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Single lag screw and reverse distal femur locking compression plate for concurrent cervicotrochanteric and shaft fractures of the femur: biomechanical study validated with a clinical series

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

The optimal surgical management of concurrent cervicotrochanteric and shaft fractures of the femur has not been consensual. The authors investigated the reliability of combined single lag screw and reverse distal femur locking compression plate (LCP-DF) by finite element (FE) study and retrospectively described the present technique for these dual fractures.

Method

Intact femurs were derived from CT data, and the implant models were created by using CAD software. The fractured femur and implant models were virtually aligned based on the surgical techniques before converting to the FE model. In the FE model, applied boundary conditions included body weight, muscle forces, and constraint of the joints. Regarding clinical series, three patients with these dual fractures of the femur and 2 with cervicotrochanteric fractures with subtrochanteric extension were operated on by the proposed technique. The collected data include operative time, postoperative complications, union times, and clinical outcomes.

Results

Equivalent von Mises stress exhibited on dynamic hip screws with an anti-rotational screw was higher than the other techniques, close to the yield stress of the material. Multiple screw fixation produced better stability for transcervical fractures whereas the proposed technique of combined single lag screw and reverse LCP-DF provided better stability for intertrochanteric fractures. No significant difference in cortical bone stress was found between multiple screw construct and the proposed technique. The proposed technique presented a lower risk of secondary fractures, as the strain energy density (SED) in cancellous bone was lower than multiple screw construct. Regarding clinical series, all fractures were united with a mean union time of—16.1 weeks (range 12–20). There were no any postoperative complications. Regarding the Harris score, 1 was determined to be excellent value, and 4 to be good.

Conclusion

By the FE results, a combination of a single lag screw and reverse LCP-DF is an effective technique for fixation of cervicotrochanteric fractures. Empowered by the clinical results, this proposed technique could be an alternative for concurrent cervicotrochanteric and shaft fractures of the femur especially when either single-system or dual-system devices seem not to be suitable.

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References

  1. Mohan K, Ellanti P, French H, Hogan N, McCarthy T (2019) Single versus separate implant fixation for concomitant ipsilateral femoral neck and shaft fractures: a systematic review. Orthop Rev (Pavia) 11(2):22–4

    Article  Google Scholar 

  2. Hak DJ, Mauffrey C, Hake M, Hammerberg EM, Stahel PF (2015) Ipsilateral femoral neck and shaft fractures: current diagnostic and treatment strategies. Orthopedics 38(4):247–51

    Article  PubMed  Google Scholar 

  3. Alho A (1996) Concurrent ipsilateral fractures of the hip and femoral shaft: a meta-analysis of 659 cases. Acta Orthop 67(1):19–28

    Article  CAS  Google Scholar 

  4. Seong YJ, Jang JH, Bin Jeon S, Moon NH (2019) Characteristics and surgical outcomes of intertrochanteric or subtrochanteric fractures associated with ipsilateral femoral shaft fractures treated with closed intramedullary nailing: a review of 31 consecutive cases over four years at a single institutio. Hip Pelvis 31(4):190

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tsarouhas A, Hantes ME, Karachalios T, Bargiotas K, Malizos KN (2011) Reconstruction nailing for ipsilateral femoral neck and shaft fractures. Strateg Trauma Limb Reconstr 6(2):69–75

    Article  Google Scholar 

  6. Wu KT, Lin SJ, Chou YC, Cheng HH, Wen PC, Lin CH et al (2020) Ipsilateral femoral neck and shaft fractures fixation with proximal femoral nail antirotation II (PFNA II): technical note and cases series. J Orthop Surg Res 15(1):1–7

    Article  CAS  Google Scholar 

  7. Shetty MS, Kumar MA, Ireshanavar SS, Sudhakar D (2007) Ipsilateral hip and femoral shaft fractures treated with intramedullary nails. Int Orthop 31(1):77–81

    Article  PubMed  Google Scholar 

  8. Hung SH, Hsu CY, Hsu SF, Huang PJ, Cheng YM, Chang JK et al (2004) Surgical treatment for ipsilateral fractures of the hip and femoral shaft. Injury 35(2):165–9

