scholarly journals Minimally Invasive Internal Fixation of Femoral Shaft Fractures—A Biomechanical Study with a Disruptive Technique

Life ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1254
Author(s):  
Frank Layher ◽  
Georg Matziolis ◽  
Leos N. Kayhan ◽  
Matthias Bungartz ◽  
Olaf Brinkmann
Keyword(s):  
Internal Fixation ◽  
Plate Osteosynthesis ◽  
Damage Control ◽  
Femoral Shaft ◽  
Biomechanical Properties ◽  
Biomechanical Study ◽  
Deformation Analysis ◽  
Control Approach ◽  
Femur Fractures ◽  
Rod System

(1) Background: In polytrauma patients, femur fractures are usually stabilised by external fixation for damage control, later being treated with definitive plate or nail osteosynthesis. Screw/rod systems established in spinal surgery might be inserted for internal fixation, providing sufficient fracture stability that subsequent intervention is unnecessary. This was to be investigated biomechanically. (2) Methods: The unilaterally applied spinal internal fixator (IF) was subjected to load and deformation analysis on artificial femurs with 32-A3 fracture according to AO classification. Distance of screws to fracture and rod to cortical bone were analysed as parameters influenced surgically as stiffness and deformation of the treated fracture. In addition, the stability of another construct with a second screw/rod system was determined. The axial load in stance phase during walking was simulated. The results were compared against an established fixed-angle plate osteosynthesis (IP). (3) Results: There were no implant failures in the form of fractures, avulsions or deformations. All unilateral IF combinations were inferior to IP in terms of stability and stiffness. The bilateral construct with two screw/rod systems achieved biomechanical properties comparable to IP. 4) Conclusion: Biomechanically, a biplanar screw/rod system is suitable for definitive fracture stabilisation of the femur, despite a damage control approach.

scholarly journals Rotational Stability of Proximally Unlocked Retrograde Femoral Nail In Damage Control Surgery – Biomechanical Study

2021 ◽  
Author(s):  
Rahil Muzaffar ◽  
Muadh Hamood Nasser Al Zeedi ◽  
Khurshid Alam ◽  
Ahmed Yaseen ◽  
Sultan Al Maskari
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Femoral Shaft ◽  
Torsion Test ◽  
Maximum Load ◽  
Biomechanical Study ◽  
Rotational Stability ◽  
Lateral Compression ◽  
Compression Screw ◽  
Rotational Displacement

Abstract BACKGROUND: This biomechanical study was performed to look into the rotational stability of retrograde femoral intramedullary nail when it is used without proximal locking as a damage control device for management of femoral shaft fractures in emergency situations. This study compares this technique with the accepted methods for femoral shaft fixations in damage control surgeries. An alternative technique of using lateral compression screw to provide additional rotational stability is described.METHODS: Experiments were divided into four different sets. Distally locked retrograde nail was passed across the fracture without any proximal fixation in set 1, a compression screw passed from lateral cortex in set 2, a proximal locking screw fixation in set 3. In set 4, Saw bone was fixed with external fixator.The lateral compression screw group was further sub divided into three subgroups based on the amount of torque applied manually.The torsion test was applied to create an rotational displacement of 10 degrees and the maximum load required to create the rotational displacement was noted.RESULTS: Application of a compression screw improved the rotational stability significantly in comparison to no proximal locking. In the subgroup III of lateral compression screw application, the rotational stability was found to be equivalent to stability achieved with Nail with proximal locking and was found to be greater in comparison to external fixator application.CONCLUSION: This study shows that the addition of a lateral compression screw significantly improves rotational stability and has the potential to be used in emergency lifesaving procedures.

Biomechanical Testing of Distal Radius Fracture Treatments: Boundary Conditions Significantly Affect the Outcome of In Vitro Experiments

2016 ◽  
Vol 32 (2) ◽  
pp. 210-214 ◽  
Author(s):  
Alexander Synek ◽  
Yan Chevalier ◽  
Christian Schröder ◽  
Dieter H. Pahr ◽  
Sebastian F. Baumbach
Keyword(s):  
Boundary Conditions ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Plate Osteosynthesis ◽  
Biomechanical Testing ◽  
Biomechanical Properties ◽  
Biomechanical Study ◽  
Radius Fracture ◽  
Compression Tests

