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Warner S, Sommer C, Zderic I, Woodburn W, Castle R, Penman J, Saura-Sanchez E, Helfet DL, Gueorguiev B, Stoffel K. Lateral rim variable angle locked plating versus tension band wiring of simple and complex patella fractures: a biomechanical study. Arch Orthop Trauma Surg 2024; 144:2131-2140. [PMID: 38520547 DOI: 10.1007/s00402-024-05266-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 03/03/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Treatment of both simple and complex patella fractures is a challenging clinical problem. Although tension band wiring has been the standard of care, it can be associated with high complication rates. The aim of this study was to investigate the biomechanical performance of recently developed lateral rim variable angle locking plates versus tension band wiring used for fixation of simple and complex patella fractures. MATERIALS AND METHODS Sixteen pairs of human anatomical knees were used to simulate either two-part transverse simple AO/OTA 34-C1 or five-part complex AO/OTA 34-C3 patella fractures by means of osteotomies, with each fracture model created in eight pairs. The complex fracture pattern was characterized by a medial and a lateral proximal fragment, together with an inferomedial, an inferolateral, and an inferior (central distal) fragment mimicking comminution around the distal patellar pole. The specimens with simple fractures were pairwise assigned for fixation with either tension band wiring through two parallel cannulated screws or a lateral rim variable angle locking plate. The knees with complex fractures were pairwise treated with either tension band wiring through two parallel cannulated screws plus circumferential cerclage wiring or a lateral rim variable angle locking plate. Each specimen was tested over 5000 cycles by pulling on the quadriceps tendon, simulating active knee extension and passive knee flexion within the range of 90° flexion to full extension. Interfragmentary movements were captured via motion tracking. RESULTS For both fracture types, the articular displacements measured between the proximal and distal fragments at the central patella aspect between 1000 and 5000 cycles, together with the relative rotations of these fragments around the mediolateral axis were all significantly smaller following the lateral rim variable angle locked plating compared with tension band wiring, p ≤ 0.01. CONCLUSIONS From a biomechanical perspective, lateral rim variable angle locked plating of both simple and complex patella fractures provides superior construct stability versus tension band wiring under dynamic loading.
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Affiliation(s)
- Stephen Warner
- University of Texas Health Science Center, Houston, TX, USA
| | | | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland.
| | | | | | | | | | - David L Helfet
- New York Presbyterian Hospital, New York Weill Cornell Center, New York, NYC, USA
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Wittauer M, Stoffel K. An Unconventional Solution for Persistent Lateral Hip Prosthetic Friction Syndrome (LHPFS) after Revision Total Hip Arthroplasty. Case Rep Orthop 2024; 2024:7934419. [PMID: 38665697 PMCID: PMC11045277 DOI: 10.1155/2024/7934419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
We report on a 77-year-old male patient, who presented with excessive bone loss at the area of the greater trochanter after several hip revision surgeries resulting in a persistent friction syndrome caused directly by the rough surface and sharp edges of the prosthetic shoulder of a well-fixed Wagner-type revision stem. Surgery was performed by creating a cemented neotrochanter with an attached polyester patch around the proximal lateral shaft and performing a Z-plasty of the iliotibial tract. Twelve months postoperatively, the patient reported a reduction in subjective pain of 50% and improvement of the Harris Hip Score from 45 to 75 points. Without a definition in the current literature, the authors propose the term "lateral hip prosthetic friction syndrome" (LHPFS) to describe this medical condition.
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Affiliation(s)
- Matthias Wittauer
- Department of Trauma and Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Karl Stoffel
- Department of Trauma and Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Eckardt H, Windischbauer D, Morgenstern M, Stoffel K, Clauss M. Analysis of complications in 97 periprosthetic Vancouver B2 fractures treated either by internal fixation or revision arthroplasty. Arch Orthop Trauma Surg 2024; 144:1647-1653. [PMID: 38400900 PMCID: PMC10965665 DOI: 10.1007/s00402-024-05223-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 02/07/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION The treatment of Vancouver B2 periprosthetic fractures after hip arthroplasty is still a matter of debate. Revision Arthroplasty (RA) was long thought to be the treatment of choice, however several recent papers suggested that Open Reduction and Internal Fixation (ORIF) is a viable option for selected B2 fractures. Complication rates of 14-26% have been reported following surgical treatment of B2 fractures. No significant difference between RA and ORIF in the complication rates nor in the functional outcome was observed. METHOD We conducted a retrospective analysis of 97 consecutive Vancouver B2 fractures treated according to the algorithm at our institution from 2007 to 2020 and recorded complications and patient specific data. RESULT From the 97 patient, 45 fractures were treated with RA while 52 fractures were treated with ORIF. Thirteen patients in the RA group had a complication that needed revision (28%) and 11 patients in the ORIF group needed revision (21%). There was no significant difference between complication rates. The reason for failure in the 13 RA patients were infection (n = 4), stem subsidence (n = 1), refracture after a new fall (n = 3), secondary dislocation of the greater trochanter (n = 1) and dislocation (n = 4). The reason for failure in the 11 ORIF patients that were revised were infection (n = 5), persistent symptomatic stem loosening (n = 3) and refracture (n = 3) after a new fall. CONCLUSION ORIF can be used to revise cemented and non-cemented shafts in more than half of Vancouver B2 fractures with no difference in complication rates when compared to RA. A periprosthetic fracture around the hip has a 21-28% risk of a re-operation after revision surgery with infection and re-fracture after a new fall being the most frequent cause of re-operation.
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Affiliation(s)
- H Eckardt
- Department of Orthopedics and Trauma Surgery, Basel University Hospital, Basel, Switzerland.
- Crossklinik, Clinic for Orthopaedic Surgery and Sports Medicine, Basel, Switzerland.
| | - D Windischbauer
- Department of Orthopedics and Trauma Surgery, Basel University Hospital, Basel, Switzerland
| | - M Morgenstern
- Department of Orthopedics and Trauma Surgery, Basel University Hospital, Basel, Switzerland
- Center for Musculoskeletal Infections, Basel University Hospital, Basel, Switzerland
| | - K Stoffel
- Department of Orthopedics and Trauma Surgery, Basel University Hospital, Basel, Switzerland
| | - M Clauss
- Department of Orthopedics and Trauma Surgery, Basel University Hospital, Basel, Switzerland
- Center for Musculoskeletal Infections, Basel University Hospital, Basel, Switzerland
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Mauch M, Nüesch C, Bühl L, Chocholac T, Mündermann A, Stoffel K. Reconstruction of proximal hamstring ruptures restores joint biomechanics during various walking conditions. Hip Int 2024:11207000241230282. [PMID: 38372148 DOI: 10.1177/11207000241230282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
PURPOSE We aimed to examine the functional outcome in different walking conditions in elderly adults who underwent surgical repair after a non-contact hamstring injury. Our objective was to compare lower limb kinematics and kinetics over the entire gait cycle between the injured and contralateral leg in overground and level and uphill treadmill walking. METHODS 12 patients (mean ± SD, age: 65 ± 9 years; body mass index: 30 ± 6 kg/m2) walked at self-selected speed in overground (0% slope) and treadmill conditions (0% and 10% slope). We measured spatiotemporal parameters, joint angles (normalised to gait cycle) and joint moments (normalised to stance phase) of the hip, knee and ankle. Data between sides were compared using paired sample t-tests (p < 0.05) and continuous 95% confidence intervals of the paired difference between trajectories. RESULTS Patients walked at an average speed of 1.31 ± 0.26 m/second overground and 0.92 ± 0.31 m/second on the treadmill. Spatiotemporal parameters were comparable between the injured and contralateral leg (p > 0.05). Joint kinematic and joint kinetic trajectories were comparable between sides for all walking conditions. CONCLUSIONS Refixation of the proximal hamstring tendons resulted in comparable ambulatory mechanics at least 1 year after surgery in the injured leg and the contralateral leg, which were all within the range of normative values reported in the literature. These results complement our previous findings on hamstring repair in terms of clinical outcomes and muscle strength and support that surgical repair achieves good functional outcomes in terms of ambulation in an elderly population. TRIAL REGISTRATION clinicaltrials.gov (NCT04867746).
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Affiliation(s)
- Marlene Mauch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Linda Bühl
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Tomas Chocholac
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
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Dammeyer C, Nüesch C, Visscher RMS, Kim YK, Ismailidis P, Wittauer M, Stoffel K, Acklin Y, Egloff C, Netzer C, Mündermann A. Classification of inertial sensor-based gait patterns of orthopaedic conditions using machine learning: A pilot study. J Orthop Res 2024. [PMID: 38341759 DOI: 10.1002/jor.25797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/21/2023] [Accepted: 01/19/2024] [Indexed: 02/13/2024]
Abstract
Elderly patients often have more than one disease that affects walking behavior. An objective tool to identify which disease is the main cause of functional limitations may aid clinical decision making. Therefore, we investigated whether gait patterns could be used to identify degenerative diseases using machine learning. Data were extracted from a clinical database that included sagittal joint angles and spatiotemporal parameters measured using seven inertial sensors, and anthropometric data of patients with unilateral knee or hip osteoarthritis, lumbar or cervical spinal stenosis, and healthy controls. Various classification models were explored using the MATLAB Classification Learner app, and the optimizable Support Vector Machine was chosen as the best performing model. The accuracy of discrimination between healthy and pathologic gait was 82.3%, indicating that it is possible to distinguish pathological from healthy gait. The accuracy of discrimination between the different degenerative diseases was 51.4%, indicating the similarities in gait patterns between diseases need to be further explored. Overall, the differences between pathologic and healthy gait are distinct enough to classify using a classical machine learning model; however, routinely recorded gait characteristics and anthropometric data are not sufficient for successful discrimination of the degenerative diseases.
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Affiliation(s)
- Constanze Dammeyer
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Psychology and Sport Science, University of Bielefeld, Bielefeld, Germany
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Rosa M S Visscher
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Yong K Kim
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Matthias Wittauer
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Yves Acklin
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Christian Egloff
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Cordula Netzer
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Suhm N, Stoffel K. [Do All Very Old Patients Benefit from Osteoporosis Drug Treatment?]. Praxis (Bern 1994) 2024; 113:15-19. [PMID: 38381105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Osteoanabolic osteoporosis drugs have become better available. The osteoanabolic therapeutic principle has a stronger, faster-onset fracture-reducing effect than the antiresorptive preparations. It has also been newly recognized that the significance of a first fragility fracture as a risk factor is time-dependent: the less time that has elapsed since the first fracture, the higher the resulting re-fracture risk. Patients older than 65 years whose index fragility fracture occurred less than two years before are therefore grouped in a separate "Imminent Fracture Risk" category. These innovations were implemented by updating the osteoporosis therapy guideline. According to this guideline, patients in the "Imminent Fracture Risk" category should be offered osteoporosis therapy as soon as possible, in order to avoid as many fractures as possible. We are critical of an overly strict implementation of this algorithm in very old fracture patients. Our own data indicate that more than 30 % of this subpopulation do not experience the effect of a newly started osteoporosis therapy. We advocate a clinically based indication for osteoporosis therapy. For this, we propose a "Question Surprise" modified for osteological purposes. "Would I be surprised if I had to treat the same patient for a fracture again in a year?" If the question is answered with "No," then that patient could be a candidate for specific osteoporosis treatment.
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Affiliation(s)
- Norbert Suhm
- Klinik für Orthopädie und Traumatologie des Bewegungsapparates, Universitätsspital Basel, Basel, Schweiz
| | - Karl Stoffel
- Klinik für Orthopädie und Traumatologie des Bewegungsapparates, Universitätsspital Basel, Basel, Schweiz
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Wallace DT, Stoffel K, Baines J. Technical note: acetabular augmentation with customisable cementless all-polyethylene insert. Hip Int 2024; 34:92-95. [PMID: 37680129 DOI: 10.1177/11207000231194582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Acetabular augmentation is a challenge for complex primary and revision hip surgery. Several methods exist to recreate a supportive, hemispherical acetabulum where a defect exists, however, these can be complex, expensive, time consuming, and limited by available size and shape. We present a simple, inexpensive, quick and customisable method of acetabular augmentation using cementless polyethylene with titanium coating. The first case is presented with follow-up up to 8 years.
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Affiliation(s)
- David T Wallace
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, UK
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Basel, Basel-Stadt, Switzerland
| | - Joe Baines
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, UK
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Schader JF, Thalmann C, Maier KS, Schiener T, Stoffel K, Frigg A. Prospective evaluation of clinical and radiographic 10-year results of Fitmore short-stem total hip arthroplasty. J Orthop Surg Res 2023; 18:893. [PMID: 37993946 PMCID: PMC10666308 DOI: 10.1186/s13018-023-04359-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Short stems were introduced into total hip arthroplasty (THA) to preserve bone stock, to transmit more load to the proximal femur, and to enable minimal invasive approaches. This study is the first long-term study (with a follow-up of 10 years) of the survival as well as the clinical and radiographic outcomes of the Fitmore hip stem, a short curved uncemented stem. METHODS In total, 123 Fitmore hip stems were prospectively evaluated. At the final 10-year follow-up, 80 Fitmore stems (78 patients: 30 female, 48 male) were eligible for evaluation. Clinical parameters were thigh pain, EQ-5D, Harris Hip Score (HHS) and Oxford Hip Score. Radiographic parameters were cortical hypertrophy (CH), bone condensation, cortical thinning, radiolucency, reactive lines, calcar rounding, calcar resorption, subsidence and varus/valgus position. RESULTS After 10 years, there was a survival rate of 99% (1 revision because of aseptic stem loosening). HHS had improved from 59 to 94 and Oxford Hip Score from 22 to 43. CH rate after 1 year was 69% and after 10 years 74%. In the first year, radiolucency was found in 58% and in 17.5% after 10 years. Subsidence after 1 year was 1.6 ± 1.6 mm and 5.0 ± 3.1 mm after 10 years. CONCLUSIONS The Fitmore hip stem showed a survival rate of 99% as well as good clinical and radiographic outcomes in the long-term follow-up of 10 years.
