Biomechanical assessment of newly-designed proximal femoral medial buttress plate for treatment of reverse oblique femoral intertrochanteric fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGRui , LUOPeng , HUWei , KEChenrong , WANGJianshun ,  GUOXiaoshan

Department of Orthopaedics, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou Zhejiang, 325027, P.R.China;

Corresponding author：

GUOXiaoshan, Email: guoxiaoshan666@163.com

Keywords：

Reverse oblique intertrochanteric fracture; proximal femoral medial buttress plate; internal fixation; Biomechanics

DOI：

10.7507/1002-1892.201609103

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Objective To evaluate the biomechanical properties of proximal femoral medial buttress plate (PFMBP) for fixing the reverse oblique intertrochanteric fractures by comparing with proximal femoral locking compression plate (PFLCP) and proximal femoral nail antirotation (PFNA). Methods Eighteen synthetic femoral bone models (Synbone) were divided into 3 groups (group PFLCP, group PFNA, and group PFMBP), 6 models in each group; an AO 31-A3.1 reverse oblique femoral intertrochanteric fracture was made based on the same criterion. After being fixed and embeded, the axial load testing, torsion testing, and axial load-to-failure testing were performed on each model. The axial displacement of different loads, torque of different torsion angles, and failure load of each model were recorded, and the stiffness of axial load and torsion were calculated. Results The axial stiffness in groups PFLCP, PFNA, and PFMBP were (109.42±30.14), (119.13±29.14), and (162.05±22.05) N/mm respectively, showing significant differences between groups (P<0.05). There were significant differences in torque between different torsion angles in the same group, as well as in the torque between groups at the same torsional angle (P<0.05). The torsion stiffness in groups PFLCP, PFNA, and PFMBP were (1.45±0.44), (1.10±0.13), and (1.36±0.32) N·mm/deg respectively; there were significant differences when compared groups PFLCP and PFMBP with group PFNA (P<0.05), but no significant difference was found between group PFLCP and group PFMBP (P>0.05). The failure loads of groups PFLCP, PFNA, and PFMBP were (1 408.88± 0.17), (1 696.56±0.52), and (2 154.65±0.10) N respectively, showing significant differences between groups (P<0.05). Conclusion The newly-designed PFMBP is better than PFNA and PFLCP in axial load stiffness and torsion stiffness for fixing reverse oblique intertrochanteric fracture by biomechanical test, indicating that reconstruction of medial stability is a key element for unstable intertrochanteric fracture.

Citation： ZHANGRui, LUOPeng, HUWei, KEChenrong, WANGJianshun, GUOXiaoshan. Biomechanical assessment of newly-designed proximal femoral medial buttress plate for treatment of reverse oblique femoral intertrochanteric fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(2): 165-170. doi: 10.7507/1002-1892.201609103 Copy