The variety of experimental setups used during in vitro testing of distal radius fracture treatments impairs interstudy comparison and might lead to contradictory results. Setups particularly differ with respect to their boundary conditions, but the influence on the experimental outcome is unknown. The aim of this biomechanical study was to investigate the effects of 2 common boundary conditions on the biomechanical properties of an extra-articular distal radius fracture treated using volar plate osteosynthesis. Uniaxial compression tests were performed on 10 synthetic radii that were randomized into a proximally constrained group (ProxConst) or proximally movable group (ProxMove). The load was applied distally through a ball joint to enable distal fragment rotation. A significantly larger (ProxConst vs ProxMove) stiffness (671.6 ± 118.9 N·mm−1 vs 259.6 ± 49.4 N·mm−1), elastic limit (186.2 ± 24.4 N vs 75.4 ± 20.2 N), and failure load (504.9 ± 142.5 N vs 200.7 ± 49.0 N) were found for the ProxConst group. The residual tilt did not differ significantly between the 2 groups. We concluded that the boundary conditions have a profound impact on the experimental outcome and should be considered more carefully in both study design and interstudy comparison.

Orthogonal Plating of Vancouver B1 and C-Type Periprosthetic Femur Fracture Nonunions

2017 ◽  
Vol 27 (6) ◽  
pp. 578-583 ◽  
Author(s):  
Christopher E. Birch ◽  
Michael Blankstein ◽  
Jesse D. Chlebeck ◽  
Craig S. Bartlett 3rd
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Femur Fracture ◽  
Plate Osteosynthesis ◽  
Perioperative Complications ◽  
Femoral Shaft ◽  
Open Reduction Internal Fixation ◽  
Fixation Method ◽  
Periprosthetic Femur Fracture ◽  
Fracture Nonunions

Background Periprosthetic femoral shaft fractures are a significant complication after total hip arthroplasty (THA). Plate osteosynthesis has been the mainstay of treatment around well-fixed stems. Nonunions are a rare and challenging complication of this fixation method. We report the outcomes of a novel orthogonal plating surgical technique for Vancouver B1 and C-type periprosthetic fractures that previously failed open reduction internal fixation (ORIF). Methods A retrospective review identified all patients with Vancouver B1/C THA periprosthetic femoral nonunions from 2010 to 2015. Exclusion criteria included open fractures and periprosthetic infections. The technique utilised a mechanobiologic strategy of atraumatic exposure, resection of necrotic tissue, bone grafting with adjuvant bone morphogenetic protein (BMP) and revision open reduction internal fixation with orthogonal plate osteosynthesis. Results 6 Vancouver B1/C periprosthetic femoral nonunions were treated. 5 patients were female with an average age of 80.3 years (range 72-91 years). The fractures occurred at a mean of 5.8 years (range 1-10 years) from their initial arthroplasty procedure. No patients underwent further revision surgery; there were no perioperative complications. All patients had a minimum of 11 months follow-up (mean 18.6, range 11-36 months). All fractures achieved osseous union, defined as solid bridging callus over at least 2 cortices and pain free, independent ambulation, at an average of 24.4 weeks (range 6.1-39.7 weeks). Conclusions This is the 1st series describing orthogonal locked compression plating using modern implants for periprosthetic femoral nonunions. This technique should be considered in periprosthetic femur fracture nonunions around a well-fixed stem.

scholarly journals Bridge Plating of Comminuted Shaft of Femur Fractures

2015 ◽  
Vol 3 (1) ◽  
pp. 7-12
Author(s):  
Mohammad Abul Kalam ◽  
Pradeep Kumar ◽  
Mohammad Afzal Hussain ◽  
Iqbal Ahmad
Keyword(s):  
Prospective Study ◽  
Plate Osteosynthesis ◽  
Femoral Shaft ◽  
Invasive Technique ◽  
Operating Table ◽  
Femoral Shaft Fractures ◽  
Femur Fractures ◽  
Shaft Fractures ◽  
Bridge Plate ◽  
Bridge Plating

A prospective study of forty comminuted femoral shaft fractures, open and close, treated with a relatively minimally invasive technique termed as bridge plate osteosynthesis or biological fixation. Less invasive procedure, Short operative time and less blood loss was seen during surgical procedure. This prospective study was conducted at Nobel Medical College, Biratnagar from 2010 to 2011. This study was done because most of the femoral shaft fractures treated under C-arm mobile image intensifier but bridge plating system does not require such advanced costly equipment. Almost all cases were free from long term complications. All fractures healed within 6 months. Bone grafting was done for 2 cases as a secondary procedure. The complication of infections was seen in two of open fractures. This procedure can easily be carried out in general operating table by appropriable surgeons.DOI: http://dx.doi.org/10.3126/jonmc.v3i1.12230Journal of Nobel Medical CollegeVol. 3, No.1 Issue 6, 2014, Page: 7-12

Plate fixation of periprosthetic femur fractures: What happens to the cement mantle?

