Biomechanical comparison of Vancouver C type periprosthetic femoral fractures Fixed with Locking Plate Of Different Length

doi:10.3877/cma.j.issn.2096-0263.2020.01.005

Abstract

Abstract:

Objective

Comparing the biomechanical differences of four different locking plate fixation of different lengths in the treatment of Vancouver C type periprosthetic femoral fractures, the relationship between the position of locking plates relative to the distal end of the femoral stem and the stiffness and stress concentration was analyzed.

Methods

Ten pairs of fresh adult femoral specimens were randomly divided into four groups. Then, the modle of Vancouver C type periprosthetic femoral fractures was established. Fixed with locking plates of four different lengths: in group A, the proximal bicortical locking screw of the plate was 1 femoral diameter to the tip of the prosthesis; in group B, the proximal bicortical locking screw of the plate was the same level with the tip of the prosthesis; in group C, the proximal single cortical locking screw of the plate overlapped with the tip of the prosthesis by 1 femoral diameter; in group D, the proximal single cortical locking screw of the plate overlapped with the tip of the prosthesis by 2 femoral diameter. All of the models are performed by axial ballast test, torsion test, four-point bend test inside and outside, and four-point bend test front and behind. The data of each group were recorded and analyzed statisticallyby SPSS software. Finally, the cyclic loading test was carried out and the fracture line distribution was recorded.

Results

The stiffness of each group showed significant difference, and the stiffness of group D were the largest in all tests (P<0.05). In the cyclic loading experiment, the fracture of group D were distributed near the tips of femoral prosthesis, proximal locking nails and distal plates. The fracture of group A and C were concentrated between proximal locking nails and the tips of femoral prosthesis. The fracture of group B were concentrated in the linear region between the tips of femoral prosthesis and the tips of steel plates. The results showed that the stress concentration of group D was lower than that of group A, B and C (P<0.05).

Conclusions

In the treatment of Vancouver Ctype periprosthetic femoral fractures with locking plate, the stability of internal fixation increases with the plate length; the overlapping fixation of locking plate and the tip of femoral stem does not increase the stress concentration, and the stress is significantly dispersed, with increasing with the overlapping area of plate and femoral prosthesis.

Key words: Periprosthetic femoral fracture, Vancouver Type C, Biomechanics, Locking plate

Pengyuan Luo, Kuo Zhao, Zhongzheng Wang, Yingchao Yin, Ruipeng Zhang, Jialiang Guo, Zhiyong Hou, Yingze Zhang. Biomechanical comparison of Vancouver C type periprosthetic femoral fractures Fixed with Locking Plate Of Different Length[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2020, 06(01): 18-24.

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Figures/Tables 6

References 32

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组别	钢板最近端锁定孔与假体远端距离	虚拟骨折线两端锁定螺钉数量及方式
组别	钢板最近端锁定孔与假体远端距离	近端	远端
A组	相距1个股骨直径	4个双皮质螺钉	4个双皮质螺钉
B组	相距0个股骨直径	4个双皮质螺钉	4个双皮质螺钉
C组	重叠1个股骨直径	3个双皮质螺钉、2单皮质螺钉	4个双皮质螺钉
D组	重叠2个股骨直径	3个双皮质螺钉、2单皮质螺钉	4个双皮质螺钉

组别	钢板最近端锁定孔与假体远端距离	虚拟骨折线两端锁定螺钉数量及方式
组别	钢板最近端锁定孔与假体远端距离	近端	远端
A组	相距1个股骨直径	4个双皮质螺钉	4个双皮质螺钉
B组	相距0个股骨直径	4个双皮质螺钉	4个双皮质螺钉
C组	重叠1个股骨直径	3个双皮质螺钉、2单皮质螺钉	4个双皮质螺钉
D组	重叠2个股骨直径	3个双皮质螺钉、2单皮质螺钉	4个双皮质螺钉

组别	轴向压载实验（N/mm）	扭转实验（N·m/度）	内外四点侧弯实验（N/mm）	前后四点侧弯实验（N/mm）
A组	852±16	4.4±1.9	695 ±62	1201±11
B组	934±14	6. 1±0.4	892±59	1425±25
C组	1168±27	6.3±0.4	974±51	1448±7
D组	1432±69	6.98±0.6	1241±7	1599±7
F值	634.68	87.255	624.844	3126.78
P值	<0.05	<0.05	<0.05	<0.05

组别	轴向压载实验（N/mm）	扭转实验（N·m/度）	内外四点侧弯实验（N/mm）	前后四点侧弯实验（N/mm）
A组	852±16	4.4±1.9	695 ±62	1201±11
B组	934±14	6. 1±0.4	892±59	1425±25
C组	1168±27	6.3±0.4	974±51	1448±7
D组	1432±69	6.98±0.6	1241±7	1599±7
F值	634.68	87.255	624.844	3126.78
P值	<0.05	<0.05	<0.05	<0.05

组别	轴向压载实验		扭转实验		内外四点侧弯实验		前后四点侧弯实验
组别	q值	P值	q值	P值	q值	P值	q值	P值
A组vs B组	5.8448	<0.05	12.584	<0.05	20.977	<0.05	76.193	<0.05
A组vs C组	23.657	<0.05	16.273	<0.05	30.631	<0.05	85.16	<0.05
A组vs D组	42.296	<0.05	22.065	<0.05	60.161	<0.05	135.44	<0.05
B组vs C组	17.812	<0.05	3.689	<0.05	9.654	<0.05	8.966	<0.05
B组vs D组	36.451	<0.05	9.481	<0.05	39.183	<0.05	59.249	<0.05
C组vs D组	18.639	<0.05	5.792	<0.05	29.53	<0.05	50.283	<0.05

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