    Article  PubMed  Google Scholar 

  9. Oh CW, Oh JK, Park BC, Jeon IH, Kyung HS, Kim SY et al (2006) Retrograde nailing with subsequent screw fixation for ipsilateral femoral shaft and neck fractures. Arch Orthop Trauma Surg 126(7):448–53

    Article  PubMed  Google Scholar 

  10. Ostrum RF, Tornetta P, Watson JT, Christiano A, Vafek E (2014) Ipsilateral proximal femur and shaft fractures treated with hip screws and a reamed retrograde intramedullary nail. Clin Orthop Relat Res 472(9):2751–8

    Article  PubMed  Google Scholar 

  11. Sambandam SN, Chandrasekharan J, Mounasamy V, Mauffrey C (2016) Intertrochanteric fractures: a review of fixation methods. Eur J Orthop Surg Traumatol 26(4):339–53

    Article  PubMed  Google Scholar 

  12. Shah S, Desai P, Mounasamy V (2015) Retrograde nailing of femoral fractures: a retrospective study. Eur J Orthop Surg Traumatol 25(6):1093–7

    Article  PubMed  Google Scholar 

  13. Gogna P, Mukhopadhyay R, Singh A, Devgan A, Arora S, Batra A et al (2015) Contralateral reversed distal femoral locking plate for fixation of subtrochanteric femoral fractures. Chin J Traumatol 18(5):279–83

    Article  PubMed  Google Scholar 

  14. Oh CW, Kim JJ, Byun YS, Oh JK, Kim JW, Kim SY et al (2009) Minimally invasive plate osteosynthesis of subtrochanteric femur fractures with a locking plate: a prospective series of 20 fractures. Arch Orthop Trauma Surg 129(12):1659–65

    Article  PubMed  Google Scholar 

  15. Chantarapanich N, Sitthiseripratip K, Mahaisavariya B, Siribodhi P (2016) Biomechanical performance of retrograde nail for supracondylar fractures stabilization. Med Biol Eng Comput 54(6):939–52

    Article  PubMed  Google Scholar 

  16. Latifi MH, Ganthel K, Rukmanikanthan S, Mansor A, Kamarul T, Bilgen M (2012) Correction: Prospects of implant with locking plate in fixation of subtrochanteric fracture: experimental demonstration of its potential benefits on synthetic femur model with supportive hierarchical nonlinear hyperelastic finite element analysis. Biomed Eng Online 11:1–18

    Article  Google Scholar 

  17. Raja Izaham RMA, Abdul Kadir MR, Abdul Rashid AH, Hossain MG, Kamarul T (2012) Finite element analysis of Puddu and Tomofix plate fixation for open wedge high tibial osteotomy. Injury 43(6):898–902

    Article  PubMed  Google Scholar 

  18. Taylor WR, Roland E, Ploeg H, Hertig D, Klabunde R, Warner MD, Hobatho MC, Rakotomanana L, Clift SE (2002) Determination of orthotropic bone elastic constants using FEA and modal analysis. J Biomech 35(6):767–773

    Article  CAS  PubMed  Google Scholar 

  19. Krone R, Schuster P (2006) An investigation on the importance of material anisotropy in finite-element modeling of the human femur. SAE Tech Pap 2006-01-0064

  20. Behrens BA, Nolte I, Wefstaedt P, Stukenborg-Colsman C, Bouguecha A (2009) Numerical investigations on the strain-adaptive bone remodelling in the periprosthetic femur: influence of the boundary conditions. Biomed Eng Online 8:1–9

    Article  Google Scholar 

  21. Heller MO, Bergmann G, Kassi JP, Claes L, Haas NP, Duda GN (2005) Determination of muscle loading at the hip joint for use in pre-clinical testing. J Biomech 38(5):1155–63

    Article  CAS  PubMed  Google Scholar 

  22. Koval KJ, Sala DA, Kummer FJ, Zuckerman JD (1998) Postoperative weight-bearing after a fracture of the femoral neck or an intertrochanteric fracture. J Bone Jt Surg Ser A 80(3):352–6

    Article  CAS  Google Scholar 

  23. Speirs AD, Heller MO, Duda GN, Taylor WR (2007) Physiologically based boundary conditions in finite element modelling. J Biomech 40(10):2318–23

