A biomechanical analysis of locking plate fixation with minimally invasive plate osteosynthesis in a subtrochanteric fracture model

Joon Woo Kim, Chang Wug Oh, Young Soo Byun, Jong-Keon Oh, Hee June Kim, Woo Kie Min, Sung Ki Park, Byung Chul Park

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objective:The objective of this study was to establish the relative fixation strengths of a locking plate, a dynamic condylar screw (DCS) plate, and a long proximal femoral nail (PFN). Methods:The study involved three groups of composite large femoral synthetic bones of five specimens per group; plating using a locking compression plate-distal femur (LCP-DF), plating using a DCS plate, and nailing using a long PFN. A gap osteotomy model was used to simulate a comminuted subtrochanteric femur fracture. For each femur, a minimal preload of 100 N was applied before loading to failure. A vertical load was applied at 10 mm/min until femur failure. Load to failure, mode of failure, and displacement at load to failure were documented. Results:Fixation strength (load or moment to failure) of LCP-DF (1,330 N; range, 1,217-1,460 N) was 26.6% and was greater in axial loading compared with DCS (1050.5 N; range, 956.4-1194.5 N) and 250% less in axial loading compared with long PFN (3633.1 N; range, 3337.2-4020.4 N; p = 0.002). Ultimate displacement in axial loading was similar for LCP-DF (18.4 mm; standard deviation [SD], 1.44), DCS (18.3 mm; SD, 3.25), and long PFN (16.7 mm; SD, 1.82). Conclusions:The LCP-DF construct proved stronger than the DCS in terms of ultimate strength by biomechanical testing of a simulated subtrochanteric femur fracture with comminution. Although the nail construct proved strongest, the biomechanical performance of the locking plate construct may lend credence to the use of a locking plate versus the DCS plate for minimally invasive plate osteosynthesis of subtrochanteric femur fractures, which may be technically difficult to fix using a nail.

Original languageEnglish
Pages (from-to)E19-E23
JournalJournal of Trauma
Volume70
Issue number1
DOIs
Publication statusPublished - 2011 Jan 1

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Hip Fractures
Femur
Nails
Thigh
Weight-Bearing
Osteotomy
Bone and Bones

Keywords

  • Biomechanical study
  • Locking plate
  • Stiffness
  • Subtrochanteric fracture

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

A biomechanical analysis of locking plate fixation with minimally invasive plate osteosynthesis in a subtrochanteric fracture model. / Kim, Joon Woo; Oh, Chang Wug; Byun, Young Soo; Oh, Jong-Keon; Kim, Hee June; Min, Woo Kie; Park, Sung Ki; Park, Byung Chul.

In: Journal of Trauma, Vol. 70, No. 1, 01.01.2011, p. E19-E23.

Research output: Contribution to journalArticle

Kim, Joon Woo ; Oh, Chang Wug ; Byun, Young Soo ; Oh, Jong-Keon ; Kim, Hee June ; Min, Woo Kie ; Park, Sung Ki ; Park, Byung Chul. / A biomechanical analysis of locking plate fixation with minimally invasive plate osteosynthesis in a subtrochanteric fracture model. In: Journal of Trauma. 2011 ; Vol. 70, No. 1. pp. E19-E23.
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abstract = "Objective:The objective of this study was to establish the relative fixation strengths of a locking plate, a dynamic condylar screw (DCS) plate, and a long proximal femoral nail (PFN). Methods:The study involved three groups of composite large femoral synthetic bones of five specimens per group; plating using a locking compression plate-distal femur (LCP-DF), plating using a DCS plate, and nailing using a long PFN. A gap osteotomy model was used to simulate a comminuted subtrochanteric femur fracture. For each femur, a minimal preload of 100 N was applied before loading to failure. A vertical load was applied at 10 mm/min until femur failure. Load to failure, mode of failure, and displacement at load to failure were documented. Results:Fixation strength (load or moment to failure) of LCP-DF (1,330 N; range, 1,217-1,460 N) was 26.6{\%} and was greater in axial loading compared with DCS (1050.5 N; range, 956.4-1194.5 N) and 250{\%} less in axial loading compared with long PFN (3633.1 N; range, 3337.2-4020.4 N; p = 0.002). Ultimate displacement in axial loading was similar for LCP-DF (18.4 mm; standard deviation [SD], 1.44), DCS (18.3 mm; SD, 3.25), and long PFN (16.7 mm; SD, 1.82). Conclusions:The LCP-DF construct proved stronger than the DCS in terms of ultimate strength by biomechanical testing of a simulated subtrochanteric femur fracture with comminution. Although the nail construct proved strongest, the biomechanical performance of the locking plate construct may lend credence to the use of a locking plate versus the DCS plate for minimally invasive plate osteosynthesis of subtrochanteric femur fractures, which may be technically difficult to fix using a nail.",
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AB - Objective:The objective of this study was to establish the relative fixation strengths of a locking plate, a dynamic condylar screw (DCS) plate, and a long proximal femoral nail (PFN). Methods:The study involved three groups of composite large femoral synthetic bones of five specimens per group; plating using a locking compression plate-distal femur (LCP-DF), plating using a DCS plate, and nailing using a long PFN. A gap osteotomy model was used to simulate a comminuted subtrochanteric femur fracture. For each femur, a minimal preload of 100 N was applied before loading to failure. A vertical load was applied at 10 mm/min until femur failure. Load to failure, mode of failure, and displacement at load to failure were documented. Results:Fixation strength (load or moment to failure) of LCP-DF (1,330 N; range, 1,217-1,460 N) was 26.6% and was greater in axial loading compared with DCS (1050.5 N; range, 956.4-1194.5 N) and 250% less in axial loading compared with long PFN (3633.1 N; range, 3337.2-4020.4 N; p = 0.002). Ultimate displacement in axial loading was similar for LCP-DF (18.4 mm; standard deviation [SD], 1.44), DCS (18.3 mm; SD, 3.25), and long PFN (16.7 mm; SD, 1.82). Conclusions:The LCP-DF construct proved stronger than the DCS in terms of ultimate strength by biomechanical testing of a simulated subtrochanteric femur fracture with comminution. Although the nail construct proved strongest, the biomechanical performance of the locking plate construct may lend credence to the use of a locking plate versus the DCS plate for minimally invasive plate osteosynthesis of subtrochanteric femur fractures, which may be technically difficult to fix using a nail.

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