Abstract/Details

Biomechanical comparison of locked plating and spiral blade retrograde nailing of supracondylar femur fractures


2012 2012

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Abstract (summary)

Background. Comminuted supracondylar femur fractures in the elderly are often treated with either retrograde femoral nailing or locked plating. Early weight-bearing is typically restricted after fixing supracondylar fractures, thereby impairing the patient's mobilization. In general, surgeons are more comfortable allowing early weight-bearing of long bone fractures after nailing rather than plating, but early studies of retrograde nails for supracondylar fractures using standard distal locking showed poor fixation compared with locked plating. Newer generation distal locking techniques, such as the spiral blade, may demonstrate improved fixation, potentially allowing early weight bearing. The purpose of this study is to biomechanically compare locked plating with retrograde nailing of osteoporotic supracondylar femur fractures with simulated physiologic weight-bearing in the post-operative period.

Methods. The Locking Condylar Plate (LCP) and Retrograde/Antegrade EX Femoral Nail (RAFN) with spiral blade locking were tested using 10 paired elderly cadaveric femurs, divided into normal and low BMD groups, with a simulated AO/OTA type 33-A3 supracondylar femur fracture. Each specimen was subjected to 200,000 loading cycles simulating six weeks of postoperative recovery with full weight-bearing for an average individual and the construct subsidence and axial stiffness were measured.

Results. LCP fixation compared to RAFN showed higher axial stiffness for normal and low BMD groups (80% and 57% respectively). After cyclic loading, axial stiffness of both constructs decreased by 20% and RAFN fixation resulted in twice as much subsidence (1.9±0.6 mm). Two RAFN constructs with low BMD failed after a few cycles whereas the matched pairs fixed with LCP failed after 68,000 and 100,000 cycles.

Conclusions. The LCP construct was stiffer than RAFN construct. Early weight bearing may cause 3–4 mm of subsidence in elderly patients with low BMD. However, because of the observed failures in two of the samples treated with RAFN in the low BMD group, early weight bearing is not recommended in osteoporotic bones treated with RAFN.

Indexing (details)


Subject
Surgery;
Biomechanics
Classification
0576: Surgery
0648: Biomechanics
Identifier / keyword
Health and environmental sciences; Biological sciences
Title
Biomechanical comparison of locked plating and spiral blade retrograde nailing of supracondylar femur fractures
Author
Assari, Soroush
Number of pages
29
Publication year
2012
Degree date
2012
School code
0225
Source
MAI 50/04M, Masters Abstracts International
Place of publication
Ann Arbor
Country of publication
United States
ISBN
9781267149398
Advisor
Darvish, Kurosh
Committee member
Pillapakkam, Shriram; Rehman, Saqib
University/institution
Temple University
Department
Mechanical Engineering
University location
United States -- Pennsylvania
Degree
M.S.M.E.
Source type
Dissertations & Theses
Language
English
Document type
Dissertation/Thesis
Dissertation/thesis number
1505782
ProQuest document ID
920001948
Copyright
Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works.
Document URL
http://search.proquest.com/docview/920001948
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