    Article  PubMed  Google Scholar 

  24. Chantarapanich N, Rojanasthien S, Chernchujit B, Mahaisavariya B, Karunratanakul K, Chalermkarnnon P et al (2017) 3D CAD/reverse engineering technique for assessment of Thai morphology: proximal femur and acetabulum. J Orthop Sci 22(4):703–9

    Article  PubMed  Google Scholar 

  25. Arastu MH, Phillips L, Duffy P (2013) An unusual failure of a sliding hip screw in the immediate post-operative period. Inj Extra 44(2):23–7

    Article  Google Scholar 

  26. Xu H, Ye D, Mei L (2017) A study of the back stress and the friction stress behaviors of Ti-6Al-4V alloy during low cycle fatigue at room temperature. Mater Sci Eng A 700:530–9

    Article  CAS  Google Scholar 

  27. Hosseini S (2012) Fatigue of Ti-6Al-4V. In: Hudak R, Penhaker M, Majernik J (eds) Biomedical engineering - technical applications in medicine. IntechOpen, London

    Google Scholar 

  28. Stacey SC, Renninger CH, Hak D, Mauffrey C (2016) Tips and tricks for ORIF of displaced femoral neck fractures in the young adult patient. Eur J Orthop Surg Traumatol 26(4):355–63

    Article  PubMed  Google Scholar 

  29. Ozkan K, Cift H, Akan K, Sahin A, Eceviz E, Ugutmen E (2010) Proximal femoral nailing without a fracture table. Eur J Orthop Surg Traumatol 20(3):229–31

    Article  Google Scholar 

  30. McConnell A, Zdero R, Syed K, Peskun C, Schemitsch E (2008) The biomechanics of ipsilateral intertrochanteric and femoral shaft fractures: a comparison of 5 fracture fixation techniques. J Orthop Trauma 22(8):517–24

    Article  PubMed  Google Scholar 

  31. Singh R, Rohilla R, Magu NK, Siwach R, Kadian V, Sangwan SS (2008) Ipsilateral femoral neck and shaft fractures: a retrospective analysis of two treatment methods. J Orthop Traumatol 9(3):141–7

    Article  PubMed  PubMed Central  Google Scholar 

  32. W-yue Wang, T-fu Yang, Liu L, F-xing Pei, L-ming Xie (2012) A comparative study of ipsilateral intertrochanteric and femoral shaft fractures treated with long proximal femoral nail antirotation or plate combinations. Orthop Surg 4(1):41–6

    Article  Google Scholar 

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Funding

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Authors and Affiliations

  1. Department of Orthopedics, Buddhachinaraj Hospital, Phitsanulok, Thailand

    Surasak Jitprapaikulsarn, Arthit Gromprasit & Chawanan Patamamongkonchai

  2. Department of Mechanical Engineering, Faculty of Engineering at Sriracha, Kasetsart University, Sriracha, Chonburi, Thailand

    Nattapon Chantarapanich

  3. Golden Jubilee Medical Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Chantas Mahaisavariya

Authors
  1. Surasak Jitprapaikulsarn
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  2. Nattapon Chantarapanich
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  3. Arthit Gromprasit
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  4. Chantas Mahaisavariya
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  5. Chawanan Patamamongkonchai
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Contributions

SJ and NC were involved in drafting and revising the manuscript for content, including the medical writing for the content, the study concept and design, the analysis and interpretation of the data, as well as the acquisition of the data. AG, CM and CP were involved in revising the manuscript for content as well as the analysis and interpretation of the data.

Corresponding author

Correspondence to Nattapon Chantarapanich.

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Conflicts of Interest

S. Jitprapaikulsarn, N. Chantarapanich, A. Gromprasit, C. Mahaisavariya, and C Patamamongkonchai declare that they have no conflict of interest.

Ethical approval

This study has been approved by the ethical committees of Buddhachinaraj Hospital in accordance with the Declaration of Helsinki.

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Jitprapaikulsarn, S., Chantarapanich, N., Gromprasit, A. et al. Single lag screw and reverse distal femur locking compression plate for concurrent cervicotrochanteric and shaft fractures of the femur: biomechanical study validated with a clinical series. Eur J Orthop Surg Traumatol 31, 1179–1192 (2021). https://doi.org/10.1007/s00590-020-02868-z

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  • DOI: https://doi.org/10.1007/s00590-020-02868-z

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