ◽  
Denture Base ◽  
Denture Teeth ◽  
Significant Difference ◽  
Experimental Laboratory ◽  
Bond Strengths ◽  
The Mean

Abstract Aim Debonding of denture teeth from the denture base can be frustrating for both the clinician as well as his or her patients. The wear resistance of composite denture teeth has been well investigated since their introduction, but there have been few studies about the bonding of these teeth to acrylic denture base resins. The aim of this study was to compare the bond strengths of two brands of acrylic and one brand of multilithic denture teeth to acrylic denture base material. Methods and Materials In this experimental-laboratory study, three types of denture teeth—Yaghoot, Super Brilian, and Major—were used. After grinding the glossy ridge lap surfaces, the teeth were mounted on two sides of triangularshaped wax models. Then the wax elimination and resin processing laboratory procedures were carried out as is done with the fabrication of a complete denture. Each of the specimens was tested using a universal testing machine with a cross head speed of 5mm/min at an angle of 130 degrees to the long axis of the teeth. The data were analyzed using one-way ANOVA and Chisquare tests. Results The mean bond strength in the Yaghoot group was 717.43±293.59 N while in the Super Brilian group it was 578.40±395.38 and in the Major group, 547.95±296.75N. However, there was no significant difference between the three groups (p=0.194). Conclusion Although the mean bond strength in the multilithic group was higher than in the other groups, no significant difference was found between the three groups. There was no significant difference between the three groups with regard to the prevalence and type of fracture site. Clinical Significance The bonding strength of multilithic denture teeth to denture base resins was found to be comparable to, and even slightly higher than, acrylic conventional denture teeth, making them a promising choice for clinicians in the fabrication of removable dentures. Citation Mosharraf R, Abed-Haghighi M. A Comparison of Acrylic and Multilithic Teeth Bond Strengths to Acrylic Denture Base Material. J Contemp Dent Pract [Internet]. 2009 Sept; 10(5). Available from: http://www.thejcdp.com/journal/ view/a-comparison-of-acrylic-andmultilithic-teethbond- strengths-to-acrylic-den.

scholarly journals Comparison of Mechanical Resistance to Maximal Torsion Stress in Original and Nonoriginal or Compatible Prosthetic Implant Screws: An In Vitro Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
António Sérgio Silva ◽  
José Manuel Mendes ◽  
Tiago Araújo ◽  
Carlos Aroso ◽  
Pedro Barreiros
Keyword(s):  
Testing Machine ◽  
In Vitro Study ◽  
Fracture Site ◽  
Mechanical Resistance ◽  
Mean Values ◽  
Maximal Torsion ◽  
Significant Difference ◽  
Bone Preservation ◽  
Prosthetic Implant

Micromovements of the implant-abutment connection influence peri-implant bone preservation. The maximal torque after a cycle of implant prosthetic screw tightening using original components of different manufacturers and replicas produced by other companies is evaluated and quantified in this study. A total of 30 Mis Seven® standard platform implants and 30 interfaces were used, and 30 standard platform screws were tested, 10 Mis®, 10 Iconekt®, and 10 Exaktus®. The screws were tightened with an MIS® torquemeter until their respective fracture, and the fracture point was measured through the equipment’s load cell, CS-Dental Testing Machine®. The screws were analyzed under an Olympus® SZ61 microscope. The fracture points were recorded and compared among all samples. To compare the mean values of the fracture torques, t-tests were performed using the reference values associated with each brand and the sample results. The variable “Place of Fracture” between the original Mis® brand and the Exaktus® replica compared to the Iconekt® replica presented a statistically significant difference (p < 0.001). When analyzing the variable “Fracture Torque,” although it was verified that the replica screws (Iconekt® and Exaktus®) had a lower maximum torque, 65.11 Nm and 62.89 Nm, respectively, compared to the original Mis® brand (70 Nm and 69 Nm), there were no statistically significant differences p > 0.05. Nonoriginal screws did not present different fracture resistances compared to the original Mis® brand screws. The fracture site of Iconekt® screws showed a different pattern compared to the other brands.

