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Lodde MF, Raschke MJ, Stolberg-Stolberg J, Everding J, Rosslenbroich S, Katthagen JC. Union rates and functional outcome of double plating of the femur: systematic review of the literature. Arch Orthop Trauma Surg 2022; 142:1009-1030. [PMID: 33484313 PMCID: PMC9110521 DOI: 10.1007/s00402-021-03767-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/01/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The optimal treatment strategy for the surgical management of femur fractures and non-unions remains unknown. The aim of this study is to assess union rates, complications and outcome after femoral double plating. Treatment of shaft, distal, periprosthetic fractures and pathological proximal femur fractures as well as femoral non-unions with double plating were evaluated. METHODS A systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was conducted. Published literature reporting on the treatment and clinical outcome of femoral fractures and non-unions with double plating was identified. In total, 24 studies with 436 cases of double plating, 64 cases of single plating, 84 cases of intramedullary nailing (IM), and 1 interfragmentary screw treatment met the inclusion criteria of this systematic review. The evaluated literature was published between 1991 and 2020. RESULTS Double plating of femoral fractures achieved high healing rates and few complications were reported. It displayed significantly less intraoperative haemorrhage, shorter surgery time reduced risk of malunion in polytraumatised patients when compared to IM. Fracture healing rate of double-plating distal femoral fractures was 88.0%. However, there were no significant differences regarding fracture healing, complication or functional outcome when compared to single plating. Treatment of periprosthetic fractures with double plating displayed high healing rates (88.5%). Double plating of non-unions achieved excellent osseous union rates (98.5%). CONCLUSIONS The literature provides evidence for superior outcomes when using double plating in distal femoral fractures, periprosthetic fractures and femoral non-unions. Some evidence suggests that the use of double plating of femoral fractures in polytraumatised patients may be beneficial over other types of fracture fixation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- M. F. Lodde
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert- Schweitzer-Campus 1, 48149 Münster, Germany
| | - M. J. Raschke
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert- Schweitzer-Campus 1, 48149 Münster, Germany
| | - J. Stolberg-Stolberg
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert- Schweitzer-Campus 1, 48149 Münster, Germany
| | - J. Everding
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert- Schweitzer-Campus 1, 48149 Münster, Germany
| | - S. Rosslenbroich
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert- Schweitzer-Campus 1, 48149 Münster, Germany
| | - J. C. Katthagen
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert- Schweitzer-Campus 1, 48149 Münster, Germany
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Lifka S, Baumgartner W. A Novel Screw Drive for Allogenic Headless Position Screws for Use in Osteosynthesis-A Finite-Element Analysis. Bioengineering (Basel) 2021; 8:136. [PMID: 34677209 PMCID: PMC8533393 DOI: 10.3390/bioengineering8100136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
Due to their osteoconductive properties, allogenic bone screws made of human cortical bone have advantages regarding rehabilitation compared to other materials such as stainless steel or titanium. Since conventional screw drives like hexagonal or hexalobular drives are difficult to manufacture in headless allogenic screws, an easy-to-manufacture screw drive is needed. In this paper, we present a simple drive for headless allogenic bone screws that allows the screw to be fully inserted. Since the screw drive is completely internal, no threads are removed. In order to prove the mechanical strength, we performed simulations of the new drive using the Finite-Element method (FEM), validated the simulations with a prototype screw, tested the novel screw drive experimentally and compared the simulations with conventional drives. The validation with the prototype showed that our simulations provided valid results. Furthermore, the simulations of the new screw drive showed good performance in terms of mechanical strength in allogenic screws compared to conventional screw drives. The presented screw drive is simple and easy to manufacture and is therefore suitable for headless allogenic bone screws where conventional drives are difficult to manufacture.
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Affiliation(s)
- Sebastian Lifka
- Institute of Biomedical Mechatronics, Johannes Kepler University Linz, 4040 Linz, Austria;
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Merckaert SR, Fontanellaz-Castiglione CD, Fornari ED, Tannast M. Double-plate compound osteosynthesis for pathological fractures of the proximal femur: high survivorship and low complication rate. Arch Orthop Trauma Surg 2020; 140:1327-1338. [PMID: 31811373 DOI: 10.1007/s00402-019-03310-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Management of pathological fractures of the proximal femur is often challenging. Compound double-plate osteosynthesis has been specifically developed for surgical treatment of these pathological fractures. To our knowledge, this study represents the largest series to date of double-plate compound osteosynthesis with the longest follow-up. MATERIALS AND METHODS Using our institutional digital database, we identified 61 procedures in 53 patients at the proximal femur. Patients were divided into two groups. A 'primary' group with all cases in which a double-plate compound osteosynthesis was performed as initial procedure (n = 46) and a 'revision' group with all cases in which a double-plate compound osteosynthesis was performed as revision procedure after failed previous attempts of internal fixation (n = 15). (1) The survivorship of the hip was calculated using the Kaplan-Meier survivorship analysis. (2) Complications were graded using Sink's classification. (3) The functional outcome was quantified with the Merle d'Aubigné and Postel score. (4) Risk factors were identified based on a multivariate Cox-regression analysis. RESULTS The cumulative Kaplan-Meier survivorship of the primary group was 96% at 6 months, 90% at 1 year, 5 years and thereafter and 83% at 6 months, 74% at 1 year, 53% at 2 years for the 'revision' group (p = 0.0008). According to the classification of Sink et al., the rate of grade III and IV complications was significantly lower in the primary group (p < 0.0001). The mean Merle d'Aubigné score was 14 ± 7 at 0-3 months, 13 ± 3 at 3-6 months, 15 ± 3 at 6-12 months and 15 ± 4 thereafter (p = 0.54). The only multivariate negative predictor was previous surgery with a hazard ratio of 9.2 (p < 0.006). CONCLUSION Double-plate compound osteosynthesis is a valuable treatment option for pathological fractures in proximal femur with good functional results.