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Affiliation(s)
- Jana F Schader
- Department of Orthopaedic Surgery, Cantonal Hospital Graubuenden, 7000, Chur, Switzerland.
| | - Caroline Thalmann
- Department of Orthopaedic Surgery, Cantonal Hospital Graubuenden, 7000, Chur, Switzerland
| | | | | | - Karl Stoffel
- University of Basel, 4001, Basel, Switzerland
- Department of Orthopaedic Surgery, University Hospital Basel, 4031, Basel, Switzerland
| | - Arno Frigg
- University of Basel, 4001, Basel, Switzerland
- Department of Orthopaedic Surgery, University Hospital Basel, 4031, Basel, Switzerland
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Pastor T, Zderic I, Drenchev L, Skulev HK, Berk T, Beeres FJP, Link BC, Gueorguiev B, Stoffel K, Knobe M. Is augmented femoral lateral plating with helically shaped medial plates biomechanically advantageous over straight medial plates? J Orthop Res 2023. [PMID: 37975265 DOI: 10.1002/jor.25730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
Dual plating of comminuted distal femoral fractures allows for early patient mobilization. An additional helically shaped medial plate avoids the medial vital structures of the thigh. The aim of this study is to investigate the biomechanical competence of an augmented lateral locking compression plate distal femur (LCP-DF) using an additional straight versus a helically shaped medial LCP of the same length. Ten pairs of human cadaveric femora were instrumented with a lateral anatomical 15-hole LCP-DF. Following, they were pairwise instrumented with either an additional medial straight 14-hole LCP (group 1) or a 90°-helical shape LCP (group 2). All specimens were biomechanically tested under quasi-static and progressively increasing combined cyclic axial and torsional loading until failure. Initial interfragmentary axial displacement and flexion under static compression were significantly smaller in group 1 (0.11 ± 0.12 mm and 0.21 ± 0.10°) versus group 2 (0.31 ± 0.14 mm and 0.68 ± 0.16°), p ≤ 0.007. Initial varus deformation under static compression remained not significantly different between group 1 (0.57 ± 0.23°) and group 2 (0.75 ± 0.34°), p = 0.085. Flexion movements during dynamic loading were significantly bigger in group 2 (2.51 ± 0.54°) versus group 1 (1.63 ± 1.28°), p = 0.015; however, no significant differences were observed in terms of varus, internal rotation, and axial and shear displacements between the groups, p ≥ 0.204. Cycles to failure and load at failure were higher in group 2 (25,172 ± 6376 and 3017 ± 638 N) compared to group 1 (22,277 ± 4576 and 2728 ± 458 N) with no significant differences between them, p = 0.195. From a biomechanical perspective, helical double plating may be considered a useful alternative to straight double plating, demonstrating ameliorated damping capacities during flexion deformation and safer application as the medial neurovascular structures of the thigh are avoided.
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Affiliation(s)
- Torsten Pastor
- AO Research Institute Davos, Davos, Switzerland
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | - Ludmil Drenchev
- Bulgarian Academy of Sciences, Institute of Metal Science "Acad. A. Balevski", Sofia, Bulgaria
| | - Hristo K Skulev
- Bulgarian Academy of Sciences, Institute of Metal Science "Acad. A. Balevski", Sofia, Bulgaria
| | - Till Berk
- AO Research Institute Davos, Davos, Switzerland
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany
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Mauch M, Brecht H, Clauss M, Stoffel K. Use of Short Stems in Revision Total Hip Arthroplasty: A Retrospective Observational Study of 31 Patients. Medicina (Kaunas) 2023; 59:1822. [PMID: 37893539 PMCID: PMC10608113 DOI: 10.3390/medicina59101822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/25/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Implantation of a short femoral stem in revision total hip arthroplasty (rTHA) could reduce the perioperative time, soft tissue damage, and preserve the bone stock of the proximal femur. The objective of this study was to describe the clinical and radiographic outcomes after the use of short stems in rTHA with a follow-up of 1 to 5 years. Materials and Methods: This retrospective, single center, and observational study analyzed the data of 31 patients (12 female, 19 male) with a median (interquartile range) age of 68.2 years (61.2-78.4) and BMI of 26.7 kg/m2 (24.6-29.4) who received an uncemented short femoral stem in rTHA between 2015 and 2020. Clinical outcomes were extracted from medical reports and assessed using the modified Harris Hip Score (mHHS), the numerical rating scale (NRS) for pain and satisfaction, and the UCLA Physical Activity Score. Radiographs were analyzed for stem subsidence, fixation, and bone parameters. The Wilcoxon test was used for pre-post rTHA differences (p < 0.05); clinical relevance was interpreted based on effect sizes according to Cohen's d. Results: All the clinical outcome measures improved significantly (p ≤ 0.001) at follow-up compared to preoperative status, with large effect sizes (Cohen's d) ranging from 2.8 to 1.7. At the last follow-up, the median (interquartile) mHHS was 80.9 (58.6-93.5). Stem fixation was stable in all cases. Complications included stem subsidence of 3 mm (n = 1) and 10 mm (n = 1), heterotopic ossification Brooker stage III (n = 2), intraoperative femur perforation (n = 1), periprosthetic fracture Vancouver type A (n = 1), and dislocation (n = 2). Conclusions: The good clinical results in our selective study population of patients with mild to moderate bone deficiency, supported by large effect sizes, together with a complication rate within the normal range, support the consideration of short stems as a surgical option after a thorough preoperative analysis.
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Affiliation(s)
- Marlene Mauch
- Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (H.B.); (M.C.); (K.S.)
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Hendrik Brecht
- Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (H.B.); (M.C.); (K.S.)
| | - Martin Clauss
- Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (H.B.); (M.C.); (K.S.)
- Center for Musculoskeletal Infections (ZMSI), University Hospital Basel, 4031 Basel, Switzerland
| | - Karl Stoffel
- Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (H.B.); (M.C.); (K.S.)
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11
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Zhelev D, Hristov S, Zderic I, Ivanov S, Visscher L, Baltov A, Ribagin S, Stoffel K, Kralinger F, Winkler J, Richards RG, Varga P, Gueorguiev B. Treatment of Metaphyseal Defects in Plated Proximal Humerus Fractures with a New Augmentation Technique-A Biomechanical Cadaveric Study. Medicina (Kaunas) 2023; 59:1604. [PMID: 37763723 PMCID: PMC10536689 DOI: 10.3390/medicina59091604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Unstable proximal humerus fractures (PHFs) with metaphyseal defects-weakening the osteosynthesis construct-are challenging to treat. A new augmentation technique of plated complex PHFs with metaphyseal defects was recently introduced in the clinical practice. This biomechanical study aimed to analyze the stability of plated unstable PHFs augmented via implementation of this technique versus no augmentation. Materials and Methods: Three-part AO/OTA 11-B1.1 unstable PHFs with metaphyseal defects were created in sixteen paired human cadaveric humeri (average donor age 76 years, range 66-92 years), pairwise assigned to two groups for locked plate fixation with identical implant configuration. In one of the groups, six-milliliter polymethylmethacrylate bone cement with medium viscosity (seven minutes after mixing) was placed manually through the lateral window in the defect of the humerus head after its anatomical reduction to the shaft and prior to the anatomical reduction of the greater tuberosity fragment. All specimens were tested biomechanically in a 25° adduction, applying progressively increasing cyclic loading at 2 Hz until failure. Interfragmentary movements were monitored by motion tracking and X-ray imaging. Results: Initial stiffness was not significantly different between the groups, p = 0.467. Varus deformation of the humerus head fragment, fracture displacement at the medial humerus head aspect, and proximal screw migration and cut-out were significantly smaller in the augmented group after 2000, 4000, 6000, 8000 and 10,000 cycles, p ≤ 0.019. Cycles to 5° varus deformation of the humerus head fragment-set as a clinically relevant failure criterion-and failure load were significantly higher in the augmented group, p = 0.018. Conclusions: From a biomechanical standpoint, augmentation with polymethylmethacrylate bone cement placed in the metaphyseal humerus head defect of plated unstable PHFs considerably enhances fixation stability and can reduce the risk of postoperative complications.
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Affiliation(s)
- Daniel Zhelev
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
- Department of Orthopedics and Traumatology, University Hospital for Active Treatment, 8018 Burgas, Bulgaria;
| | - Stoyan Hristov
- Department of Orthopedics and Traumatology, University Hospital for Active Treatment, 8018 Burgas, Bulgaria;
| | - Ivan Zderic
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
| | - Stoyan Ivanov
- Department of Orthopaedics and Traumatology, Medical University of Varna, 9002 Varna, Bulgaria;
| | - Luke Visscher
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
- School of Medicine, Queensland University of Technology, Brisbane 4000, Australia
| | - Asen Baltov
- Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine ‘N. I. Pirogov’, 1606 Sofia, Bulgaria;
| | - Simeon Ribagin
- Department of Health Pharmaceutical Care, Medical College, University ‘Prof. Dr. Asen Zlatarov’, 8010 Burgas, Bulgaria;
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland;
| | - Franz Kralinger
- Department of Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria;
- Trauma and Sports Department, Ottakring Clinic, Teaching Hospital, Medical University of Vienna, 1160 Vienna, Austria
| | - Jörg Winkler
- Cantonal Hospital Graubuenden, 7000 Chur, Switzerland;
| | - R. Geoff Richards
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
| | - Peter Varga
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
| | - Boyko Gueorguiev
- AO Research Institute Davos, 7270 Davos, Switzerland; (D.Z.); (I.Z.); (L.V.); (R.G.R.); (P.V.)
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12
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Stoffel K, Michelitsch C, Arora R, Babst R, Candrian C, Eickhoff A, Gebhard F, Platz A, Schmid FA, Weschenfelder W, Sommer C. Clinical performance of the Femoral Neck System within 1 year in 125 patients with acute femoral neck fractures, a prospective observational case series. Arch Orthop Trauma Surg 2023; 143:4155-4164. [PMID: 36460761 PMCID: PMC10293436 DOI: 10.1007/s00402-022-04686-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/27/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Osteosynthesis of femoral neck fractures (FNFs) is an important treatment option, especially for younger patients. We aimed to assess the rate of early implant-related complications in FNF osteosynthesis using the Femoral Neck System (FNS). PATIENTS AND METHODS Consecutive patients diagnosed with displaced or nondisplaced FNFs were treated with FNS in this prospective, observational, multicenter investigation. Patients were followed up for minimally 3 months and up to 12 months if radiologic bone union and no pain was not achieved beforehand. Predefined treatment-related adverse events (AEs, defined as implant failure, loss of reduction, iatrogenic fractures, deep infection, and surgical revision), radiologic bone union, and patient-reported Harris hip score (HHS) and EQ-5D-5L index score were assessed. RESULTS One hundred and twenty-five patients were included in the study. Thirty-eight (30.4%) fractures were displaced (Garden III and IV), and 37 (29.6%) were vertical fractures (Pauwels type III). Predefined treatment-related AE rate at 3 months was 8 patients, 6.4% (95% CI, 2.8-12.2), and at 12 months, 11 patients, 8.8% (95% CI, 4.5-15.2). Cumulative incidences of bone union were 68% at 3 months, 90% at 6 months, and 98% at 12 months. The mean changes of HHS and EQ-5D-5L index score between preinjury and at 12 months were -7.5 (95% CI, [ - 21.1] to [6.2]) and - 0.03 (95% CI, [ - 0.21] to [0.15]), respectively; neither were statistically significant. CONCLUSION The current study on osteosynthesis of FNFs with the FNS resulted in treatment-related complication rates of 6.4% (95% CI, 2.8-12.2) at 3 months and 8.8% (95% CI, 4.5-15.2) at 12 months. On average, patients returned to preinjury function and quality of life. The current study may also indicate that the conventional wisdom of treating stable FNF in patients aged between 60 and 80 years with osteosynthesis may need to be reconsidered. REGISTRATION The study is registered with ClinicalTrials.gov (registration number: NCT02422355).
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Affiliation(s)
- Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | | | - Rohit Arora
- Department for Orthopaedics Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Reto Babst
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Orthopedics and Trauma, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Alexander Eickhoff
- Department of Trauma Surgery, Hand, Plastic and Reconstructive Surgery, University of Ulm, Ulm, Germany
| | - Florian Gebhard
- Department of Trauma Surgery, Hand, Plastic and Reconstructive Surgery, University of Ulm, Ulm, Germany
| | - Andreas Platz
- Department of General, Hand, and Trauma Surgery, City Hospital Triemli, Zurich, Switzerland
| | - Florian Andreas Schmid
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland
| | - Wolfram Weschenfelder
- Department of Trauma, Hand and Reconstructive Surgery, Friedrich-Schiller-University Jena, Jena, Germany
| | - Christoph Sommer
- Department of Surgery, Kantonsspital Graubuenden, Chur, Switzerland
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13
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Ismailidis P, Mündermann A, Stoffel K. A Monocortical Screw for Preventing Trochanteric Escape in Extended Trochanteric Osteotomy: A Simple Solution to a Complicated Problem? J Clin Med 2023; 12:jcm12082947. [PMID: 37109281 PMCID: PMC10145078 DOI: 10.3390/jcm12082947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/26/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Extended trochanteric osteotomy (ETO) is an established method in revision total hip arthroplasty. Proximal migration of the greater trochanter fragment and the resulting non-union of the osteotomy remains a major problem, and several techniques have been developed to prevent its occurrence. This paper describes a novel modification of the original surgical technique in which a single monocortical screw is placed distally to one of the cerclages used for the fixation of the ETO. The contact between the screw and the cerclage counteracts the forces applied on the greater trochanter fragment and prevents trochanteric escape under the cerclage. The technique is simple and minimally invasive, does not require special skills or additional resources, or add to surgical trauma or operating time, and therefore represents a simple solution to a complicated problem.
