Biomechanical evaluation of periprosthetic femoral fracture fixation.
BACKGROUND
A variety of methods are available for the fixation of femoral shaft fractures after total hip arthroplasty. However, few studies in the literature have quantified the performance of such repair constructs. The aim of this study was to evaluate biomechanically four different constructs for the fixation of periprosthetic femoral shaft fractures following total hip arthroplasty.


METHODS
Twenty synthetic femora were tested in axial compression, lateral bending, and torsion to determine initial stiffness, as well as stiffness following fixation of a simulated femoral midshaft fracture with and without a bone gap. Four fracture fixation constructs (five specimens per group) were assessed: construct A was a Synthes locked plate (a twelve-hole broad dynamic compression plate) with locked screws; construct B, a Synthes locked plate (a twelve-hole broad dynamic compression plate) with cables and locked screws; construct C, a Zimmer nonlocking (eight-hole) cable plate with cables and nonlocked screws; and construct D, a Zimmer nonlocking (eight-hole) cable plate with allograft strut, cables, and nonlocked screws. Axial stiffness, lateral bending stiffness, and torsional stiffness were assessed with respect to baseline intact specimen values. Axial load to failure was also measured for the specimens.


RESULTS
Construct D demonstrated either equivalent or superior stiffness in all testing modes compared with the other constructs in femora with both a midshaft fracture and a bone gap. A comparison of constructs A, B, and C demonstrated equivalent stiffness in all test modes (with one exception) in femora with a midshaft fracture and a bone gap.


CONCLUSIONS
A combination of a nonlocking plate with an allograft strut (construct D) resulted in the highest stiffness of the constructs examined for treating a periprosthetic fracture around a stable femoral component of a total hip replacement.
Zdero
Rad
R
Martin Orthopaedic Biomechanics Laboratory, Shuter Wing (Room 5-066), St. Michael's Hospital, 30 Bond Street, Toronto, ON L5G-456, Canada.
Walker
Richard
R
Waddell
James P
JP
Schemitsch
Emil H
EH
D019644:Arthroplasty, Replacement, Hip; D001696:Biomechanical Phenomena; D001860:Bone Plates; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006622:Hip Prosthesis; D006801:Humans; D008422:Materials Testing; D011183:Postoperative Complications / Q000601:surgery; D011474:Prosthesis Design