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Affiliation(s)
- Sophie R Merckaert
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Eric D Fornari
- Pediatric Orthopedic Surgery and Sports Medicine, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY, USA
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. .,Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Chemin des Pensionnats 2-6, 1708, Fribourg, Switzerland.
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Omlor GW, Lohnherr V, Lange J, Gantz S, Merle C, Fellenberg J, Raiss P, Lehner B. Enchondromas and atypical cartilaginous tumors at the proximal humerus treated with intralesional resection and bone cement filling with or without osteosynthesis: retrospective analysis of 42 cases with 6 years mean follow-up. World J Surg Oncol 2018; 16:139. [PMID: 30005680 PMCID: PMC6044097 DOI: 10.1186/s12957-018-1437-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 06/26/2018] [Indexed: 01/27/2023] Open
Abstract
Background Enchondromas and atypical cartilaginous tumors (ACT) are often located at the proximal humerus. Most lesions can be followed conservatively, but surgical resection may alleviate pain, avoid pathological fractures, and prevent transformation into higher grade chondrosarcomas. Rigorous intralesional resection and filling with polymethylmethacrylate bone cement has been proposed for enchondromas but also for ACT, as an alternative for extralesional resection. We intended to analyze radiological, clinical, and functional outcome of this strategy and compare bone cement without osteosynthesis to bone cement compound osteosynthesis, which has not been analyzed so far. Methods We retrospectively analyzed 42 consecutive patients (mean follow-up 73 months; range 8–224) after curettage and bone cement filling with or without osteosynthesis. Exclusion criteria were Ollier’s disease and cancellous bone filling. Twenty-five patients only received bone cement. Seventeen patients received additional proximal humerus plate for compound osteosynthesis to increase stability after curettage. Demographics and radiological and clinical outcome were analyzed including surgery time, blood loss, hospitalization, recurrences, and complications. An additional telephone interview at the final follow-up assessed postoperative satisfaction, pain, and function in the quick disabilities of the arm, shoulder, and hand (DASH) score and the Musculoskeletal Tumor Society (MSTS) score. Statistics included the Student T tests, Mann-Whitney U tests, and chi-square tests. Results No osteosynthesis compared to compound osteosynthesis showed smaller tumors (4.2 (± 1.5) cm versus 6.6 (± 3.0) cm; p = 0.005) and smaller bone cement fillings after curettage (5.7 (± 2.1) cm versus 9.6 (± 3.2) cm; p = 0.0001). A score evaluating preoperative scalloping and soft-tissue extension did not significantly differ (1.9 (± 0.9) versus 2.0 (± 1.0); rating scale 0–4; p = 0.7). Both groups showed high satisfaction (9.2 (± 1.5) versus 9.2 (± 0.9); p = 0.5) and low pain (1.0(±1.7) versus 1.9(±1.8); p = 0.1) in a rating scale from 0 to 10. Clinical and functional outcome was excellent for both groups in the DASH score (6.0 (± 11.8) versus 11.0 (± 13.2); rating scale 0–100; p = 0.2) and the MSTS score (29.0 (± 1.7) versus 28.7 (± 1.1); rating scale 0–30; p = 0.3). One enchondroma recurrence was found in the group without osteosynthesis. Complications (one fracture and one intra-articular screw) were only detected after osteosynthesis. Osteosynthesis had longer surgery time (70 (± 21) min versus 127 (± 22) min; p < 0.0001), more blood loss (220 (± 130) ml versus 460 (± 210) ml; p < 0.0001), and longer stay in the hospital (6 (± 2) days versus 8 (± 2) days; p = 0.004). Conclusions Intralesional tumor resection was oncologically safe and clinically successful with or without osteosynthesis. Osteosynthesis did not reduce the risk for fracture but was more invasive.