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Affiliation(s)
- Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
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14
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Stoffel K, Zderic I, Pastor T, Woodburn W, Castle R, Penman J, Saura-Sanchez E, Gueorguiev B, Sommer C. Anterior variable-angle locked plating versus tension band wiring of simple and complex patella fractures - a biomechanical investigation. BMC Musculoskelet Disord 2023; 24:279. [PMID: 37041618 PMCID: PMC10088273 DOI: 10.1186/s12891-023-06394-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/03/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the biomechanical performance of novel anterior variable-angle locking plates versus tension band wiring used for fixation of simple and complex patella fractures. METHODS Sixteen pairs of human cadaveric knees were used to simulate two-part simple transverse AO/OTA 34-C1 and five-part complex AO/OTA 34-C3 patella fractures. The complex fracture pattern was characterized with a medial and a lateral proximal fragment, together with an inferomedial, an inferolateral and an inferior fragment mimicking comminution around the distal patella pole. Eight pairs with simple fractures were split for fixation via either tension band wiring (TBW) through two parallel cannulated screws or anterior variable-angle locked plating, whereas other eight pairs with complex fractures were split for either TBW through two parallel cannulated screws plus circumferential cerclage wiring, or anterior variable-angle locked plating using a cortical caudo-cranial polar screw. Each specimen was tested over 5000 cycles with a range of motion from 90° flexion to full extension by pulling on the quadriceps tendon. Interfragmentary movements were captured by motion tracking. RESULTS For both fracture types, the longitudinal and shear articular displacements, measured between the proximal and distal fragments at the central patella aspect between 1000 and 5000 cycles, together with the relative rotations of these fragments around the mediolateral axis were all significantly smaller following anterior variable-angle locked plating versus TBW, p ≤ 0.01. CONCLUSIONS From a biomechanical perspective, anterior locked plating of both simple and complex patella fractures resulted in less interfragmentary displacement under extended cyclic loading.
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Affiliation(s)
- Karl Stoffel
- University Hospital Basel, Petersgraben 4, Basel, 4031, Switzerland
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, Davos, 7270, Switzerland.
| | - Torsten Pastor
- AO Research Institute Davos, Clavadelerstrasse 8, Davos, 7270, Switzerland
- Cantonal Hospital Lucerne, Spitalstrasse 16, Lucerne, 6000, Switzerland
| | | | - Richard Castle
- DePuy Synthes, Goshen Pkwy, West Chester, PA, 1310, 19380, USA
| | - Jessica Penman
- DePuy Synthes, Goshen Pkwy, West Chester, PA, 1310, 19380, USA
| | - Eladio Saura-Sanchez
- University Hospital of Elche, Carrer Almazara, 11, Elche, Alicante, 03203, Spain
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, Davos, 7270, Switzerland
| | - Christoph Sommer
- Cantonal Hospital Graubünden, Loestrasse 170, Chur, 7000, Switzerland
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15
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Kaufmann M, Nüesch C, Clauss M, Pagenstert G, Eckardt A, Ilchmann T, Stoffel K, Mündermann A, Ismailidis P. Functional assessment of total hip arthroplasty using inertial measurement units: Improvement in gait kinematics and association with patient-reported outcome measures. J Orthop Res 2023; 41:759-770. [PMID: 35880355 DOI: 10.1002/jor.25421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 07/08/2022] [Accepted: 07/23/2022] [Indexed: 02/04/2023]
Abstract
Inertial measurement units (IMUs) are commonly used for gait assessment, yet their potential for quantifying improvements in gait function and patterns after total hip arthroplasty (THA) has not been fully explored. The primary aim of this study was to compare spatiotemporal parameters and sagittal plane kinematic patterns of patients with hip osteoarthritis (OA) before and after THA, and to asymptomatic controls. The secondary aim was to assess the association between dynamic hip range of motion (ROM) during walking and the Hip Osteoarthritis Outcome Scores (HOOS). Twenty-four patients with hip OA and 24 matched asymptomatic controls completed gait analyses using the RehaGait® sensor system. Patients were evaluated pre- and 1 year postoperatively, controls in a single visit. Differences in kinematic data were analyzed using statistical parametric mapping, and correlations between dynamic hip ROM and HOOS were calculated. Walking speed and stride length significantly increased (+0.08 m/s, p = 0.019; +0.06 m, p = 0.048) after THA but did not reach the level of asymptomatic controls (-0.11 m/s, p = 0.028; -0.14 m, p = 0.001). Preoperative hip and knee kinematics differed significantly from controls. After THA, they improved significantly and did not differ from controls. Dynamic hip flexion-extension ROM correlated positively with all HOOS subscores (r > 0.417; p ≤ 0.001). The change in HOOS symptoms in patients was explained by the combination of baseline HOOS symptoms and change in dynamic hip ROM (r2 = 0.748) suggesting that the additional information gained with IMU gait analysis helps to complement and objectify patient-reported outcome measures pre- and postoperatively and monitor treatment-related improvements.
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Affiliation(s)
- Mara Kaufmann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Martin Clauss
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Center for Musculoskeletal Infections, University Hospital Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland.,Clarahof Clinic of Orthopaedic Surgery, Basel, Switzerland
| | - Anke Eckardt
- ENDO-Team, Hirslanden Klinik, Birshof, Münchenstein, Switzerland
| | - Thomas Ilchmann
- ENDO-Team, Hirslanden Klinik, Birshof, Münchenstein, Switzerland
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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16
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Pukalski Y, Barcik J, Zderic I, Yanev P, Baltov A, Malouchev O, Stoffel K, Richards G, Gueorguiev B, Enchev D. Superior fixation strength of coronoid process replacement using individually designed 3D printed prosthesis with curved cemented intramedullary stem. J Shoulder Elbow Surg 2023; 32:1079-1087. [PMID: 36737031 DOI: 10.1016/j.jse.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/06/2022] [Accepted: 12/28/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Coronoid fractures frequently occur as part of complex elbow injuries and account for 2-15% of the cases with dislocations. Comminuted fractures and non-unions necessitate surgical treatment. Considering the latest technological advancements, the aim of this study was to investigate the fixation strength of coronoid replacement using an individualized 3D printed prosthesis with curved cemented intramedullary stem versus both radial head grafted reconstruction and coronoid fixation. METHODS Twenty-four human cadaveric paired forearms were stripped of soft tissue and their CT scanned ulnas were randomized to four groups for coronoid replacement (prosthesis group), radial head grafted reconstruction (radial head group), fixation (fixation group) or no treatment (intact group). The ulnas in all groups except the intact one were osteotomized at 40% of the coronoid height and either replaced with a 3D printed stainless-steel coronoid prosthesis with curved cemented intramedullary stem, individually designed based on the contralateral scan (prosthesis group), reconstructed with an ipsilateral radial head autograft fixed with two anteroposterior screws (radial head group), or coronoid process fixed in situ with two anteroposterior screws (fixation group). All specimens were biomechanically tested under ramped quasi-static axial loading. RESULTS Bone mineral density was not significantly different among the groups (p=0.95). Stiffness and failure load in the prosthesis group was significantly higher compared to all other groups (p≤0.04) and in addition it was significantly lower in the fixation group compared to the intact group (=0.03), with no further detected significant differences among the groups (p≥0.72). Absorbed energy to failure in the prosthesis group was significantly more compared to both radial head and fixation groups (p≤0.04) but not versus the intact group. Failure deformation at the osteotomy site was not significantly different among the groups (p=0.26). CONCLUSIONS Coronoid process replacement using an anatomically shaped individually designed 3D printed prosthesis with curved cemented intramedullary stem seems to be an effective method to restore the coronoid buttress function under axial loading. This method provides superior fixation strength over both radial head grafted reconstruction and screw fixation.
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Affiliation(s)
- Yavor Pukalski
- AO Research Institute Davos, Davos, Switzerland; University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N I Pirogov', Sofia, Bulgaria.
| | - Jan Barcik
- AO Research Institute Davos, Davos, Switzerland
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | - Parvan Yanev
- AO Research Institute Davos, Davos, Switzerland; University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N I Pirogov', Sofia, Bulgaria
| | - Asen Baltov
- University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N I Pirogov', Sofia, Bulgaria
| | | | | | | | | | - Dian Enchev
- University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N I Pirogov', Sofia, Bulgaria
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17
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Pastor T, Zderic I, Gehweiler D, Gardner MJ, Stoffel K, Richards G, Knobe M, Gueorguiev B. Biomechanical analysis of recently released cephalomedullary nails for trochanteric femoral fracture fixation in a human cadaveric model. Arch Orthop Trauma Surg 2022; 142:3787-3796. [PMID: 34748055 DOI: 10.1007/s00402-021-04239-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recently, two novel concepts for intramedullary nailing of trochanteric fractures using a helical blade or interlocking dual screws have demonstrated advantages as compared to standard single-screw systems. However, these two concepts have not been subjected to a direct biomechanical comparison so far. The aims of this study were to investigate in a human cadaveric model with low bone quality (1) the biomechanical competence of nailing with the use of a helical blade versus interlocking screws, and (2) the effect of cement augmentation on the fixation strength of the helical blade. METHODS Twelve osteoporotic and osteopenic human cadaveric femoral pairs were assigned for pairwise implantation using either a short TFN-ADVANCED Proximal Femoral Nailing System (TFNA) with a helical blade head element or a short TRIGEN INTERTAN Intertrochanteric Antegrade Nail (InterTAN) with interlocking screws. Six osteoporotic femora, implanted with TFNA, were augmented with bone cement. Four groups were created: group 1 (TFNA) paired with group 2 (InterTAN), both consisting of osteopenic specimens, and group 3 (TFNA augmented) paired with group 4 (InterTAN), both consisting of osteoporotic specimens. An unstable trochanteric AO/OTA 31-A2.2 fracture was simulated and all specimens were tested until failure under progressively increasing cyclic loading. RESULTS Stiffness in group 3 was significantly higher versus group 4, p = 0.03. Varus (°) and femoral head rotation around the femoral neck axis (°) after 10,000 cycles were 1.9 ± 1.0/0.3 ± 0.2 in group 1, 2.2 ± 0.7/0.7 ± 0.4 in group 2, 1.5 ± 1.3/0.3 ± 0.2 in group 3 and 3.5 ± 2.8/0.9 ± 0.6 in group 4, being significantly different between groups 3 and 4, p = 0.04. Cycles to failure and failure load (N) at 5° varus or 10° femoral head rotation around the neck axis in groups 1-4 were 21,428 ± 6020/1571.4 ± 301.0, 20,611 ± 7453/1530.6 ± 372.7, 21,739 ± 4248/1587.0 ± 212.4 and 18,622 ± 6733/1431.1 ± 336.7, being significantly different between groups 3 and 4, p = 0.04. CONCLUSIONS Nailing of trochanteric femoral fractures with use of helical blades is comparable to interlocking dual screws fixation in femoral head fragments with low bone quality. Bone cement augmentation of helical blades provides significantly greater fixation strength compared to interlocking screws constructs.
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Affiliation(s)
- Torsten Pastor
- AO Research Institute Davos, Davos, Switzerland.
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | | | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, Stanford, CA, USA
| | | | | | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
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18
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Hristov S, Visscher L, Winkler J, Zhelev D, Ivanov S, Veselinov D, Baltov A, Varga P, Berk T, Stoffel K, Kralinger F, Gueorguiev B. A Novel Technique for Treatment of Metaphyseal Voids in Proximal Humerus Fractures in Elderly Patients. Medicina (B Aires) 2022; 58:medicina58101424. [PMID: 36295586 PMCID: PMC9611038 DOI: 10.3390/medicina58101424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/24/2022] [Accepted: 09/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives: The treatment of proximal humerus fractures in elderly patients is challenging, with reported high complication rates mostly related to implant failure involving screw cut-out and penetration. Metaphyseal defects are common in osteoporotic bone and weaken the osteosynthesis construct. A novel technique for augmentation with polymethylmethacrylate (PMMA) bone cement was developed for the treatment of patients in advanced age with complex proximal humerus fractures and metaphyseal voids, whereby the cement was allowed to partially cure for 5–7 min after mixing to achieve medium viscosity, and then it was manually placed into the defect through the traumatic lateral window with a volume of 4–6 mL per patient. The aim of this retrospective clinical study was to assess this technique versus autologous bone graft augmentation and no augmentation. Materials and Methods: The outcomes of 120 patients with plated Neer three- and four-part fractures, assigned to groups of 63 cases with no augmentation, 28 with bone graft augmentation and 29 with cement augmentation, were assessed in this study. DASH, CS, pain scores and range of motion were analyzed at 3, 6 and 12 months. Statistical analysis was performed with factors for treatment and age groups, Neer fracture types and follow-up periods, and with the consideration of age as a covariate. Results: DASH and CS improved following cement augmentation at three and six months compared to bone grafting, being significant when correcting for age as a covariate (p ≤ 0.007). While the age group had a significant effect on both these scores with worsened values at a higher age for non-augmented and grafted patients (p ≤ 0.044), this was not the case for cement augmented patients (p ≥ 0.128). Cement augmentation demonstrated good clinical results at 12 months with a mean DASH of 10.21 and mean CS percentage of 84.83% versus the contralateral side, not being significantly different among the techniques (p ≥ 0.372), despite the cement augmented group representing the older population with more four-part fractures. There were no concerning adverse events specifically related to the novel technique. Conclusions: This study has detailed a novel technique for the treatment of metaphyseal defects with PMMA cement augmentation in elderly patients with complex proximal humerus fractures and follow-up to one year, whereby the cement was allowed to partially cure to achieve medium viscosity, and then it was manually placed into the defect through the traumatic lateral window. The results demonstrate clinically equivalent short-term results to 6 months compared to augmentation with bone graft or no augmentation—despite the patient group being older and with a higher rate of more severe fracture patterns. The technique appears to be safe with no specifically related adverse events and can be added in the surgeon’s armamentarium for the treatment of these difficult to manage fractures.
