The biomechanical effect of bone quality and fracture topography on locking plate fixation in periprosthetic femoral fractures
The biomechanical effect of bone quality and fracture topography on locking plate fixation in periprosthetic femoral fractures
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DOI：
10.1016/j.injury.2014.10.060
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发表时间：
2015-02-01
影响因子：
2.5
通讯作者：
Tsiridis, Eleftherios
中科院分区：
文献类型：
--
作者：
Leonidou, Andreas;Moazen, Mehran;Tsiridis, Eleftherios
固定良好假体周围股骨假体周围骨折（PFF）的最佳处理（Vancouver B1）仍然存在争议，因为需要在不影响假体稳定性的情况下实现足够的固定。本研究的目的是强调骨质量（即椎管厚度比（CTR））和骨折形貌（即骨折角度及其相对于柄的位置）对温哥华B1骨折锁定钢板生物力学的影响。在本研究中使用了先前证实的股骨与骨水泥全髋关节置换术柄的简化有限元模型。在不同的模型中，研究了管层厚度比（CTR）和裂缝形貌的变化，以及这些变化对锁定板上von Mises应力和裂缝位移的影响。增加CTR可以降低锁定板上的von Mises应力和骨折运动。关于内侧皮质的骨折角度，研究表明，锐角比钝角导致板上的von Mises应力更低。此外，与本文考虑的其他骨折相比，急性骨折角度导致的骨折位移较小。椎弓根尖端周围的骨折对锁定钢板具有相同的生物力学效应。然而，远端骨折会导致应力、应变和骨折位移的增加。结果表明，在骨质量好、骨折角度急的情况下，单锁定钢板内固定可能是较好的治疗方法。相反，对于骨质量差和骨折角度钝的患者，由于固定失败的风险较高，可能需要其他治疗方法。PFF治疗的临床研究需要进一步支持我们的发现。(C) 2014 Elsevier Ltd.版权所有。
Optimal management of periprosthetic femoral fractures (PFF) around a well fixed prosthesis (Vancouver B1) remains controversial as adequate fixation needs to be achieved without compromising the stability of the prosthesis. The aim of this study was to highlight the effect of bone quality i.e. canal thickness ratio (CTR), and fracture topography i.e. fracture angle and its position in relation to the stem, on the biomechanics of a locking plate for a Vancouver B1 fracture. A previously corroborated simplified finite element model of a femur with a cemented total hip replacement stem was used in this study. Canal thickness ratio (CTR) and fracture topography were altered in several models and the effect of these variations on the von Mises stress on the locking plate as well as the fracture displacement was studied. Increasing the CTR led to reduction of the von Mises stress on the locking plate as well as the fracture movement. In respect to the fracture angle with the medial cortex, it was shown that acute angles resulted in lower von Mises stress on the plate as opposed to obtuse angles. Furthermore, acute fracture angles resulted in lower fracture displacement compared to the other fractures considered here. Fractures around the tip of the stem had the same biomechanical effect on the locking plate. However, fractures more distal to the stem led to subsequent increase of stress, strain, and fracture displacement. Results highlight that in good bone quality and acute fracture angles, single locking plate fixation is perhaps an appropriate management method. On the contrary, for poor bone quality and obtuse fracture angles alternative management methods might be required as the fixation might be under higher risk of failure. Clinical studies for the management of PFF are required to further support our findings. (C) 2014 Elsevier Ltd. All rights reserved.