Periprosthetic supracondylar femoral fractures following knee arthroplasty: a biomechanical comparison of four methods of fixation
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The aim of this study was to determine the biomechanical properties of four fixation options for periprosthetic supracondylar femoral fractures.
Fourth-generation composite femurs were implanted with a posterior-stabilizing femoral component of total knee arthroplasty. All femurs were osteotomized to produce a AO/OTA 33-A3 fracture pattern and four different constructs were tested: (1) non-locking plate; (2) polyaxial locking plate; (3) intramedullary fibular strut allograft with polyaxial locking plate; (4) retrograde intramedullary nail. The composite femurs underwent non-destructive tests to determine construct stiffness in axial and torsional cyclic loading. The final testing consisted of quasi-static axial loading until failure.
Under cyclic torsional loading, the retrograde intramedullary nail was less stiff than non-locking plate, polyaxial locking plate and intramedullary fibular strut allograft with polyaxial locking plate (p = 0.046). No differences were detected in cyclic axial loading between the different constructs. During quasi-static axial loading to failure, the intramedullary nail achieved the highest axial stiffness while the non-locking plate showed the lowest (p = 0.036).
The intramedullary fibular strut allograft with polyaxial locking plate did not prove to be significantly better to the polyaxial locking plate only in a periprosthetic distal femur fracture model.
KeywordsPeriprosthetic fracture Total knee arthroplasty Locked plate Intramedullary nail Allograft
H. S. Dhotar, M. Woodside, T. L. Willett and P. R. T. Kuzyk have received funding from the Orthopaedic Research and Education Foundation Young Investigators Grant. All the implants used in this study were provided by Zimmer Inc.
Conflicts of interest
The authors state there are no conflicts of interest.
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