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Affiliation(s)
- Stoyan Hristov
- Department of Orthopedics and Traumatology, University Hospital for Active Treatment, 8018 Burgas, Bulgaria
| | - Luke Visscher
- AO Research Institute Davos, 7270 Davos, Switzerland
- School of Medicine, Queensland University of Technology, Brisbane 4000, Australia
| | - Jörg Winkler
- Cantonal Hospital Graubuenden, 7000 Chur, Switzerland
| | - Daniel Zhelev
- Department of Orthopedics and Traumatology, University Hospital for Active Treatment, 8018 Burgas, Bulgaria
- AO Research Institute Davos, 7270 Davos, Switzerland
| | - Stoyan Ivanov
- Department of Orthopaedics and Traumatology, Medical University of Varna, 9002 Varna, Bulgaria
| | - Deyan Veselinov
- Bulgarian Academy of Sciences, Institute of Metal Science ‘Acad. A. Balevski’, 1574 Sofia, Bulgaria
| | - Asen Baltov
- Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine ‘N. I. Pirogov’, 1606 Sofia, Bulgaria
| | - Peter Varga
- AO Research Institute Davos, 7270 Davos, Switzerland
| | - Till Berk
- AO Research Institute Davos, 7270 Davos, Switzerland
- Department of Traumatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland
| | - Franz Kralinger
- Department of Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Trauma and Sports Department, Teaching Hospital Medical University of Vienna, Ottakring Clinic, 1160 Vienna, Austria
| | - Boyko Gueorguiev
- AO Research Institute Davos, 7270 Davos, Switzerland
- Correspondence:
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19
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Abstract
For complex distal femoral fractures, a single lateral locking compression plate or retrograde intramedullary nail may not achieve a stable environment for fracture healing. Various types of double fixation constructs have been featured in the current literature. Double-plate construct and nail-and-plate construct are two common double fixation constructs for distal femoral fractures. Double fixation constructs have been featured in studies on comminuted distal femoral fractures, distal femoral fracture with medial bone defects, periprosthetic fractures, and distal femoral non-union. A number of case series reported a generally high union rate and satisfactory functional outcomes for double fixation of distal femoral fractures. In this review, we present the state of the art of double fixation constructs for distal femoral fractures with a focus on double-plate and plate-and-nail constructs.
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Affiliation(s)
- Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Christoph Sommer
- Department of Surgery, Kantonsspital Graubuenden, Chur, Switzerland
| | - Mark Lee
- Department of Orthopaedic Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Tracy Y Zhu
- AO Innovation Translation Center, AO Foundation, Davos, Switzerland
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20
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Zderic I, Gueorguiev B, Blauth M, Weber A, Koch R, Dauwe J, Schader JF, Stoffel K, Finkemeier C, Hessmann M. Angular stable locking in a novel intramedullary nail improves construct stability in a distal tibia fracture model. Injury 2022; 53:878-884. [PMID: 34782117 DOI: 10.1016/j.injury.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/02/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Intramedullary nails are frequently used for treatment of unstable distal tibia fractures. However, insufficient fixation of the distal fragment could result in delayed healing, malunion or nonunion. Recently, a novel concept for angular stable nailing was developed that maintains the principle of relative stability and introduces improvements expected to reduce nail toggling, screw migration and secondary loss of reduction. The aim of this study was to investigate the biomechanical competence of the novel angular stable intramedullary nail concept for treatment of unstable distal tibia fractures, compared to a conventional nail locking in a human cadaveric model under dynamic loading. MATERIALS AND METHODS Ten pairs of fresh-frozen human cadaveric tibiae with a simulated AO/OTA 42-A3.1 fracture were assigned to 2 groups for reamed intramedullary nailing using either a conventional (non-angular stable) Expert Tibia Nail (ETN) with 3 distal screws or the novel Tibia Nail Advanced (TNA) system with 2 distal angular stable locking low-profile retaining screws. The specimens were biomechanically tested under conditions including initial quasi-static loading, followed by progressively increasing combined cyclic axial and torsional loading in internal rotation until failure of the bone-implant construct. Both tests were monitored by means of motion tracking. RESULTS Initial nail toggling of the distal tibia fragment in varus and flexion under axial loading was lower for TNA compared to ETN, being significant in flexion, P = 0.91 and P = 0.03. After 5000 cycles, interfragmentary movements in terms of varus, flexion, internal rotation, axial displacement, and shear displacement at the fracture site were all lower for TNA compared to ETN, with flexion and shear displacement being significant, P = 0.14, P = 0.04, P = 0.25, P = 0.11 and P = 0.04, respectively. Cycles to failure until both interfragmentary 5° varus and 5° flexion were significantly higher for TNA compared to ETN, P = 0.04. CONCLUSION From a biomechanical perspective, the novel angular stable intramedullary nail concept provides increased construct stability and maintains it over time while reducing the number of required locking screws without impeding the flexibility of the nail itself and resists better towards loss of reduction under dynamic loading, compared to conventional locking in intramedullary nailed unstable distal tibia fractures.
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Affiliation(s)
- Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland.
| | | | | | | | | | - Jan Dauwe
- AO Research Institute Davos, Davos, Switzerland.
| | | | | | - Christopher Finkemeier
- Orthopaedic Trauma Surgeons of Northern California, Roseville, CA, United States of America.
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21
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Hadzhinikolova M, Zderic I, Ciric D, Barcik JP, Enchev D, Baltov A, Rusimov L, Varga P, Stoffel K, Richards G, Gueorguiev B, Rashkov M. Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment - a biomechanical study. BMC Musculoskelet Disord 2022; 23:35. [PMID: 34986819 PMCID: PMC8734044 DOI: 10.1186/s12891-021-04989-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
Complex intraarticular distal radius fractures (DRFs), commonly managed with volar locking plates, are challenging. Combined volar and dorsal plating is frequently applied for treatment, however, biomechanical investigations are scant. The aim of this biomechanical study was to investigate volar plating versus double plating in DRFs with different degrees of lunate facet comminution.Thirty artificial radii with simulated AO/OTA 23-C2.1 and C3.1 DRFs, including dorsal defect and lunate facet comminution, were assigned to 3 groups: Group 1 with two equally-sized lunate facet fragments; Group 2 with small dorsal and large volar fragment; Group 3 with three equally-sized fragments. The specimens underwent volar and double locked plating and non-destructive ramped loading in 0° neutral position, 40° flexion and 40° extension.In each tested position, stiffness: (1) did not significantly differ among groups with same fixation method (p ≥ 0.15); (2) increased significantly after supplemental dorsal plating in Group 2 and Group 3 (p ≤ 0.02).Interfragmentary displacements between styloid process and lunate facet in neutral position were below 0.5 mm, being not significantly different among groups and plating techniques (p ≥ 0.63).Following volar plating, angular displacement of the lunate facet to radius shaft was significantly lower in Group 1 versus both Group 2 and Group 3 (p < 0.01). It decreased significantly after supplemental dorsal plating in Group 2 and Group 3 (p < 0.01), but not in Group 1 (p ≥ 0.13), and did not differ significantly among the three groups after double plating (p ≥ 0.74).Comminution of the lunate facet within its dorsal third significantly affected the biomechanical outcomes related to complex intraarticular DRFs treated with volar and double locked plates.Double plating demonstrates superior stability versus volar plating only for lunate facet comminution within its dorsal third. In contrast, volar plating could achieve stability comparable with double plating when the dorsal third of the lunate facet is not separated by the fracture pattern. Both fixation methods indicated achievable absolute stability between the articular fragments.
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Affiliation(s)
- Mariya Hadzhinikolova
- AO Research Institute Davos, Davos, Switzerland.,Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | - Daniel Ciric
- AO Research Institute Davos, Davos, Switzerland.,Flinders University, Tonsley, South Australia
| | | | - Dian Enchev
- Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Asen Baltov
- Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Lyubomir Rusimov
- AO Research Institute Davos, Davos, Switzerland.,Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
| | | | | | | | - Mihail Rashkov
- Department of Trauma Surgery, University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
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22
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Abstract
The burden of periprosthetic distal femoral fractures is projected to increase accordingly with the increase in total knee arthroplasties (TKAs) performed globally in the future. Less invasive plating and intramedullary (IM) nailing techniques still seem to provide similar outcomes based on current literature. Double-plating and combination techniques may prove to be beneficial in the future pending further large-scale studies but currently have not demonstrated superiority over single plating and IM nailing based on current evidence. Distal femoral replacement may provide a useful option for future treatment, provided it is performed by a trained knee arthroplasty surgeon.
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Affiliation(s)
- Gerard A Sheridan
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Aresh Sepehri
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Gellertstrasse 144, 4052 Basel, Switzerland
| | - Bassam A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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23
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Nüesch C, Ismailidis P, Koch D, Pagenstert G, Ilchmann T, Eckardt A, Stoffel K, Egloff C, Mündermann A. Assessing Site Specificity of Osteoarthritic Gait Kinematics with Wearable Sensors and Their Association with Patient Reported Outcome Measures (PROMs): Knee versus Hip Osteoarthritis. Sensors (Basel) 2021; 21:s21165363. [PMID: 34450828 PMCID: PMC8398113 DOI: 10.3390/s21165363] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 12/13/2022]
Abstract
There is a great need for quantitative outcomes reflecting the functional status in patients with knee or hip osteoarthritis (OA) to advance the development and investigation of interventions for OA. The purpose of this study was to determine if gait kinematics specific to the disease—i.e., knee versus hip OA—can be identified using wearable sensors and statistical parametric mapping (SPM) and whether disease-related gait deviations are associated with patient reported outcome measures. 113 participants (N = 29 unilateral knee OA; N = 30 unilateral hip OA; N = 54 age-matched asymptomatic persons) completed gait analysis with wearable sensors and the Knee/Hip Osteoarthritis Outcome Score (KOOS/HOOS). Data were analyzed using SPM. Knee and hip kinematics differed between patients with knee OA and patients with hip OA (up to 14°, p < 0.001 for knee and 8°, p = 0.003 for hip kinematics), and differences from controls were more pronounced in the affected than unaffected leg of patients. The observed deviations in ankle, knee and hip kinematic trajectories from controls were associated with KOOS/HOOS in both groups. Capturing gait kinematics using wearables has a large potential for application as outcome in clinical trials and for monitoring treatment success in patients with knee or hip OA and in large cohorts representing a major advancement in research on musculoskeletal diseases.
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Affiliation(s)
- Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department of Spine Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
| | - Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
| | - David Koch
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department for Sport, Movement and Health, University of Basel, 4052 Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
- Clarahof Clinic of Orthopaedic Surgery, 4058 Basel, Switzerland
| | - Thomas Ilchmann
- ENDO-Team, Hirslanden Klinik Birshof, 4142 Münchenstein, Switzerland; (T.I.); (A.E.)
| | - Anke Eckardt
- ENDO-Team, Hirslanden Klinik Birshof, 4142 Münchenstein, Switzerland; (T.I.); (A.E.)
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
| | - Christian Egloff
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department of Spine Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
- Correspondence:
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24
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Fletcher JWA, Sommer C, Eckardt H, Knobe M, Gueorguiev B, Stoffel K. Intracapsular Femoral Neck Fractures-A Surgical Management Algorithm. ACTA ACUST UNITED AC 2021; 57:medicina57080791. [PMID: 34440996 PMCID: PMC8400014 DOI: 10.3390/medicina57080791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 01/04/2023]
Abstract
Background and Objectives: Femoral neck fractures are common and constitute one of the largest healthcare burdens of the modern age. Fractures within the joint capsule (intracapsular) provide a specific surgical challenge due to the difficulty in predicting rates of bony union and whether the blood supply to the femoral head has been disrupted in a way that would lead to avascular necrosis. Most femoral neck fractures are treated surgically, aiming to maintain mobility, whilst reducing pain and complications associated with prolonged bedrest. Materials and Methods: We performed a narrative review of intracapsular hip fracture management, highlighting the latest advancements in fixation techniques, generating an evidence-based algorithm for their management. Results: Multiple different fracture configurations are encountered within the category of intracapsular hip fractures, with each pattern having different optimal surgical strategies. Additionally, these injuries typically occur in patients where further procedures due to operative complications are associated with a considerable increase in mortality, highlighting the need for choosing the correct index operation. Conclusions: Factors such as pathological causes for the fracture, pre-existing symptomatic osteoarthritis, patient’s physiological age and fracture displacement all need to be considered when choosing optimal management.
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Affiliation(s)
- James W. A. Fletcher
- AO Research Institute Davos, 7270 Davos, Switzerland;
- Department for Health, University of Bath, Bath BA2 7AY, UK
- Correspondence:
| | | | - Henrik Eckardt
- University Hospital Basel, 4052 Basel, Switzerland; (H.E.); (K.S.)
| | - Matthias Knobe
- Department of Orthopaedics and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland;
| | | | - Karl Stoffel
- University Hospital Basel, 4052 Basel, Switzerland; (H.E.); (K.S.)
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25
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Martinho T, Stoffel K. Treatment of Intertrochanteric Femur Fractures with Hip Arthroplasty in Older Patients: A Narrative Review of Indications and Outcomes. Medicina (Kaunas) 2021; 57:medicina57080763. [PMID: 34440969 PMCID: PMC8400749 DOI: 10.3390/medicina57080763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/26/2021] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- Tiago Martinho
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Street 22, 81675 Munich, Germany;
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Correspondence:
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26
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Schader JF, Zderic I, Gehweiler D, Dauwe J, Mys K, Danker C, Acklin YP, Sommer C, Gueorguiev B, Stoffel K. Standardized artificially created stable pertrochanteric femur fractures present more homogenous results compared to osteotomies for orthopaedic implant testing. BMC Musculoskelet Disord 2021; 22:371. [PMID: 33879133 PMCID: PMC8058974 DOI: 10.1186/s12891-021-04234-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/06/2021] [Indexed: 11/22/2022] Open
Abstract
Background With regard to biomechanical testing of orthopaedic implants, there is no consensus on whether artificial creation of standardized bone fractures or their simulation by means of osteotomies result in more realistic outcomes. Therefore, the aim of this study was to artificially create and analyze in an appropriate setting the biomechanical behavior of standardized stable pertrochanteric fractures versus their simulation via osteotomizing. Methods Eight pairs of fresh-frozen human cadaveric femora aged 72.7 ± 14.9 years (range 48–89 years) were assigned in paired fashion to two study groups. In Group 1, stable pertrochanteric fractures AO/OTA 31-A1 were artificially created via constant force application on the anterior cortex of the femur through a blunt guillotine blade. The same fracture type was simulated in Group 2 by means of osteotomies. All femora were implanted with a dynamic hip screw and biomechanically tested in 20° adduction under progressively increasing physiologic cyclic axial loading at 2 Hz, starting at 500 N and increasing at a rate of 0.1 N/cycle. Femoral head fragment movements with respect to the shaft were monitored by means of optical motion tracking. Results Cycles/failure load at 15° varus deformation, 10 mm leg shortening and 15° femoral head rotation around neck axis were 11324 ± 848/1632.4 ± 584.8 N, 11052 ± 1573/1605.2 ± 657.3 N and 11849 ± 1120/1684.9 ± 612.0 N in Group 1, and 10971 ± 2019/1597.1 ± 701.9 N, 10681 ± 1868/1568.1 ± 686.8 N and 10017 ± 4081/1501.7 ± 908.1 N in Group 2, respectively, with no significant differences between the two groups, p ≥ 0.233. Conclusion From a biomechanical perspective, by resulting in more consistent outcomes under dynamic loading, standardized artificial stable pertrochanteric femur fracture creation may be more suitable for orthopaedic implant testing compared to osteotomizing the bone.