2016 ◽  
Vol 231 (2) ◽  
pp. 138-142 ◽  
Author(s):  
Lukas Konstantinidis ◽  
Benjamin Schmidt ◽  
Anke Bernstein ◽  
Anja Hirschmüller ◽  
Steffen Schröter ◽  
...  
Keyword(s):  
Crack Formation ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Cement Mantle ◽  
Biomechanical Study ◽  
Screw Insertion ◽  
Locking Screws ◽  
Femur Fractures ◽  
Periprosthetic Femur Fractures ◽  
The Relationship

Osteosynthesis of periprosthetic femur fractures by screw fixation around the implanted prosthetic stem is currently regarded as the biomechanically superior option compared with cerclage. The aim of this biomechanical study was damage analysis of the cement mantle after revision screw insertion. A prosthetic stem (Bicontact) was implanted in 20 cadaveric femora in cemented technique. A locking compression plate (Synthes) was then applied to the lateral femur at the level of the prosthetic stem. The method of plate fixation to the femur was assigned randomly to three groups: bicortical non-locking screws, monocortical locking screws, and bicortical locking screws. This was followed by applying a fluctuating axial load (2100 N, 0.5 Hz) for 20,000 cycles. After testing, macroscopic and microscopic evaluations of the cement mantle were conducted. Cracks formed in the cement mantle in 14% of the 80 screw holes. The type of screw (bicortical or monocortical; locking or non-locking) had no significant effect on the number of cracks (p = 0.52). The relationship between manifestation of crack damage and cement mantle thickness was not significant (p = 0.36), whereas the relationship between crack formation and screw position was significant (p = 0.019). Those screws whose circumference was only partially within the cement mantle yielded a significantly lower number of cracks compared with screws positioned completely within the cement mantle or even touching the prosthetic stem. In order to reduce the incidence of crack formation in the cement mantle during plate osteosynthesis of periprosthetic femur fractures, the screws should not be either placed within the cement mantle or make direct contact with the stem.

scholarly journals External skeletal fixation of femoral shaft fractures in polytrauma patients

2008 ◽  
Vol 61 (9-10) ◽  
pp. 497-502 ◽  
Author(s):  
Predrag Stojiljkovic ◽  
Zoran Golubovic ◽  
Desimir Mladenovic ◽  
Ivan Micic ◽  
Sasa Karalejic ◽  
...  
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Damage Control ◽  
Healing Time ◽  
Safe Procedure ◽  
Femur Fractures ◽  
Definitive Method ◽  
Polytrauma Patients ◽  
Rigid Stabilisation

Introduction. Polytrauma remains a major social, economic and medicine affliction. A successful surgical treatment of polytrauma patients requires an approach predicated on prioritizing injuries. An isolated femur fractures rarely poses any threat but in association with multiple injuries, this fracture assumes greater significance. The proper management of femur fractures in polytrauma can greatly reduce the mortality and morbidity. Material and methods. We present our results in the treatment of 24 femur shaft fracture in 22 polytrauma patients treated by Mitkovic external fixator in 5 year period (2000-2004) on Orthopeadic and Traumatology Clinic - Clinical Center Nis. The average of patients age was 32.8 years (ranging from 17 to 62). There were 11 (46%) closed and 13 (54%) open fractures. Results. Eighteen fractures were treated by external fixation until union. The remaining six fractures were treated by conversion of the external fixation to internal fixation. Sixteen fractures (88.88%), in which the external fixation was the definitive method of treatment, healed completely. The average healing time was 6.29 (4-9) months. There were three pin-track infections (16.66%), one nonunion (5.55%) and only one deep infection (5.55%). Conclusion. The external fixation by the use of Mitkovic external fixator in the treatment of femur fractures is a safe procedure to achieve temporary rigid stabilisation in polytrauma patients before the subsequent internal fixation (damage control orthopaedics). The external fixation using Mitkovic external fixator can be definitive method of choice in treatment of open and comminutiwe femur fractures in polytrauma patients until union.

scholarly journals Minimally invasive plate osteosynthesis of lower end of femur fractures using locking compression plating: a prospective study

2017 ◽  
Vol 3 (5) ◽  
pp. 1043 ◽  
Author(s):  
Raghu Kumar J. ◽  
Prasanna Anaberu ◽  
Vinit M. Oswal
Keyword(s):  
Minimally Invasive ◽  
Internal Fixation ◽  
Closed Reduction ◽  
Distal Femur ◽  
Tissue Injury ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Soft Tissue Injury ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Femur Fractures

