Biomechanical testing of a computationally optimized far cortical locking plate versus traditional implants for distal femur fracture repair.

Autor: Brzozowski P; Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada. Electronic address: pawel.brzozowski@lhsc.on.ca., Inculet C; Division of Orthopaedic Surgery, Western University, London, ON, Canada. Electronic address: Clayton.Inculet@lhsc.on.ca., Schemitsch EH; Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada; Division of Orthopaedic Surgery, Western University, London, ON, Canada. Electronic address: emil.schemitsch@lhsc.on.ca., Zdero R; Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada.
Jazyk: angličtina
Zdroj: Clinical biomechanics (Bristol, Avon) [Clin Biomech (Bristol, Avon)] 2024 Jul; Vol. 117, pp. 106296. Date of Electronic Publication: 2024 Jun 21.
DOI: 10.1016/j.clinbiomech.2024.106296
Abstrakt: Background: This study experimentally validated a computationally optimized screw number and screw distribution far cortical locking distal femur fracture plate and compared the results to traditional implants.
Methods: 24 artificial femurs were osteotomized with a 10 mm fracture gap 60 mm proximal to the intercondylar notch. Three fixation constructs were used. (i) Standard locking plates secured with three far cortical locking screws inserted according to a previously optimized distribution in the femur shaft (n = 8). (ii) Standard locking plates secured with four standard locking screws inserted in alternating plate holes in the femur shaft (n = 8). (iii) Retrograde intramedullary nail secured proximally with one anterior-posterior screw and distally with two oblique screws (n = 8). Axial hip forces (700 and 2800 N) were applied while measuring axial interfragmentary motion, shear interfragmentary motion, and overall stiffness.
Findings: Experimental far cortical locking plate results compared well to published computational findings. Far cortical locking femurs contained the highest axial motion within the potential ideal range of 0.2-1 mm and a sheer-to-axial motion ratio < 1.6 at toe-touch weight-bearing (700 N). At full weight-bearing (2800 N), Standard locking-plated femurs had the only axial motion within 0.2-1 mm but had an excess shear-to-axial motion ratio. Nail-implanted femurs underperformed at both forces.
Interpretation: For toe-touch weight-bearing, the far cortical locking construct provided optimal biomechanics to allow moderate motion, which has been suggested to encourage early callus formation. Conversely, at full weight-bearing, the standard locking construct offered the biomechanical advantage on fracture motion.
Competing Interests: Declaration of competing interest Emil H. Schemitsch previously received personal fees and research support from Zimmer Biomet. Radovan Zdero previously received “in kind” research support from Zimmer Biomet. No conflicts exist for the other authors.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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