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Affiliation(s)
- J F Schader
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos Platz, Switzerland. .,University of Basel, Basel, Switzerland. .,Department of Surgery, Cantonal Hospital Graubuenden, Chur, Switzerland.
| | - I Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos Platz, Switzerland
| | - D Gehweiler
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos Platz, Switzerland
| | - J Dauwe
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos Platz, Switzerland.,Department of Trauma Surgery, UZ Leuven, Leuven, Belgium
| | - K Mys
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos Platz, Switzerland
| | - C Danker
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos Platz, Switzerland
| | - Y P Acklin
- University Hospital Basel, Basel, Switzerland
| | - C Sommer
- Department of Surgery, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - B Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos Platz, Switzerland
| | - K Stoffel
- University of Basel, Basel, Switzerland.,University Hospital Basel, Basel, Switzerland
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Sermon A, Zderic I, Khatchadourian R, Scherrer S, Knobe M, Stoffel K, Gueorguiev B. Bone cement augmentation of femoral nail head elements increases their cut-out resistance in poor bone quality- A biomechanical study. J Biomech 2021; 118:110301. [PMID: 33582598 DOI: 10.1016/j.jbiomech.2021.110301] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 01/11/2021] [Accepted: 01/23/2021] [Indexed: 10/22/2022]
Abstract
The aim of this study was to analyze biomechanically the impact of bone cement augmentation on the fixation strength and cut-out resistance of Proximal Femoral Nail Antirotation (PFNA) and Trochanteric Fixation Nail Advanced (TFNA) head elements within the femoral head in a human cadaveric model with poor bone quality. Methodology: Fifteen pairs of fresh-frozen human cadaveric femoral heads were randomized to three sets of five pairs each for center-center implantation of either TFNA blade, TFNA screw, or PFNA blade. By splitting the specimens of each pair for treatment with or without bone cement augmentation, six study groups were created. All specimens were biomechanically tested under progressively increasing cyclic loading featuring a physiologic loading trajectory in a setup simulating a reduced intertrochanteric fracture with lack of posteromedial support. Number of cycles to 5° varus collapse was evaluated together with the corresponding load at failure. Results: Compared to the non-augmented state, all types of implants demonstrated significantly higher numbers of cycles to failure and load at failure following augmentation, p ≤ 0.03. Augmented TFNA blades resulted in highest numbers of cycles to failure and loads at failure (30492; 4049 N) followed by augmented PFNA blades (30033; 4003 N) and augmented TFNA screws (19307; 2930 N), p = 0.11. Augmented TFNA screws showed similar numbers of cycles to failure and loads at failure compared to both non-augmented TFNA and PFNA blades, P = 0.98. From a biomechanical perspective, bone cement augmentation significantly increases the cut-out resistance of instrumented TFNA and PFNA head elements and is a valid supplementary treatment option to these nailing procedures in poor bone quality.
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Affiliation(s)
- An Sermon
- Department of Traumatology, University Hospitals Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland.
| | | | - Simon Scherrer
- DePuy Synthes Trauma, Luzernstrasse 21, 4528 Zuchwil, Switzerland.
| | - Matthias Knobe
- Department of Trauma Surgery, Cantonal Hospital Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland.
| | - Karl Stoffel
- University Hospital Basel, Bethesda Spital, Gellertstrasse 144, 4052 Basel, Switzerland.
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland.
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28
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Sepehri A, von Roth P, Stoffel K, Acklin Y, Oussedik S, Wijburg B, Wada A, Cunningham M, Masri BA. Surgical Skills Training Using Simulation for Basic and Complex Hip and Knee Arthroplasty. Orthop Clin North Am 2021; 52:1-13. [PMID: 33222980 DOI: 10.1016/j.ocl.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Skills training is important in an arthroplasty curriculum and can focus either on "part tasks" or on full procedures. The most commonly used simulations in orthopedics including arthroplasty are anatomic specimens, dry bone models, and virtual or other technology-enhanced systems. A course curriculum planning committee must identify the gaps to address, define what learners need to be able to do, and select the most appropriate simulation modality and assessment for delivery. Each simulation must have a clear structure with learning objectives, steps, and take-home messages. Feedback from learners and faculty must be integrated to improve processes and models for future learning.
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Affiliation(s)
- Aresh Sepehri
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada; Department of Orthopaedics, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada
| | | | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
| | - Yves Acklin
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
| | - Sam Oussedik
- University College Hospital London, 235 Euston Road, Bloomsbury, London NW1 2BU, UK
| | - Bas Wijburg
- AO Recon, Clavadelerstrasse 8, Davos Platz 7270, Switzerland
| | - Arisa Wada
- Education, AO Recon, Clavadelerstrasse 8, Davos Platz 7270, Switzerland
| | - Michael Cunningham
- Curriculum Development, AO Foundation - AO Education Institute, Stettbachstrasse 6, Dübendorf 8600, Switzerland
| | - Bassam A Masri
- Department of Orthopaedics, Complex Joint Reconstruction Clinic, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 3rd Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada.
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Kfuri M, Escalante I, Schopper C, Zderic I, Stoffel K, Sommer C, Qawasmi F, Knobe M, Richards G, Gueorguiev B. Comminuted patellar fractures: The role of biplanar fixed angle plate constructs. J Orthop Translat 2020; 27:17-24. [PMID: 33344168 PMCID: PMC7732873 DOI: 10.1016/j.jot.2020.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/02/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022] Open
Abstract
Background Comminuted patellar fractures represent a challenging clinical problem. Treatment aims to restore the integrity of the extensor mechanism and the congruity of patellofemoral joint. Controversy exists regarding the ideal fixation method. Metallic constructs aiming to convert pulling forces on the anterior aspect of the patella into compression forces across the fracture site are the standard of care. More recently, low profile plates have been described in the management of comminuted patellar fractures. The aims of this study were to (1) develop a novel unstable patellar fracture model and (2) to compare biomechanically three different constructs for fixation comminuted patellar fractures. We hypothesized that an orthogonal biplanar disposition of the screws within an anteriorly placed locking plate provides the best biomechanical properties in the management of comminuted fractures. Methods Six-part complex AO 34–C3 patella fractures were simulated in 18 human cadaveric knees by means of osteotomies including comminution around the distal patellar pole. The specimens were randomly assigned to 3 fixation techniques (n = 6) for either anterior plating, antero-lateral plating, or tension band wiring (TBW). Biomechanical testing was performed over 5000 cycles in active extension and passive flexion, followed by ultimate destructive quasi-static testing. Interfragmentary movements were captured by means of optical motion tracking. Results Displacement between the proximal and distal medial patella fragments was lower after anterior plating compared to both antero-lateral plating (P = 0.084) and TBW (P < 0.001). Moreover, displacement between the proximal and distal lateral fragments was significantly lower after anterior plating compared to both other techniques (P ≤ 0.032). In addition, it was significantly lower for antero-lateral plating versus TBW (P < 0.001). Rotation around the medio-lateral axis between the proximal and distal medial fragments was significantly lower after anterior plating compared to TBW (P = 0.017). Conclusions Anterior mesh plating with biplanar placement of locking screws provides superior stability for fixation of comminuted patellar fractures when compared to both antero-lateral mesh plating and TBW. The latter is associated with considerably inferior performance.
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Affiliation(s)
- Mauricio Kfuri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States
| | | | - Clemens Schopper
- AO Research Institute Davos, Davos, Switzerland.,Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Austria
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | | | - Christoph Sommer
- Department of Surgery, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Feras Qawasmi
- AO Research Institute Davos, Davos, Switzerland.,Department of Trauma Surgery, Hadassah Medical Center Jerusalem, Israel
| | - Matthias Knobe
- Department of Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
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30
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Lenz M, Acklin YP, Kasper LA, Mischler D, Varga P, Zderic I, Gehweiler D, Klos K, Gueorguiev B, Stoffel K. Biomechanical evaluation of the docking nail concept in periprosthetic fracture fixation around a stemmed total knee arthroplasty. J Biomech 2020; 115:110109. [PMID: 33257010 DOI: 10.1016/j.jbiomech.2020.110109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/02/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Abstract
Intramedullary femoral nails provide an ideal mechanical axis for periprosthetic fracture fixation. Slotted nails allow a connection to a total knee arthroplasty (TKA) stem. This study aims to compare implant and construct stiffness, interfragmentary movement and cycles to failure between an antegrade slotted femoral nail construct docked to a TKA stem and a distal femoral locking plate in a human periprosthetic femoral fracture model. In eight pairs of fresh-frozen human femora with stalked TKA, a 10 mm transverse osteotomy gap was set simulating a Rorabeck type II, Su type I fracture. The femora were pairwise instrumented with either an antegrade slotted nail coupled to the prosthesis stem, or a locking plate. Cyclic testing with a progressively increasing physiologic loading profile was performed at 2 Hz until catastrophic construct failure. Relative movement at the osteotomy site was monitored by means of optical motion tracking. In addition, four-point bending implant stiffness, torsional implant stiffness and frictional fit of the stem-nail connection were investigated via separate non-destructive tests. Intramedullary nails exhibited significantly higher four-point bending and significantly lower torsional implant stiffness than plates, P < 0.01. Increasing difference between nail and stem diameters decreased frictional fit at the stem-nail junction. Nail constructs provided significantly higher initial axial bending stiffness and cycles to failure (200 ± 83 N/mm; 16'871 ± 5'227) compared to plate constructs (93 ± 35 N/mm; 7'562 ± 1'064), P = 0.01. Relative axial translation at osteotomy level after 2'500 cycles was significantly smaller for nail fixation (0.14 ± 0.11 mm) compared with plate fixation (0.99 ± 0.20 mm), P < 0.01. From a biomechanical perspective, the docking nail concept offers higher initial and secondary stability under dynamic axial loading versus plating in TKA periprosthetic fracture fixation.
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Affiliation(s)
- Mark Lenz
- AO Research Institute Davos, Switzerland; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Germany.
| | | | - Lena Anna Kasper
- AO Research Institute Davos, Switzerland; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Germany.
| | | | | | | | | | - Kajetan Klos
- Gelenkzentrum Rhein-Main, Hochheim (Main), Germany.
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31
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Abstract
The majority of periprosthetic femoral fractures are treated surgically. Surgical treatment may be revision only, revision in combination with open reduction and internal fixation (ORIF), or ORIF only. The treatment decision is dependent on whether the stem is loose or not, but loose stems are not always identified, resulting in unsatisfactory treatments. This article presents an algorithmic approach to identifying loose stems around proximal femoral periprosthetic fractures, taking patient history, stem design, and plain radiographs into consideration. This approach may help identifying loose stems and increase the probability of effective treatments.
Cite this article: EFORT Open Rev 2020;5:449-456. DOI: 10.1302/2058-5241.5.190086
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Affiliation(s)
- Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Tamara Horn
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Luigi Zagra
- Hip Department, IRCCS Galeazzi Orthopaedic Institute, Milano, Italy
| | - Michael Mueller
- Orthopaedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Perka
- Orthopaedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Henrik Eckardt
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
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32
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Schopper C, Zderic I, Menze J, Müller D, Rocci M, Knobe M, Shoda E, Richards G, Gueorguiev B, Stoffel K. Higher stability and more predictive fixation with the Femoral Neck System versus Hansson Pins in femoral neck fractures Pauwels II. J Orthop Translat 2020; 24:88-95. [PMID: 32775200 PMCID: PMC7387742 DOI: 10.1016/j.jot.2020.06.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/17/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
Objectives To evaluate the biomechanical performance of the Femoral Neck System (FNS) versus the Hansson Pin System (Hansson Pins) with two parallel pins in a Pauwels II femoral neck fracture model with posterior comminution. Methods Forty-degree Pauwels II femoral neck fractures AO 31-B2.1 with 15° posterior wedge were simulated in fourteen paired fresh-frozen human femora, followed by instrumentation with either FNS or Hansson Pins in pair-matched fashion. Implant positioning was quantified by measuring shortest implant distances to inferior cortex (DI) and posterior cortex (DP) on anteroposterior and axial X-rays, respectively. Biomechanical testing was performed in 20° adduction and 10° flexion with simulated iliopsoas muscle tension. Progressively increasing cyclic loading was applied until construct failure. Interfragmentary femoral head-to-shaft movements were measured with optical motion tracking. Results Cycles to 10° varus deformation were significantly higher for FNS (23007 ± 5496) versus Hansson Pins (17289 ± 4686), P = 0.027. Cycles to 10° femoral head dorsal tilting (FNS: 12765 ± 3425; Hansson Pins: 13357 ± 6104) and cycles to 10° rotation around the femoral neck axis (FNS: 24453 ± 5073; Hansson Pins: 20185 ± 11065) were comparable between the implants, P ≥ 0.314. For Hansson Pins, the outcomes for varus deformation and dorsal tilting correlated significantly with DI and DP, respectively (P ≤ 0.047), whereas these correlations were not significant for FNS (P ≥ 0.310). Conclusions From a biomechanical perspective, by providing superior resistance against varus deformation and performing in a less sensitive way to variations in implant placement, the angular stable Femoral Neck System can be considered as a valid alternative to the Hansson Pin System for the treatment of Pauwels II femoral neck fractures. Level of evidence therapeutic, Level V. The Translational potential of this article The translational potential of this article is to compare the performance of the FNS with Hansson Pins in a AO 31-B2.1 fracture model featuring a 15 posterior wedge to show the implants behavior concerning the dorsal tilting tendency.
