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Bicortical screw fixation provides superior biomechanical stability but devastating failure modes in periprosthetic femur fracture care using locking plates

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Abstract

Purpose

The incidence of periprosthetic fractures is inevitably increasing. Sufficient stabilisation and proper screw placement next to large-volume implants remains difficult. Modern locking plates allow polyaxial, thus bicortical, screw placement around a prosthetic stem. This study analysed the biomechanical properties of different screw configurations in a locking plate construct of a periprosthetic femoral fracture model.

Methods

A total of 20 Sawbones were used to stabilise a Vancouver-B1 femoral fracture with a locking plate using either four monocortical screws or three bicortical screws for proximal fixation. These were loaded with an increasing axial compression until failure.

Results

Bicortical screw purchase was significantly superior to monocortical regarding load to failure (1,510 N ± 284 N versus 2,350 N ± 212 N, p < 0.001) and maximal number of cycles (6803 ± 760 versus 4041 ± 923, p < 0.001). However, the mode of failure in the bicortical group was a severe comminuted fracture pattern as opposed to the monocortical group in which a pull-out of the screws without further damage to the bone was observed.

Conclusions

Bicortical screw placement enhances the primary stability in treating periprosthetic femoral fractures. Notably, the mode of failure may limit the salvage options in case of revision surgery.

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Compliance with Ethical Standards

For this type of study formal consent is not required.

Conflict of interest

The authors were not compensated. Benefits were received in support of the research material described in this article from Zimmer GmbH (Winterthur, Switzerland).

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Authors and Affiliations

  1. Centre for Musculoskeletal Surgery, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Clemens Gwinner & Sven Märdian

  2. Department of Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany

    Tobias Dröge, Martin Schulze, Michael J. Raschke & Richard Stange

Authors
  1. Clemens Gwinner
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  2. Sven Märdian
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  3. Tobias Dröge
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  4. Martin Schulze
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  5. Michael J. Raschke
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  6. Richard Stange
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Corresponding author

Correspondence to Clemens Gwinner.

Additional information

Clemens Gwinner and Sven Märdian contributed equally to this paper

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Gwinner, C., Märdian, S., Dröge, T. et al. Bicortical screw fixation provides superior biomechanical stability but devastating failure modes in periprosthetic femur fracture care using locking plates. International Orthopaedics (SICOT) 39, 1749–1755 (2015). https://doi.org/10.1007/s00264-015-2787-6

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  • DOI: https://doi.org/10.1007/s00264-015-2787-6

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