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">The treatment of distal femur fractures has recently evolved towards indirect reduction and minimally invasive techniques. The goal is to strike a balance between the mechanical stability of the fragments and the biological viability. Pre-contoured Locking compression plates (LCPs) have shown to give best results in terms of recovery, fracture union, return to work and functional outcome. Advent of MIPO technique has reduced the amount of soft tissue injury, delayed healing, tissue necrosis and infections.</span>The objective was <span lang="EN-IN">to study the functional result of fracture distal femur treated by closed reduction with LCP by minimally invasive plate osteosynthesis (MIPO).</span></p><p class="abstract"><strong>Methods:</strong> 20 cases of fracture distal end of femur were treated by closed reduction and internal fixation using LCP by MIPO between 1st October 2013 to 30th September 2015 at our centre. The patients were evaluated clinically and radiologically for functional outcomes. All patients were followed up for an average of 12 months. Outcome was assessed using NEER’s score.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">8 of my patients were male and 12 were female. All of them were closed injuries and fresh cases. The mean age was 51.8 years (21-68 yrs). 13 patients sustained RTA and 7 patients had accidental fall. 8 patients had right sided distal femur fracture and 12 had left sided injury. According to NEER’s score 50% had excellent results, 35% had good results and 15% had fair results. Gait and weight bearing after union was satisfactory. Range of motion of knee joint in majority of patients was within acceptable limits. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Closed reduction and internal fixation of fracture lower end of femur by MIPO using LCP is one of the best modalities of treatment for good results.</span></p>

scholarly journals Treatment of Intertrochanteric Femur Fractures with Hip Arthroplasty in Older Patients: A Narrative Review of Indications and Outcomes

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 763
Author(s):  
Tiago Martinho ◽  
Karl Stoffel
Keyword(s):  
High Risk ◽  
Surgical Technique ◽  
Internal Fixation ◽  
Functional Outcome ◽  
Hip Arthroplasty ◽  
Older Patients ◽  
Bipolar Hemiarthroplasty ◽  
Intramedullary Nails ◽  
Fixation Failure ◽  
Femur Fractures

Intertrochanteric femur fractures are common in older patients and often have a significant impact on disability. The treatment aims to achieve a rapid return to the prior functional level with a low rate of complications and mortality. Surgical management by internal fixation is the mainstay of treatment for most of these fractures. Even when treated with intramedullary nails, the overall complication rates are high, especially for unstable or highly comminuted fractures or in the presence of poor bone quality. Hip arthroplasty is an alternative in older patients with intertrochanteric femur fractures at high risk of fixation failure or with concomitant intraarticular pathologies. Especially patients whose condition precludes prolonged bedrest and who are at risk of significant deterioration if their locomotor function cannot be restored rapidly are likely to benefit from hip arthroplasty. The choice of the surgical technique mainly depends on the surgeon’s preferences and the fracture characteristics. Bipolar hemiarthroplasty is the most common type of prosthesis used with primary or revision femoral stems. Compared with intramedullary nails, hip arthroplasty has a better early functional outcome and lower rates of surgical complications as well as reoperations. However, the functional outcome and the mortality rate in the longer term tend to favor intramedullary nails, even though the results are inconsistent, and a statistically significant difference cannot always be obtained. Currently, there are no guidelines that define the role of hip arthroplasty in the treatment of intertrochanteric femur fractures in older patients. The literature only offers an overview of the possibilities of the usage of hip arthroplasty, but methodological limitations are common, and evidence levels are low. Further studies are needed to identify the intertrochanteric fractures that are at high risk of internal fixation failure, the characteristics that determine which patients may benefit most from hip arthroplasty, and the optimal surgical technique.

A COMPARATIVE BIOMECHANICAL STUDY OF THE LOOPED SQUARE SLIP KNOT AND THE SIMPLE SURGICAL KNOT

Hand Surgery ◽  
2006 ◽  
Vol 11 (01n02) ◽  
pp. 93-99 ◽  
Author(s):  
Surut Jianmongkol ◽  
Geoffrey Hooper ◽  
Weerachai Kowsuwon ◽  
Tala Thammaroj
Keyword(s):  
Ultimate Strength ◽  
Hand Surgery ◽  
Biomechanical Properties ◽  
Biomechanical Study ◽  
Skin Closure ◽  
Significant Difference ◽  
Mode Of Failure ◽  
Repetitive Loading ◽  
Slip Knot

The looped square slip knot was introduced as a technique for skin closure to avoid the use of sharp instruments in suture removal after hand surgery. We compared the biomechanical properties of this knot with the simple surgical square knot. The ultimate strength of the looped square slip knot was significantly (p = 0.015) higher than the simple surgical knot. There was no significant difference between the two knots in mode of failure. Knot slippage or suture breakage did not occur in any samples when testing security by repetitive loading. Therefore, the looped square slip knot is a safe and convenient alternative to the two-throw surgical knot for use in hand surgery.

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