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Affiliation(s)
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | | | | | | | - Matthias Knobe
- Department of Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Etsuo Shoda
- Department of Orthopaedic Surgery, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan
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33
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Thalmann C, Horn Lang T, Bereiter H, Clauss M, Acklin YP, Stoffel K. An excellent 5-year survival rate despite a high incidence of distal femoral cortical hypertrophy in a short hip stem. Hip Int 2020; 30:152-159. [PMID: 31010329 DOI: 10.1177/1120700019834336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although reported results on short stems sound very promising, the occurrence of distal femoral cortical hypertrophy is often observed. The aim of the present study was to report 5-year survival data of a commercially available trochanter sparing short stem and investigate the clinical impact of distal femoral cortical hypertrophy on the outcome. METHODS 123 total hip arthroplasties were performed on 120 patients from April 2008 to May 2010 (mean age 62, range 29-89 years; 71 hips from male patients, 58%). Clinical and radiological data were collected preoperative, at 6 weeks, 1, 2, 3, and 5 years postoperative to assess the outcome. Radiographs taken immediately postoperative as well as 1 and 5 years postoperative were used to identify and assess cortical hypertrophy. RESULTS 1 stem had to be revised due to aseptic loosening, resulting in a Kaplan-Meier survival analysis with endpoint for stem revision of 99.2% (95% Confidence Interval 94.1-99.9) at 5 years. 96 radiological and 95 clinical follow-ups were analysed 5 years postoperative. 68 (71%) hips showed distal femoral cortical hypertrophy after 5 years. The average Harris Hip Score and Oxford Hip Score improved 33 (standard deviation (SD) 15.1, range 2-70), 18 (SD 12.1, range -10-43) points, respectively. Overall 16% of the patients reported thigh pain, unrelated to the presence of cortical hypertrophy. DISCUSSION This short stem shows an excellent 5-year survival rate and good clinical outcome despite a high incidence of cortical hypertrophy. However, the question of the mechanism of load transfer arises.
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Affiliation(s)
| | - Tamara Horn Lang
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Heinz Bereiter
- Orthopaedic Surgery, Kantonsspital Graubünden, Chur, Switzerland
| | - Martin Clauss
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Yves P Acklin
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Karl Stoffel
- Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Bruderholz, Switzerland
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Thalmann C, Kempter P, Stoffel K, Ziswiler T, Frigg A. Prospective 5-year study with 96 short curved Fitmore™ hip stems shows a high incidence of cortical hypertrophy with no clinical relevance. J Orthop Surg Res 2019; 14:156. [PMID: 31133027 PMCID: PMC6537407 DOI: 10.1186/s13018-019-1174-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/29/2019] [Indexed: 12/20/2022] Open
Abstract
Background An increased occurrence of cortical hypertrophy (CH) was observed 1–2 years after implanting short curved Fitmore hip stems. There are no published data about either the clinical relevance or the progression of CH over the long term. Methods Ninety-six primary total hip arthroplasties were performed between 2008 and 2010 using the Fitmore hip stem. Clinical and radiological parameters were recorded preoperatively and at 1, 2, 3, and 5 year follow-up. Results CH appeared mainly on antero-posterior radiographs in Gruen Zones 2, 3, 5, and 6. After 1 year, the diameter was 10 ± 2 mm and remained constant thereafter. The CH rate after 1 year was 69% and after 5 years 71%. Subsidence after 1 year was 1.6 ± 1.55 mm and 1.93 ± 1.72 mm after 5 years. Cortical thinning was 46% after 1 year and 56% after 5 years, mainly in Gruen Zones 7 and 8. In the first year radiolucencies were found in 51% in all Gruen Zones, and in 20% after 5 years. Patient, implant, and surgical factors did not correlate with radiological outcomes except that larger stems had more CH. After 5 years, the Harris Hip Score had improved from 59 to 94 and the Oxford Hip Score from 22 to 41. Radiographic parameters, notably CH, were not associated with clinical outcomes except that cortical thinning correlated with lower outcome scores. Conclusions CH correlated neither with clinical outcome nor with patient, surgical or implant factors, except for a positive correlation with stem size. The Fitmore hip stems settled within the first year to a stable fixation and then remained almost unchanged. However, cortical thinning is common in Gruen Zone 7 and 8 meaning that there is stress-shielding.
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Affiliation(s)
- Caroline Thalmann
- Orthopedic Department, Kantonsspital Graubünden, Loestrasse 99, 7000, Chur, Switzerland.,Orthopedic Department, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Patricia Kempter
- Orthopedic Department, Kantonsspital Graubünden, Loestrasse 99, 7000, Chur, Switzerland.,Orthopedic Department, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Karl Stoffel
- Orthopedic Department, Kantonsspital Graubünden, Loestrasse 99, 7000, Chur, Switzerland.,Orthopedic Department, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Orthopedic Department, Kantonsspital Liestal, Rheinstrasse 26, 4410, Liestal, Switzerland
| | - Thea Ziswiler
- Orthopedic Department, Kantonsspital Graubünden, Loestrasse 99, 7000, Chur, Switzerland.,Orthopedic Department, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Arno Frigg
- Orthopedic Department, Kantonsspital Graubünden, Loestrasse 99, 7000, Chur, Switzerland. .,Orthopedic Department, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland. .,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.
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35
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Triana M, Gueorguiev B, Sommer C, Stoffel K, Agarwal Y, Zderic I, Helfen T, Krieg JC, Krause F, Knobe M, Richards RG, Lenz M. LagLoc-a new surgical technique for locking plate systems. J Orthop Res 2018; 36:2886-2891. [PMID: 29917270 DOI: 10.1002/jor.24069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/04/2018] [Indexed: 02/04/2023]
Abstract
Treatment of oblique and spiral fractures remains challenging. The aim of this study was to introduce and investigate the new LagLoc technique for locked plating with generation of interfragmentary compression, combining the advantages of lag screw and locking-head-screw techniques. Oblique fracture was simulated in artificial diaphyseal bones, assigned to three groups for plating with a seven-hole locking compression plate. Group I was plated with three locking screws in holes one, four, and seven. The central screw crossed the fracture line. In group II the central hole was occupied with a lag screw perpendicular to fracture line, whereas holes one and seven were occupied with locking screws. Group III was instrumented applying the LagLoc technique as follows. Hole four was predrilled perpendicularly to the plate, followed by overdrilling of the near cortex and insertion of a locking screw-crossing the fracture line-whose head was covered by a holding sleeve to prevent temporarily the locking in the plate hole and generate interfragmentary compression. Subsequently, the screw head was released and locked in the plate hole. Holes one and seven were occupied with locking screws. Interfragmentary compression in the fracture gap was measured using pressure sensors. All screws in the three groups were tightened with 4 Nm torque. Interfragmentary compression in group I (167 ± 25 N) was significantly lower in comparison to groups II (431 ± 21 N) and III (379 ± 59 N), p ≤ 0.005. The difference in compression between groups II and III remained not significant (p = 0.999). The new LagLoc technique offers an alternative tool to generate interfragmentary compression with the application of locking plates by combining the biomechanical advantages of lag screw and locking screw fixations. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2886-2891, 2018.
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Affiliation(s)
- Miguel Triana
- AO Research Institute Davos, Davos, Switzerland.,Department of Orthopaedic Surgery, Fundación Cardioinfantil, Bogotá, Colombia.,Hospital Infantil San José, Bogotá, Colombia.,Universities of Bosque, Bogotá, Colombia.,Fundación Universitaria Ciencias de la salud, Bogotá, Colombia
| | | | - Christoph Sommer
- Department of General and Trauma Surgery, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Karl Stoffel
- University of Basel, Basel, Switzerland.,Cantonal Hospital Baselland, Orthopedic and Musculoskeletal Traumatology Clinic, Bruderholz, Switzerland
| | | | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | - Tobias Helfen
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - James C Krieg
- Division of Orthopaedic Trauma and Fracture Care, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Fabian Krause
- Department of Orthopaedic Surgery, Inselspital, University of Berne, Bern, Switzerland
| | - Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Aachen, Germany
| | | | - Mark Lenz
- Department of Trauma, Hand and Reconstructive Surgery, Friedrich Schiller University Jena, Jena, Germany
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36
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Todorov D, Zderic I, Richards RG, Lenz M, Knobe M, Enchev D, Baltov A, Gueorguiev B, Stoffel K. Is augmented LISS plating biomechanically advantageous over conventional LISS plating in unstable osteoporotic distal femoral fractures? J Orthop Res 2018; 36:2604-2611. [PMID: 29748964 DOI: 10.1002/jor.24047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 04/12/2018] [Indexed: 02/04/2023]
Abstract
Treatment of complex osteoporotic distal femur fractures with the Less Invasive Stabilization System (LISS) has been associated with high complication rates. The aim of this study was to investigate the biomechanical competence of two different techniques of augmented versus conventional LISS plating. Unstable distal femoral fracture AO/OTA 33-A3 was created via osteotomies in artificial femora simulating osteoporotic bone. Three study groups, consisting of 10 specimens each, were created for fixation with either LISS plate, LISS plate with additional polylactide intramedullary graft, or LISS plate plus medial locking plate (double plating). All specimens were non-destructively tested under axial (20-150 N) and torsional (0-4 Nm) quasi-static loading. Each bone-implant construct was tested with two different working length (WL) configurations (long and short) of the LISS plate. Relative movements between the most medial superior and inferior osteotomy aspects were investigated via three-dimensional motion tracking analysis. Double plating revealed significantly smaller longitudinal and shear displacement than the other two techniques (p ≤ 0.001). In addition, LISS plus graft fixation was with significantly less longitudinal displacement in comparison to conventional LISS plating (p < 0.001). Long WL resulted in significantly higher longitudinal and shear displacement compared to short WL for LISS and LISS plus graft (p ≤ 0.032), but not for double plating (p > 0.999). In conclusion, intramedullary grafting resulted in significantly increased fracture stability under axial loading in comparison to conventional LISS plating. Although it was not efficient enough to provide comparable stability to double plating, intramedullary grafting may be considered as a useful biological alternative to the latter in a surgeon's armamentarium. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2604-2611, 2018.
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Affiliation(s)
- Dimitar Todorov
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland.,University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | | | - Mark Lenz
- Department of Trauma, Hand and Reconstructive Surgery, Friedrich Schiller University Jena, Jena, Germany
| | - Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Aachen, Germany
| | - Dian Enchev
- University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Asen Baltov
- University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Karl Stoffel
- Cantonal Hospital Baselland, Orthopedic and Musculoskeletal Traumatology Clinic, Bruderholz, Switzerland.,University of Basel, Basel, Switzerland
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Camenzind RS, Stoffel K, Lash NJ, Beck M. Direct anterior approach to the hip joint in the lateral decubitus position for joint replacement. Oper Orthop Traumatol 2018; 30:276-285. [PMID: 29802423 DOI: 10.1007/s00064-018-0550-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 10/12/2017] [Accepted: 10/23/2017] [Indexed: 11/25/2022]
Abstract
SURGICAL PRINCIPLE AND OBJECTIVE The direct anterior approach for total hip arthroplasty is associated with higher complication rates and difficult femoral component positioning. Performing a modified technique in the lateral position allows secure component positioning. INDICATIONS Primary hip replacement (including femoral neck fracture) and cup revision without bone deficiency. CONTRAINDICATIONS Destruction/deformities of proximal femur or acetabulum, bone deficiency or malignancy. SURGICAL TECHNIQUE Strict lateral decubitus position. Straight anterior incision of 10-12 cm, starting 2 cm lateral to the anterior superior iliac spine. Incision of the fascia over the tensor fascia lata muscle (TFL). Lateral retraction of the TFL. Incision of the fascia and medial retraction of rectus femoris. Ligation of the ascending branch of the lateral femoral circumflex artery. Detachment of the iliocapsularis muscle from the capsule in a medial direction. Anterior capsule excision. Femoral neck osteotomy and removal of the head. Reaming of the acetabulum; insertion the acetabular component. Exposure of the femur. Incision/excision of the capsule medial to the greater trochanter for easy anteriorization of the femur. Reaming and implantation of femoral component. POSTOPERATIVE MANAGEMENT Weight bearing on day one with crutches for 4 weeks; deep vein thrombosis prophylaxis. RESULTS In all, 138 patients (72 women, 66 men, mean age of 67 years) were followed up over 2 years. Overall complication rate was 3.6%: 3 patients (2.2%) with grade III complications required additional intervention. Acetabular cup inclination: 35-50° in 88% of patients. Neutral femoral stem position observed in 99% of patients. Mean Harris hip score improved from 61 preoperatively to 97 after 2 years. Patient satisfaction on a visual analogue scale improved from 3.7 to 9.5.
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Affiliation(s)
- R S Camenzind
- Clinic of Orthopaedic Surgery, Luzerner Kantonsspital Luzern, Spitalstraße, 6000, Lucerne 16, Switzerland.
| | - K Stoffel
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
- University of Basel, Basel, Switzerland
| | - N J Lash
- Clinic of Orthopaedic Surgery, Luzerner Kantonsspital Luzern, Spitalstraße, 6000, Lucerne 16, Switzerland
- Consultant Surgeon, Christchurch Public Hospital, Christchurch, New Zealand
| | - M Beck
- Clinic of Orthopaedic Surgery, Luzerner Kantonsspital Luzern, Spitalstraße, 6000, Lucerne 16, Switzerland
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Sommer C, Nork SE, Graves M, Blauth M, Rudin M, Stoffel K. Quality of fracture reduction assessed by radiological parameters and its influence on functional results in patients with pilon fractures-A prospective multicentre study. Injury 2017; 48:2853-2863. [PMID: 29079366 DOI: 10.1016/j.injury.2017.10.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/18/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The management of pilon fractures remains a challenging issue. Due to the complexity of factors that influence the outcome, it has been questioned if anatomical reductions of articular fracture are relevant. The lack of a commonly accepted assessment of quality of fracture reduction compounded the uncertainty of the importance of anatomical reduction in pilon fracture. The current study aimed to define parameters that can better assess the reduction quality and to investigate the influence of reduction quality on functional outcomes. METHODS Patients with unilateral pilon fracture of the AO/OTA type 43-B or 43-C were consecutively recruited to the study and followed up for 2 years after surgery. Postoperative radiographs of the injured and the contralateral joints were evaluated and 13 radiological parameters measured by 2 independent surgeons. The reliability of the measurements for each parameter was assessed by the Intraclass Correlation Coefficient (ICC), and 4 parameters with the highest ICC scores were deemed most reliable and were selected for further analyses. Functional outcome was assessed by the Foot and Ankle Ability Measure (FAAM) for daily living and sports activities. The 4 most reliable radiologic parameters, together with 3 possible baseline confounders (age, AO/OTA fracture type, and open versus closed injury), were analysed using both univariable and multivariable analysis for their association with the FAAM scores. Secondary outcome measures including pain, ankle range of motion (ROM), quality of life (QoL), and adverse events were also reported. RESULTS The length of lateral malleolus (LLM), anterior distal tibia angle, anterior talar shift, and length of medial malleolus scored highest on reliability in ICC assessment (ICC=0.76, 0.72, 0.58, and 0.45, respectively). Only LLM exhibited statistical significant association with the 2-year FAAM results. At the 2-year follow-up, the injured joints on average achieved a ROM of 70.7% (95% CI=63.9-77.6) when compared to the contralateral joints, and patients did not regain the pre-injury QoL overall. CONCLUSION The multivariable analysis showed that LLM (independent of age, AO/OTA fracture type, and open/closed injury) was a reliable indicator of reduction quality and a prognostic factor for patient outcome in pilon fracture surgery.