1.	Simmermacher RK, Ljungqvist J, Bail H, et al. The new proximal femoral nail antirotation (PFNA^®) in daily practice: results of a multicentre clinical study. Injury, 2008, 39(8): 932-939.
2.	Makki D, Matar HE, Jacob N, et al. Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures. Injury, 2015, 46(12): 2389-2393.
3.	Chou DT, Taylor AM, Boulton C, et al. Reverse oblique intertrochanteric femoral fractures treated with the intramedullary hip screw (IMHS). Injury, 2012, 43(6): 817-821.
4.	Wirtz C, Abbassi F, Evangelopoulos DS, et al. High failure rate of trochanteric fracture osteosynthesis with proximal femoral locking compression plate. Injury, 2013, 44(6): 751-756.
5.	Streubel PN, Moustoukas MJ, Obremskey WT. Mechanical failure after locking plate fixation of unstable intertrochanteric femur fractures. J Orthop Trauma, 2013, 27(1): 22-28.
6.	Lin SJ, Huang KC, Chuang PY, et al. The outcome of unstable proximal femoral fracture treated with reverse LISS plates. Injury, 2016, 47(10): 2161-2168.
7.	Kuzyk PR, Lobo J, Whelan D, et al. Biomechanical evaluation of extramedullary versus intramedullary fixation for reverse obliquity intertrochanteric fractures. J Orthop Trauma, 2009, 23(1): 31-38.
8.	Weiser L, Ruppel AA, Nüchtern JV, et al. Extra-vs. intramedullary treatment of pertrochanteric fractures: a biomechanical in vitro study comparing dynamic hip screw and intramedullary nail. Arch Orthop Trauma Surg, 2015, 135(8): 1101-1106.
9.	Knobe M, Gradl G, Buecking B, et al. Locked minimally invasive plating versus fourth generation nailing in the treatment of AO/OTA 31A2.2 fractures: A biomechanical comparison of PCCP(®) and Intertan nail(®). Injury, 2015, 46(8): 1475-1482.
10.	Evaniew N, Bhandari M. Cochrane in CORR^®: Intramedullary nails for extracapsular hip fractures in adults (review). Clin Orthop Relat Res, 2015, 473(3): 767-774.
11.	Makki D, Matar HE, Jacob N, et al. Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures. Injury, 2015, 46(12): 2389-2393.
12.	Irgit K, Richard RD, Beebe MJ, et al. Reverse oblique and transverse intertrochanteric femoral fractures treated with the long cephalomedullary nail. J Orthop Trauma, 2015, 29(9): e299-304.
13.	Peter RE. Open reduction and internal fixation of osteoporotic acetabular fractures through the ilio-inguinal approach: use of buttress plates to control medial displacement of the quadrilateral surface. Injury, 2015, 46 Suppl 1: S2-7.
14.	Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6): 811-888.
15.	Heiner AD, Brown TD. Structural properties of a new design of composite replicate femurs and tibias. J Biomech, 2001, 34(6): 773-781.
16.	Wang JQ, Zhao CP, Su YG, et al. Computer-assisted navigation systems for insertion of cannulated screws in femoral neck fractures: a comparison of bi-planar robot navigation with optoelectronic navigation in a Synbone hip model trial. Chin Med J (Engl), 2011, 124(23): 3906-3911.
17.	张巍, 罗从风, 曾炳芳. 四种不同内固定治疗胫骨平台后外侧剪应力骨折的生物力学研究. 中华创伤骨科杂志, 2010, 12(11): 1069-1073.
18.	Luo Q, Yuen G, Lau TW, et al. A biomechanical study comparing helical blade with screw design for sliding hip fixations of unstable intertrochanteric fractures. Scientific World Journal, 2013, 2013: 351936.
19.	Forward DP, Doro CJ, O’Toole RV, et al. A biomechanical comparison of a locking plate, a nail, and a 95° angled blade plate for fixation of subtrochanteric femoral fractures. J Orthop Trauma, 2012, 26(6): 334-340.
20.	Bong MR, Patel V, Iesaka K, et al. Comparison of a sliding hip screw with a trochanteric lateral support plate to an intramedullary hip screw for fixation of unstable intertrochanteric hip fractures: a cadaver study. J Trauma, 2004, 56(4): 791-794.
21.	Fensky F, Nüchtern JV, Kolb JP, et al. Cement augmentation of the proximal femoral nail antirotation for the treatment of osteoporotic pertrochanteric fractures-a biomechanical cadaver study. Injury, 2013, 44(6): 802-807.