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Affiliation(s)
- Georg W Omlor
- Center of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Vera Lohnherr
- Center of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Jessica Lange
- Center of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Simone Gantz
- Center of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Christian Merle
- Center of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Joerg Fellenberg
- Center of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Patric Raiss
- Center of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Burkhard Lehner
- Center of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
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Janssen SJ, Teunis T, Hornicek FJ, van Dijk CN, Bramer JAM, Schwab JH. Outcome after fixation of metastatic proximal femoral fractures: A systematic review of 40 studies. J Surg Oncol 2016; 114:507-19. [PMID: 27374478 DOI: 10.1002/jso.24345] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/13/2016] [Indexed: 12/17/2022]
Abstract
Endoprosthetic reconstruction, intramedullary nailing, and open reduction internal fixation (ORIF) are the most commonly practiced surgical strategies for treatment of metastatic proximal femoral fractures. This review describes functional outcome, local, and systemic complications. All three surgical strategies result in reasonable function on average; however, wide ranges indicate that both poor and good functional levels are obtained. We found that the overall reoperation rate was comparable for endoprosthesis and intramedullary nailing, but was higher for ORIF. J. Surg. Oncol. 2016;114:507-519. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Stein J Janssen
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service Boston, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - Teun Teunis
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service Boston, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service Boston, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - C Niek van Dijk
- Department of Orthopaedic Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Jos A M Bramer
- Department of Orthopaedic Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service Boston, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
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Fracture prevention by prophylactic femoroplasty of the proximal femur--metallic compared with cemented augmentation. J Orthop Trauma 2014; 28:403-9. [PMID: 24949955 DOI: 10.1097/bot.0000000000000035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare 2 different femoral neck augmentation techniques at improving the mechanical strength of the femoral neck. METHODS Twenty pairs of human cadaveric femora were randomly divided into 2 groups. In 1 group, the femora were augmented with a steel spiral; the other group with the cemented technique. The untreated contralateral side served as an intraindividual control. Fracture strength was evaluated using an established biomechanical testing scenario mimicking a fall on the greater trochanter (Hayes fall). RESULTS The peak load to failure was significantly higher in the steel spiral group (P = 0.0024) and in the cemented group (P = 0.001) compared with the intraindividual controls. The peak load to failure showed a median of 3167 N (1825-5230 N) in the spiral group and 2485 N (1066-4395 N) in the spiral control group. The peak load to failure in the cemented group was 3698 N (SD ± 1249 N) compared with 2763 N (SD ± 1335 N) in the cement control group. Furthermore, fracture displacement was clearly reduced in the steel spiral group. CONCLUSIONS Femoral augmentations using steel spirals or cement-based femoroplasty are technically feasible procedures. Our results demonstrate that a prophylactic reinforced proximal femur has higher strength when compared with the untreated contralateral limb. Prophylactic augmentation has potential to become an auxiliary treatment option to protect the osteoporotic proximal femur against fracture.
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Zacherl M, Gruber G, Glehr M, Ofner-Kopeinig P, Radl R, Greitbauer M, Vecsei V, Windhager R. Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures: resection vs. stabilisation. INTERNATIONAL ORTHOPAEDICS 2010; 35:1537-43. [PMID: 21120477 DOI: 10.1007/s00264-010-1160-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 11/02/2010] [Accepted: 11/02/2010] [Indexed: 12/15/2022]
Abstract
Pathological femoral head and neck fractures are commonly treated by arthroplasty. Treatment options for the trochanteric region or below are not clearly defined. The purpose of this retrospective, comparative, double-centre study was to analyse survival and influences on outcome according to the surgical technique used to treat pathological proximal femoral fractures, excluding fractures of the femoral head and neck. Fifty-nine patients with 64 fractures were operated up on between 1998 and 2004 in two tertiary referral centres and divided into two groups. One group (S, n = 33) consisted of patients who underwent intramedullary nailing alone, and the other group (R, n = 31) consisted of patients treated by metastatic tissue resection and reconstruction by means of different implants. Median survival was 12.6 months with no difference between groups. Surgical complications were higher in the R group (n = 7) vs. the S group (n = 3), with no statistically significant difference. Patients with surgery-related complications had a higher survival rate (p = 0.049), as did patients with mechanical implant failure (p = 0.01). Survival scoring systems did not correlate with actual survival. Resection of metastases in patients with pathological fractures of the proximal femur, excluding femoral head and neck fractures, has no influence on survival. Patients with long postoperative survival prognosis are at risk of implant-related complications.
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Affiliation(s)
- Max Zacherl
- Department of Orthopaedic Surgery, Medical University Graz, Auenbruggerplatz 5-7, 8036, Graz, Austria.
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Abstract
Consolidation of bone is an essential clinical problem when treating fractures, fixing osteotomies and fusing joints. In most cases, the means of fixation are plates and screws. The goal is functional postoperative therapy by moving the adjacent joints and thus avoiding the deleterious disadvantages of long-lasting articular immobilization. Pre-operative planning, surgical approach, a good understanding of the precise mechanics of the structure and the biological answer for the various tissues are prerequisites of successful osteosynthesis. The choice of implants and the application of their versatility, as well as their adaptation to individual cases are the key to good results.
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