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Affiliation(s)
| | - Sean E Nork
- Department of Orthopaedic Surgery, Harborview Medical Center, USA
| | - Matthew Graves
- Department of Orthopaedic Surgery, University of Mississippi, USA
| | - Michael Blauth
- Department of Trauma Surgery, Medical University Innsbruck, Austria
| | - Mark Rudin
- Clinic of Orthopaedics and Traumatology, Kantonsspital Winterthur, Switzerland
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University of Basel and Kantonsspital Baselland, Switzerland
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Zderic I, Stoffel K, Sommer C, Höntzsch D, Gueorguiev B. Biomechanical evaluation of the tension band wiring principle. A comparison between two different techniques for transverse patella fracture fixation. Injury 2017. [PMID: 28622833 DOI: 10.1016/j.injury.2017.05.037] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to investigate the validity of the dynamic compression principle of tension band wiring in two techniques for patella fracture treatment. METHODS Twelve human cadaveric knees with simulated transverse patella fractures were assigned to two groups for treatment with tension band wiring using either Kirschner (K-) wires or cannulated screws. Biomechanical testing was performed over three knee movement cycles between 90° flexion and 0° full extension. Pressure distribution in the fracture gap and fracture site displacement were evaluated at the 3rd cycle in 15° steps, namely 90°-75°-60°-45°-30°-15°-0° extension phase and 0°-15°-30°-45°-60°-75°-90° flexion phase. RESULTS Mean anterior / posterior interfragmentary pressure in the groups with K-wires and cannulated screws ranged within 0.16-0.40MPa / 0.12-0.35MPa and 0.37-0.59MPa / 0.10-0.30MPa, respectively. These changes remained non-significant for both groups and loading phases (P≥0.171). Mean anterior / posterior fracture site displacement for K-wires and cannulated screws ranged within -0.01-0.53mm / 0.11-0.74mm and 0.11-0.55mm / -0.10-0.50mm, respectively. Anterior displacement remained without significant changes for both groups and loading phases (P≥0.112). However, posterior displacement underwent a significant increase in the course of knee extension for K-wires (P≤0.047), but not for cannulated screws (P≥0.202). Significantly smaller displacement at the posterior fracture site was detected in the group with cannulated screws compared to K-wires at 60° and 75° extension phase (P≤0.017), as well as at 45°, 60° and 75° flexion phase (P≤0.018). The critical value of 2mm displacement at the posterior fracture site was not reached for any specimen and fixation technique. Knee extension was accompanied by synchronous increase in quadriceps pulling force. CONCLUSIONS Tension band wiring fulfills from a biomechanical perspective the requirements for sufficient stability of transverse patella fracture fixation. It should, however, rather be considered as a static fixation principle than a dynamic one. Tension band wiring with cannulated screws was found advantageous over Kirschner wires in terms of interfragmentary movements at the posterior fracture site.
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Affiliation(s)
- Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland.
| | - Karl Stoffel
- Cantonal Hospital Baselland, Bruderholz, Switzerland; University of Basel, Basel, Switzerland
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Filipov O, Stoffel K, Gueorguiev B, Sommer C. Biomechanics and indications for application of the method of BDSF. Answer to manuscript draft number AOTS-D- 17-00378, Letter to the Editor concerning ''Femoral neck fracture osteosynthesis by the biplane double-supported screw fixation method (BDSF) reduces the risk of fixation failure: clinical outcomes in 207 patients'' by Filipov O, Sommer C, et al. (2017) Arch Orthop Trauma Surg. Apr 8. [Epub ahead of print]. Arch Orthop Trauma Surg 2017; 137:1167-1171. [PMID: 28667396 PMCID: PMC5511324 DOI: 10.1007/s00402-017-2716-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Orlin Filipov
- Vitosha Hospital, Simeonovsko Shose Str.108-B, 1700 Sofia, Bulgaria
| | - Karl Stoffel
- University Basel, Cantonal Hospital Baselland, Basel, Switzerland
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Filipov O, Stoffel K, Gueorguiev B, Sommer C. Femoral neck fracture osteosynthesis by the biplane double-supported screw fixation method (BDSF) reduces the risk of fixation failure: clinical outcomes in 207 patients. Arch Orthop Trauma Surg 2017; 137:779-788. [PMID: 28391429 PMCID: PMC5432592 DOI: 10.1007/s00402-017-2689-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Osteosynthesis of femoral neck fractures is related up to 46% rate of complications. The novel method of biplane double-supported screw fixation (BDSF; Filipov's method) offers better stability using three medially diverging cannulated screws with two of them buttressed on the calcar. Biomechanically, the most effective component is the distal screw placed at steeper angle and supported on a large area along the distal and posterior cortex of the femoral neck following its spiral anterior curve. Thereby, BDSF achieves the strongest possible distal-posterior cortical support for the fixation construct, which allows for immediate full weight-bearing. The aim of this study was to evaluate the outcomes from the first 5-year period of BDSF clinical application. MATERIALS AND METHODS Subject of this retrospective study were 207 patients with displaced Garden III-IV femoral neck fractures treated with BDSF. Three 7.3-mm cannulated screws were laid in two medially diverging oblique planes. The distal and the middle screws were supported on the calcar. The distal screw had additional support on the posterior neck cortex. RESULTS The outcomes in 207 patients were analysed in 29.6 ± 16.8 months follow-up. Bone union occurred in 96.6% of the cases (males 97.6%, females 96.4%, P = 0.99). Rate of nonunion was 3.4%, including fixation failure (2.4%), pseudoarthrosis (0.5%) and nonunion with AVN (0.5%). Rate of AVN was 12.1% (males 4.8%, females 13.9%, P = 0.12). Modified Harris hip score was 86.2 ± 18.9 (range 10-100), with no significant difference between genders, P = 0.07. Older patients were admitted with significantly more comorbidities (P = 0.001), and on follow-up they were significantly less mobile (P = 0.005) and had significantly more difficulties to put socks and shoes on (P < 0.001). CONCLUSIONS By providing additional cortical support, the novel BDSF method enhances femoral neck fracture fixation strength.
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Affiliation(s)
- Orlin Filipov
- Vitosha Hospital, Simeonovsko shose str.108-B, 1700 Sofia, Bulgaria
| | - Karl Stoffel
- 0000 0004 1937 0642grid.6612.3Cantonal Hospital Baselland, University Basel, Basel, Switzerland
| | - Boyko Gueorguiev
- 0000 0004 0618 0495grid.418048.1AO Research Institute Davos, Davos, Switzerland
| | - Christoph Sommer
- 0000 0004 0511 3514grid.452286.fCantonal Hospital Graubuenden, Chur, Switzerland
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Stoffel K, Sommer C, Kalampoki V, Blumenthal A, Joeris A. The influence of the operation technique and implant used in the treatment of periprosthetic hip and interprosthetic femur fractures: a systematic literature review of 1571 cases. Arch Orthop Trauma Surg 2016; 136:553-61. [PMID: 26781127 DOI: 10.1007/s00402-016-2407-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A systematic literature review on periprosthetic/interprosthetic fracture fixation after hip arthroplasties was performed to summarize available clinical data. Operation techniques and implants used were evaluated as possible risk factors for outcomes. MATERIALS AND METHODS MEDLINE and Cochrane databases were searched. Articles describing patients with postoperative periprosthetic femur fractures sustained around a hip arthroplasty and with interprosthetic fractures treated with plates, nails, screws and/or cerclage were included. Considered articles were from 2000 or newer. Eligible abstracts were screened by two independent persons and discrepancies were resolved by consensus. Absolute numbers of complications and/or reoperation events along with their corresponding rates were calculated according to operation technique and type of implant. Relative risks of having a complication and/or a reoperation according to the operation technique and the type of implant used were estimated. RESULTS Available data from 49 prospective and retrospective studies were analyzed. Of 1574 fractures, 81.7 % were treated with plating. For 83.0 % of all fractures, an open approach was applied. The overall complication rate was 14.3 %. Fixation failure and nonunion were most often reported (fixation failure: 4.4 %; nonunion: 3.9 %). Nonunion and refracture occurred more often after open approaches than after minimal invasive osteosynthesis (nonunion: 4.5 vs. 0.0 %, p = 0.001; refracture: 3.8 vs. 0.6 %. p = 0.024). The relative risk for nonunion was 11.9 (95 % CI 4.5-31.5) times higher (p < 0.0001) for non-locking plates (13.0 %) than for locking plates (1.1 %). CONCLUSIONS The clinical evidence of published studies dealing with periprosthetic/interprosthetic fractures after hip arthroplasty is generally low. This literature search suggested higher rates of nonunion and refracture after an open approach and a higher risk of nonunion for non-locking plates compared to locking plates. Based on the available clinical evidence, no treatment recommendations can be given.
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Affiliation(s)
- Karl Stoffel
- Department of Orthopedics and Traumatology, University of Basel and Kantonsspital Baselland, 4101, Bruderholz, Switzerland.
| | - Christoph Sommer
- Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland
| | - Vasiliki Kalampoki
- AO Clinical Investigation and Documentation, AO Foundation, Stettbachstrasse 6, 8600, Duebendorf, Switzerland
| | - Andrea Blumenthal
- AO Clinical Investigation and Documentation, AO Foundation, Stettbachstrasse 6, 8600, Duebendorf, Switzerland
| | - Alexander Joeris
- AO Clinical Investigation and Documentation, AO Foundation, Stettbachstrasse 6, 8600, Duebendorf, Switzerland
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Lenz M, Stoffel K, Gueorguiev B, Klos K, Kielstein H, Hofmann GO. Enhancing fixation strength in periprosthetic femur fractures by orthogonal plating-A biomechanical study. J Orthop Res 2016; 34:591-6. [PMID: 26447634 DOI: 10.1002/jor.23065] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 10/01/2015] [Indexed: 02/04/2023]
Abstract
Orthogonal plate osteosynthesis enhances fixation stability in periprosthetic femur fractures. Another option are locking attachment plates (LAP) allowing bicortical locking screw placement lateral to the prosthesis stem. Stability of lateral plate osteosynthesis with two LAP (2LAP) was compared to anterolateral orthogonal plate osteosynthesis (OP) with one LAP in a periprosthetic femur fracture model. In six pairs of fresh frozen human femora with cemented Charnley hip prosthesis, a transverse osteotomy was set distal to the tip of the prosthesis simulating a Vancouver type B1 fracture. Each pair was instrumented using a plate tensioner with either one lateral plate and two LAP, or two orthogonal anterolateral plates and one LAP. Stiffness was determined in a four-point-bending test prior to cyclic testing (2Hz) with physiologic profile and progressively increasing load up to catastrophic construct failure. Paired t-test and Wilcoxon-signed-rank test were used for statistical evaluation at a level of significance p = 0.05. The OP construct exhibited a significantly higher number of cycles and load to failure (39,627 cycles ± 4,056; 4,463 N ± 906) compared to the 2LAP construct (32,927 cycles ± 3,487; 3,793 N ± 849), p < 0.01. Mediolateral bending and torsional stiffness of the OP (1610 N/mm ± 249; 16.9 Nm/mm ± 6.3) were significantly higher compared to 2 LAP (1077 N/mm ± 189; 12.1 Nm/mm ± 3.9), p = 0.03 for both comparisons. Orthogonal plate osteosynthesis is a valuable option in periprosthetic fracture surgery, offering increased stability compared to a single lateral plate fixed with two LAP.
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Affiliation(s)
- Mark Lenz
- AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos Platz, Switzerland.,Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Germany
| | - Karl Stoffel
- Cantonal Hospital Baselland, Liestal, Switzerland.,University of Basel, Basel, Switzerland
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos Platz, Switzerland
| | - Kajetan Klos
- Department of Foot and Ankle Surgery, Catholic Hospital Mainz, Germany
| | - Heike Kielstein
- Department of Anatomy and Cell Biology, Martin-Luther-University Halle-Wittenberg, Faculty of Medicine, Halle (Saale), Germany
| | - Gunther O Hofmann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Germany
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Acklin YP, Jenni R, Bereiter H, Thalmann C, Stoffel K. Prospective clinical and radiostereometric analysis of the Fitmore short-stem total hip arthroplasty. Arch Orthop Trauma Surg 2016; 136:277-84. [PMID: 26739137 DOI: 10.1007/s00402-015-2401-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Uncemented short, curved femoral stems may help save proximal bone stock during total hip arthroplasty (THA) and facilitate insertion in minimal invasive surgery. The aim of this 2 year, prospective, single-center study was to examine the stability and migration of the Fitmore (®) stem in THA using model-based radiostereometric analysis (RSA), and thus predict the implant's long-term survival. In addition, we evaluated the stem's clinical performance using standard clinical measures. PATIENTS AND METHODS We conducted a prospective cohort study of 34 THA patients who received the short Fitmore Hip Stem (Zimmer, Winterthur, Switzerland). At 3, 6, 12 and 24 months postoperatively, the patients underwent clinical evaluation and radiostereometric analysis (RSA) to measure stem migration. RESULTS RSA analysis revealed a mean subsidence of -0.39 mm (95 % CI -0.60 to -0.18) at 3 months with no further migration after 2 years. Mean internal rotation along the longitudinal axis was 1.09° (95 % CI 0.52-1.66) at 2 years, versus 0.85° (95 % CI 0.44-1.26) at 3 months. The Harris hip score improved from 60 (range 30-80) preoperatively to 99 (range 83-100) after 2 years. Three patients underwent revision due to deep infection, non-specific thigh pain and aseptic loosening in one case. CONCLUSION We conclude that the Fitmore Hip Stem stabilizes after 3 months and achieves good short-term clinical results in most cases.
