Fixation of intraoperative proximal femoral fractures during THA using two versus three cerclage wires - a biomechanical study

BMC Musculoskeletal Disorders

Robert Möbius¹  Georg Osterhoff²  Johannes Fakler²  Melanie Edel³  Dirk Zajonz⁴  Toni Wendler⁵ 

[1] Department of Neurosurgery, Leipzig University, Leipzig, Germany;Department of Orthopaedic, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany;ZESBO - Center for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany;Department of Orthopaedic, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany;ZESBO - Center for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany;Department of Orthopaedic, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany;Department of Orthopaedic, Trauma and Plastic Surgery, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany;ZESBO - Center for Research on Musculoskeletal Systems, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany;Institute of Anatomy, Leipzig University, Leipzig, Germany;

关键词: Intraoperative fracture;    Proximal femoral fracture;    Cerclage wiring;    Cementless stem;    Total hip arthroplasty;    Biomechanical study;   

DOI  :  10.1186/s12891-021-04956-5

来源: Springer

【 摘 要 】

BackgroundIntraoperative proximal femoral fractures (IPFF) are relevant complications during total hip arthroplasty. Fixation using cerclage wires (CW) represents a minimally-invasive technique to address these fractures through the same surgical approach. The goal of treatment is to mobilise the patient as early as possible, which requires high primary stability. This study aimed to compare different cerclage wire configurations fixing IPFF with regard to biomechanical primary stability.MethodsStandardised IPFF (type II, Modified Mallory Classification) were created in human fresh frozen femora and were fixed either by two or three CW (1.6 mm, stainless steel). All cadaveric specimens (n = 42) were randomised to different groups (quasi-static, dynamic) or subgroups (2 CW, 3 CW) stratified by bone mineral density determined by Dual Energy X-ray Absorptiometry. Using a biomechanical testing setup, quasi-static and dynamic cyclic failure tests were carried out. Cyclic loading started from 200 N to 500 N at 1 Hz with increasing peak load by 250 N every 100 cycles until failure occurred or maximum load (5250 N) reached. The change of fracture gap size was optically captured.ResultsNo significant differences in failure load after quasi-static (p = 0.701) or dynamic cyclic loading (p = 0.132) were found between the experimental groups. In the quasi-static load testing, all constructs resisted 250% of the body weight (BW) of their corresponding body donor. In the dynamic cyclic load testing, all but one construct (treated by 3 CW) resisted 250% BW.ConclusionsBased on this in vitro data, both two and three CW provided sufficient primary stability according to the predefined minimum failure load (250% BW) to resist. The authors recommend the treatment using two CW because it reduces the risk of vascular injury and shortens procedure time.

【 授权许可】

CC BY