title: The biomechanical analysis of three plating fixation systems for periprosthetic femoral fracture near the tip of a total hip arthroplasty.
abstract: BACKGROUND
  A variety of techniques are available for fixation of femoral shaft fractures following total hip arthroplasty. The optimal surgical repair method still remains a point of controversy in the literature. However, few studies have quantified the performance of such repair constructs. This study biomechanically examined 3 different screw-plate and cable-plate systems for fixation of periprosthetic femoral fractures near the tip of a total hip arthroplasty.
  
  
  METHODS
  Twelve pairs of human cadaveric femurs were utilized. Each left femur was prepared for the cemented insertion of the femoral component of a total hip implant. Femoral fractures were created in the femurs and subsequently repaired with Construct A (Zimmer Cable Ready System), Construct B (AO Cable-Plate System), or Construct C (Dall-Miles Cable Grip System). Right femora served as matched intact controls. Axial, torsional, and four-point bending tests were performed to obtain stiffness values.
  
  
  RESULTS
  All repair systems showed 3.08 to 5.33 times greater axial stiffness over intact control specimens. Four-point normalized bending (0.69 to 0.85) and normalized torsional (0.55 to 0.69) stiffnesses were lower than intact controls for most comparisons. Screw-plates provided either greater or equal stiffness compared to cable-plates in almost all cases. There were no statistical differences between plating systems A, B, or C when compared to each other (p > 0.05).
  
  
  CONCLUSIONS
  Screw-plate systems provide more optimal mechanical stability than cable-plate systems for periprosthetic femur fractures near the tip of a total hip arthroplasty.
authors.affiliation: Martin Orthopaedic Biomechanics Laboratory, Shuter Wing (Room 5-066), St, Michael's Hospital, 30 Bond Street, Toronto, ON, M5B-1W8, Canada. zderor@smh.ca.
authors.forename: James P
authors.initials: JP
authors.lastname: Lever
authors.forename: Rad
authors.initials: R
authors.lastname: Zdero
authors.forename: Markku T
authors.initials: MT
authors.lastname: Nousiainen
authors.forename: James P
authors.initials: JP
authors.lastname: Waddell
authors.forename: Emil H
authors.initials: EH
authors.lastname: Schemitsch