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Affiliation(s)
- Yves P Acklin
- Orthopedic Surgery, Kantonsspital Graubünden, Loestrasse 99, 7000, Chur, Switzerland.
| | - Raphael Jenni
- Orthopedic Surgery, Kantonsspital Graubünden, Loestrasse 99, 7000, Chur, Switzerland
| | - Heinz Bereiter
- Orthopedic Surgery, Kantonsspital Graubünden, Loestrasse 99, 7000, Chur, Switzerland
| | - Caroline Thalmann
- Orthopedic Surgery, Kantonsspital Graubünden, Loestrasse 99, 7000, Chur, Switzerland
| | - Karl Stoffel
- Orthopedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, Liestal, Switzerland
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Schneider K, Oh JK, Zderic I, Stoffel K, Richards RG, Wolf S, Gueorguiev B, Nork SE. What is the underlying mechanism for the failure mode observed in the proximal femoral locking compression plate? A biomechanical study. Injury 2015; 46:1483-90. [PMID: 26113034 DOI: 10.1016/j.injury.2015.05.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 04/05/2015] [Accepted: 05/12/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE Recently, several cases of clinical failure have been reported for the Proximal Femoral Locking Compression Plate (PF-LCP). The current study was designed to explore biomechanically the underlying mechanism and to determine whether the observed failure was due to technical error on insertion or to implant design. METHODS A foam block model simulating an unstable intertrochanteric fracture was created for 3 study groups with 6 specimens each. Group C was correctly instrumented according to the manufacturer's guidelines. In Group P and Group A, the first or second proximal screw was placed with a posterior or anterior off-axis orientation by 2° measured in the transversal plane, respectively. Each construct was cyclically tested until failure using a test setup and protocol simulating complex axial and torsional loading. Radiographs were taken prior to and after the tests. Force, number of cycles to failure and failure mode were compared. RESULTS A screw deviation of 2° from the nominal axis led to significantly earlier construct failure in Group P and Group A in comparison to Group C. The failure mode was characterised by loosening of the off-axis screw due to disengagement with the plate, resulting in loss of construct stiffness and varus collapse of the fracture. CONCLUSIONS In our biomechanical test setup, the clinical failure modes observed with the PF-LCP were reproducible. A screw deviation of 2° from the nominal axis consistently led to the failure. This highlights how crucial is the accurate placement of locking screws in the proximal femur.
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Affiliation(s)
- Kerstin Schneider
- AO Research Institute Davos, Davos, Switzerland; Schulthess Clinic Zurich, Zurich, Switzerland
| | - Jong-Keon Oh
- Guro Hospital, Korea University College of Medicine, Department of Orthopaedic Surgery, Seoul, Republic of Korea.
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | - Karl Stoffel
- Cantonal Hospital Baselland, Liestal, Switzerland; University of Basel, Basel, Switzerland
| | | | | | | | - Sean E Nork
- Harborview Medical Center, Department of Orthopaedic Surgery, Seattle, WA, USA
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Shanmugam R, Ernst M, Stoffel K, Fischer MF, Wahl D, Richards RG, Gueorguiev B. Angular stable lateral plating is a valid alternative to conventional plate fixation in the proximal phalanx. A biomechanical study. Clin Biomech (Bristol, Avon) 2015; 30:405-10. [PMID: 25846324 DOI: 10.1016/j.clinbiomech.2015.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 03/18/2015] [Accepted: 03/18/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dorsal plating is commonly used in proximal phalanx fractures but it bears the risk of interfering with the extensor apparatus. In this study, dorsal and lateral plating fixation methods are compared to assess biomechanical differences using conventional 1.5mm non-locking plates and novel 1.3mm lateral locking plates. METHODS Twenty-four fresh frozen human cadaveric proximal phalanges were equally divided into four groups. An osteotomy was set at the proximal metaphyseal-diaphyseal junction and fixed with either dorsal (group A) or lateral (group B) plating using a 1.5mm non-locking plate, or lateral plating with a novel 1.3mm locking plate with bicortical (group C) or unicortical (group D) screws. The specimens were loaded in axial, dorsovolar and mediolateral direction to assess fixation stiffness followed by a cyclic destructive test in dorsovolar loading direction. FINDINGS Axial stiffness was highest in group D (mean 321.02, SEM 21.47N/mm) with a significant difference between groups D and B (P=0.033). Locking plates (groups C and D) were stiffer than non-locking plates under mediolateral loading (P=0.007), no significant differences were noted under dorsovolar loading. Furthermore, no significant differences were observed under cyclic loading to failure between any of the study groups. INTERPRETATION No considerable biomechanical advantage of using a conventional 1.5mm dorsal non-locking plate was identified over the novel 1.3mm lateral locking plate in the treatment of proximal phalanx fractures. Since the novel low-profile plate is less disruptive to the extensor mechanism, it should be considered as a valid alternative.
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Affiliation(s)
- R Shanmugam
- AO Research Institute Davos, Davos, Switzerland; Orthopaedic Department, University of Malaya, Kuala Lumpur, Malaysia
| | - M Ernst
- AO Research Institute Davos, Davos, Switzerland.
| | - K Stoffel
- Cantonal Hospital Baselland, Liestal, Switzerland; University of Basel, Basel, Switzerland
| | - M F Fischer
- AO Research Institute Davos, Davos, Switzerland
| | - D Wahl
- AO Research Institute Davos, Davos, Switzerland
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Sands A, White C, Blankstein M, Zderic I, Wahl D, Ernst M, Windolf M, Hagen JE, Richards RG, Stoffel K, Gueorguiev B. Assessment of ankle and hindfoot stability and joint pressures using a human cadaveric model of a large lateral talar process excision: a biomechanical study. Medicine (Baltimore) 2015; 94:e606. [PMID: 25789950 PMCID: PMC4602496 DOI: 10.1097/md.0000000000000606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Lateral talar process fragment excision may be followed by hindfoot instability and altered biomechanics. There is controversy regarding the ideal fragment size for internal fixation versus excision and a concern that excision of a large fragment may lead to significant instability. The aim of this study was to assess the effect of a simulated large lateral talar process excision on ankle and subtalar joint stability.A custom-made seesaw rig was designed to apply inversion/eversion stress loading on 7 fresh-frozen human cadaveric lower legs and investigate them in pre-excision, 5 cm and 10 cm lateral talar process fragment excision states. Anteroposterior radiographs were taken to assess ankle and subtalar joint tilt and calculate angular change from neutral hindfoot alignment to 10-kg forced inversion/eversion. Ankle joint pressures and contact areas were measured under 30-kg axial load in neutral hindfoot alignment.In comparison to the pre-excision state, no significantly different mediolateral angular change was observed in the subtalar joint after 5 and 10 cm lateral talar process fragment excision in inversion and eversion. With respect to the ankle joint, 10-cm fragment excision produced significantly bigger inversion tibiotalar tilt compared with the pre-excision state, P = .04. No significant change of the ankle joint pressure and contact area was detected after 5 and 10-cm excision in comparison with the pre-excison state.An excision of up to 10 cm of the lateral talar process does not cause a significant instability at the level of the subtalar joint but might be a destabilizing factor at the ankle joint under inversion stress. The latter could be related to extensive soft tissue dissection required for resection.
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Affiliation(s)
- Andrew Sands
- From the New York Presbyterian - Lower Manhattan Hospital, New York, NY (AS); AO Research Institute Davos, Davos (CW, MB, IZ, DW, ME, MW, JEH, RGR, BG); and Cantonal Hospital Baselland and University Basel, Liestal, Switzerland (KS)
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Kojima K, Gueorguiev B, Seva G, Stoffel K, de Oliveira RG, Eberli U, Nicolino T, Lenz M. Biomechanical evaluation of interfragmentary compression at tibia plateau fractures in vitro using different fixation techniques: a CONSORT-compliant article. Medicine (Baltimore) 2015; 94:e282. [PMID: 25569643 PMCID: PMC4602845 DOI: 10.1097/md.0000000000000282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Reliable osteosynthesis of intraarticular fractures depends on lasting interfragmentary compression. Its amount differs in the applied fixation method. The interfragmentary compression of cancellous and cortical lag screws and angle stable locking plates was quantified in an osteoporotic and non-osteoporotic synthetic human bone model.A split fracture of the lateral tibia plateau (AO/OTA type 41-B1.1) was mimicked by an osteotomy in right adult synthetic human tibiae with hard or soft cancellous bone. Specimens were fixed with either two 6.5 mm cancellous, four 3.5 mm cortical lag screws, or 3.5 mm LCP proximal lateral tibia plate preliminary compresed by a reduction clamp (n = 5 per group). A pressure sensor film was used to register the interfragmentary compression. One-way analysis of variance (ANOVA) with Bonferroni post hoc correction was performed for statistical analysis (p < 0.05).Interfragmentary compression under reduction clamp was 0.59 ± 0.12 MPa in the non-osteoporotic and 0.55 ± 0.14 MPa in the osteoporotic group. The locking plate itself maintained the compression in non-osteoporotic (0.53 ± 0.11 MPa) and osteoporotic bone (0.50 ± 0.14 MPa). Four 3.5 mm cortical lag screws provided a compression of 1.69 ± 0.65 MPa in non-osteoporotic bone, being not significantly different to the osteoporotic bone group (1.43 ± 0.47 MPa, P = 1.0). Two 6.5 mm cancellous lag screws showed a significantly higher compression in non-osteoporotic (2.1 ± 0.59 MPa) compared to osteoporotic (0.77 ± 0.21 MPa, P < 0.01) bone.Angle stable locking plates maintained the compression preliminarily applied by a reduction clamp. Two 6.5 mm cancellous lag screws are especially suited for non-osteoporotic bone, whereas four 3.5 mm cortical screws exhibited comparable compression in both bone qualities.
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Affiliation(s)
- K Kojima
- From the Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Sao Paulo, Brazil (KK, GS, GdO); AO Research Institute, Davos, Switzerland (BG, GS, UE, TN, ML); University of Basel, Cantonal Hospital Baselland, Liestal, Switzerland (KS); Department of Orthopaedics and Traumatology, Italian Hospital of Buenos Aires, Argentina (TN); and Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Germany (ML)
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Stoffel K, Wysocki D, Baddour E, Nicholls R, Yates P. Comparison of two intraoperative assessment methods for injuries to the ankle syndesmosis. A cadaveric study. J Bone Joint Surg Am 2009; 91:2646-52. [PMID: 19884439 DOI: 10.2106/jbjs.g.01537] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Intraoperative stress testing is required for the detection of syndesmosis instability following an ankle fracture. The present study compared two stress tests for the detection of syndesmotic injury. METHODS A true mortise radiograph of the ankle was made for fourteen cadaver joints. Specimens were randomized into two groups to simulate ligament and syndesmosis injury on the basis of the Danis-Weber classification system. In the first group, the anterior inferior tibiofibular ligament was divided first (Weber B(r)), followed sequentially by division of the interosseous membrane (Weber C) and the deltoid ligament. In the second group, the deltoid ligament was divided first, followed by the anterior inferior tibiofibular ligament. Radiographs were made at each stage with use of two methods of stressing the ankle mortise: (1) external rotation of the foot with an external moment of 7.5 Nm, and (2) application of a lateral force of 100 N. Tibiofibular overlap, tibiofibular clear space, and medial clear space were measured. RESULTS Lateral stress produced a significantly greater increase in the tibiofibular clear space than did the external rotation test for Weber C injuries and Weber C plus deltoid ligament injuries. A greater increase in the tibiofibular clear space was noted during the lateral stress test when both the deltoid and the anterior inferior tibiofibular ligament had been sectioned (p < 0.05). The external rotation stress test produced a significant increase in the medial clear space in the presence of isolated anterior inferior tibiofibular ligament and deltoid ligament injuries (p < 0.05). CONCLUSIONS For the detection of syndesmotic instability at the site of ankle fractures on stress radiographs, the lateral stress test appeared to be superior to the external rotation stress test in this cadaver model.
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Affiliation(s)
- Karl Stoffel
- Department of Orthopaedic Surgery, Level 6, B Block, Fremantle Hospital, Fremantle, Western Australia, Australia.
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Erhardt JB, Roderer G, Grob K, Forster TN, Stoffel K, Kuster MS. Early results in the treatment of proximal humeral fractures with a polyaxial locking plate. Arch Orthop Trauma Surg 2009; 129:1367-74. [PMID: 19562356 DOI: 10.1007/s00402-009-0924-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Indexed: 02/09/2023]
Abstract
OBJECTIVES We report early results using a second generation locking plate, non-contact bridging plate (NCB PH((R)), Zimmer Inc. Warsaw, IN, USA), for the treatment of proximal humeral fractures. The NCB PH combines conventional plating technique with polyaxial screw placement and angular stability. DESIGN Prospective case series. SETTING A single level-1 trauma center. PATIENTS A total of 50 patients with proximal humeral fractures were treated from May 2004 to December 2005. INTERVENTION Surgery was performed in open technique in all cases. MAIN OUTCOME MEASURES Implant-related complications, clinical parameters (duration of surgery, range of motion, Constant-Murley Score, subjective patient satisfaction, complications) and radiographic evaluation [union, implant loosening, implant-related complications and avascular necrosis (AVN) of the humeral head] at 6, 12 and 24 weeks. RESULTS All fractures available to follow-up (48 of 50) went to union within the follow-up period of 6 months. One patient was lost to follow-up, one patient died of a cause unrelated to the trauma, four patients developed AVN with cutout, one patient had implant loosening, three patients experienced cutout and one patient had an axillary nerve lesion (onset unknown). The average age- and gender-related Constant Score (n = 35) was 76. CONCLUSIONS The NCB PH combines conventional plating technique with polyaxial screw placement and angular stability. Although the complication rate was 19%, with a reoperation rate of 12%, the early results show that the NCB PH is a safe implant for the treatment of proximal humeral fractures.
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