Treatment Outcomes for Periprosthetic Femoral Fractures in Cementless Press-Fit Total Hip Replacement

2020 ◽  
Vol 33 (05) ◽  
pp. 370-376
Author(s):  
Isobel C. Monotti ◽  
Christopher A. Preston ◽  
Scott W. Kidd
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Plate Fixation ◽  
Femoral Stem ◽  
Femoral Fractures ◽  
Total Hip ◽  
Press Fit ◽  
Periprosthetic Femoral Fractures ◽  
Bone Segment ◽  
Cementless Total Hip Replacement

Abstract Objective The aim of this study was to report outcomes in dogs with periprosthetic femoral fractures associated with a press-fit cementless femoral total hip replacement implant. Materials and Methods Electronic medical records and digital radiographs were used to identify dogs with periprosthetic femoral fractures associated with press-fit cementless total hip replacement. Data collected included signalment, weight, time of fracture, cause of fracture, presence of intra-operative fissure, fracture type, repair technique, and clinical and radiographic outcomes. Long-term patient outcome was assessed by communication with owners or referring veterinarians. Results Twenty-eight dogs with femoral fracture repair associated with cementless press-fit total hip replacement were identified. Eight of the fractures occurred intraoperatively and 20 occurred at a median of 2 days postoperatively. An oblique or spiral configuration was noted in 19 cases and 15 occurred at the distal end of the femoral stem (type B), with thirteen type B1, one type B2 and one type B3 fractures. Fractures were repaired with non-locking (18/28) or locking-plate fixation (10/28). Cerclage wire was applied around the plate and proximal bone segment in 17/28 dogs. Major complications occurred in 7/28 cases (five deep infection, two mechanical failures). Bone healing was noted in 21/23 cases, for which follow-up radiographic interpretation was available. Return to function was complete in 17 cases, acceptable in 8 cases and unacceptable in 3 cases. Conclusions While cementless total hip replacement periprosthetic femoral fractures can be successfully repaired with lateral plate fixation, the risk of infection appears to be high.

HIP FRACTURES IN 5 YEARS AT HUE UNIVERSITY HOSPITAL

2014 ◽  
pp. 47-50
Author(s):  
Duy Binh Ho ◽  
Nghi Thanh Nhan Le ◽  
Maasalu Katre ◽  
Koks Sulev ◽  
Märtson Aare
Keyword(s):  
Hip Fracture ◽  
Femoral Neck ◽  
Hip Fractures ◽  
Age Groups ◽  
Femoral Fractures ◽  
Femoral Neck Fractures ◽  
University Hospital ◽  
High Risk Population ◽  
Intertrochanteric Fractures ◽  
Significant Difference

Aim: This study aimed to review the clinical findings and surgical intervention of the hip fracture at the Hue University Hospital in Vietnam. Methods:The data of proximal femoral fractures was collected retrospectively. All patients, in a period of 5 years, from Jan 2008 to December 2012, suffered either from intertrochanteric or femoral neck fractures. The numbers of patients were gathered separately for each year, by age groups (under 40, 40-49, 50-59, 60-69, 70-79, older) and by sex. We analyzed what kind of treatment options were used for the hip fracture. Results:Of 224 patients (93 men and 131 women) studied, 71% patients are over 70 years old, 103 women and 56 men (p<0.05). For patients under 40 years, there were 1 woman and 11 men (p<0.05). There were 88 intertrochanteric and 136 femoral neck fractures. There was no significant difference in the two fractures between men and women. The numbers of hip fracture increased by each year, 29/224 cases in 2010, 63/224 cases in 2011, 76/224 cases in 2012. Treatment of 88 intertrochanteric fractures: 49 cases (55.7%) of dynamic hip screw (DHS), 14 cases of hemiarthroplasty (15.9%), 2 cases of total hip replacement (2.3%). Treatment of 136 femoral neck fractures: 48 cases of total replacement (35.3%), 43 cases of hemiarthroplasty (31.6%), 15 cases of screwing (11%). In cases of 40 patients (17.9%) hip fracture was managed conservatively, 23 were femoral neck fractures and 17 were intertrochanteric fractures. Conclusions: Hip fracture is growing challenge in Hue medical university hospital. The conservative approach is still high in people who could not be operable due to severe medical conditions as well as for patients with economic difficulties. Over 70% of the hip fractures in people 70+ are caused by osteoporosis. The number of hip fracture is increasing in the following years, most likely due to the increase in the prevalence of osteoporosis. Early detection and prevention of osteoporosis should be addressed, particularly in high risk population. More aggressive surgical approach should be implemented in order to improve the quality of life in patients with hip fractures. Key words:Hip fracture.

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