1. Simmermacher RK, Ljungqvist J, Bail H, et al. The new proximal femoral nail antirotation (PFNA^®) in daily practice: results of a multicentre clinical study. Injury, 2008, 39(8): 932-939.
2. Makki D, Matar HE, Jacob N, et al. Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures. Injury, 2015, 46(12): 2389-2393.
3. Chou DT, Taylor AM, Boulton C, et al. Reverse oblique intertrochanteric femoral fractures treated with the intramedullary hip screw (IMHS). Injury, 2012, 43(6): 817-821.
4. Wirtz C, Abbassi F, Evangelopoulos DS, et al. High failure rate of trochanteric fracture osteosynthesis with proximal femoral locking compression plate. Injury, 2013, 44(6): 751-756.
5. Streubel PN, Moustoukas MJ, Obremskey WT. Mechanical failure after locking plate fixation of unstable intertrochanteric femur fractures. J Orthop Trauma, 2013, 27(1): 22-28.
6. Lin SJ, Huang KC, Chuang PY, et al. The outcome of unstable proximal femoral fracture treated with reverse LISS plates. Injury, 2016, 47(10): 2161-2168.
7. Kuzyk PR, Lobo J, Whelan D, et al. Biomechanical evaluation of extramedullary versus intramedullary fixation for reverse obliquity intertrochanteric fractures. J Orthop Trauma, 2009, 23(1): 31-38.
8. Weiser L, Ruppel AA, Nüchtern JV, et al. Extra-vs. intramedullary treatment of pertrochanteric fractures: a biomechanical in vitro study comparing dynamic hip screw and intramedullary nail. Arch Orthop Trauma Surg, 2015, 135(8): 1101-1106.
9. Knobe M, Gradl G, Buecking B, et al. Locked minimally invasive plating versus fourth generation nailing in the treatment of AO/OTA 31A2.2 fractures: A biomechanical comparison of PCCP(®) and Intertan nail(®). Injury, 2015, 46(8): 1475-1482.
10. Evaniew N, Bhandari M. Cochrane in CORR^®: Intramedullary nails for extracapsular hip fractures in adults (review). Clin Orthop Relat Res, 2015, 473(3): 767-774.
11. Makki D, Matar HE, Jacob N, et al. Comparison of the reconstruction trochanteric antigrade nail (TAN) with the proximal femoral nail antirotation (PFNA) in the management of reverse oblique intertrochanteric hip fractures. Injury, 2015, 46(12): 2389-2393.
12. Irgit K, Richard RD, Beebe MJ, et al. Reverse oblique and transverse intertrochanteric femoral fractures treated with the long cephalomedullary nail. J Orthop Trauma, 2015, 29(9): e299-304.
13. Peter RE. Open reduction and internal fixation of osteoporotic acetabular fractures through the ilio-inguinal approach: use of buttress plates to control medial displacement of the quadrilateral surface. Injury, 2015, 46 Suppl 1: S2-7.
14. Chang SM, Zhang YQ, Ma Z, et al. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg, 2015, 135(6): 811-888.
15. Heiner AD, Brown TD. Structural properties of a new design of composite replicate femurs and tibias. J Biomech, 2001, 34(6): 773-781.
16. Wang JQ, Zhao CP, Su YG, et al. Computer-assisted navigation systems for insertion of cannulated screws in femoral neck fractures: a comparison of bi-planar robot navigation with optoelectronic navigation in a Synbone hip model trial. Chin Med J (Engl), 2011, 124(23): 3906-3911.
17. 张巍, 罗从风, 曾炳芳. 四种不同内固定治疗胫骨平台后外侧剪应力骨折的生物力学研究. 中华创伤骨科杂志, 2010, 12(11): 1069-1073.
18. Luo Q, Yuen G, Lau TW, et al. A biomechanical study comparing helical blade with screw design for sliding hip fixations of unstable intertrochanteric fractures. Scientific World Journal, 2013, 2013: 351936.
19. Forward DP, Doro CJ, O’Toole RV, et al. A biomechanical comparison of a locking plate, a nail, and a 95° angled blade plate for fixation of subtrochanteric femoral fractures. J Orthop Trauma, 2012, 26(6): 334-340.
20. Bong MR, Patel V, Iesaka K, et al. Comparison of a sliding hip screw with a trochanteric lateral support plate to an intramedullary hip screw for fixation of unstable intertrochanteric hip fractures: a cadaver study. J Trauma, 2004, 56(4): 791-794.
21. Fensky F, Nüchtern JV, Kolb JP, et al. Cement augmentation of the proximal femoral nail antirotation for the treatment of osteoporotic pertrochanteric fractures-a biomechanical cadaver study. Injury, 2013, 44(6): 802-807.

Chinese Journal of Reparative and Reconstructive Surgery

Biomechanical assessment of newly-designed proximal femoral medial buttress plate for treatment of reverse oblique femoral intertrochanteric fracture

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