Distal femur fractures of the elderly--different treatment options in a biomechanical comparison |
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Authors: | Wähnert Dirk Hoffmeier Konrad Fröber Rosemarie Hofmann Gunther O Mückley Thomas |
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Affiliation: | a Friedrich Schiller University Jena, Department of Trauma, Hand and Reconstructive Surgery, Erlanger Alle 101, 07747 Jena, Germany b Friedrich Schiller University Jena, Anatomical Institute, Teichgraben 7, 07743 Jena, Germany c BG-Kliniken Bergmannstrost, Department of Trauma and Reconstructive Surgery, Merseburger Str. 165, 06112 Halle, Germany |
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Abstract: | BackgroundFractures of the distal femur, especially in the elderly patient, are an unsolved problem in orthopaedic and trauma surgery. Poor bone stock quality caused by osteoporosis often results in bad implant anchorage in the distal part with a high risk of secondary failures such as cutout. This study investigates the biomechanical characteristics of four implants with different distal locking options under quasi-static torsional and cyclic axial loading. Therefore, an osteoporotic bone model simulating severe osteoporotic conditions was used.MethodsFour different implants (T2 intramedullary nail, supracondylar nail (SCN), distal femoral nail (DFN) and the AxSOS angular stable plate) with different distal locking options were instrumented using an osteoporotic bone model. Five specimens per implant and per loading type (torsional and axial) were used. Mechanical testing was performed under physiologic loading conditions. First, a torsional test was performed in internal and external rotation (10 Nm), with a new specimen; a stepwise cyclic axial loading was conducted until failure of the construct.FindingsFor torsional loading, the lowest range of motion (ROM) and neutral zone (NZ) was found for the AxSOS plate construct. The SCN and T2 constructs showed similar results, and the highest ROM and NZ were found for the constructs treated with the DFN. Axial stiffness was highest for SCN constructs and in the same range for DFN and T2. The lowest stiffness showed in the AxSOS plate constructs with 47% of SCN stiffness. Under cyclic axial loading, the SCN constructs showed the highest number of cycles to failure, followed by AxSOS (70%), DFN (69%) and T2 (48%).InterpretationIn conclusion of this biomechanical study, we can clinically suggest that, if, in general, torsional stability is required (e.g., for bedridden patients) the AxSOS plate will be sufficient. By contrast, the findings of this study support the fact that the SCN should be considered for mobile patients where early postoperative mobilisation for rehabilitation is desired. |
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Keywords: | Distal femur Fractures Biomechanics Osteoporosis Intramedullary nail Angular stable plate Artificial bone |
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