title: Tangential Bicortical Locked Fixation Improves Stability in Vancouver B1 Periprosthetic Femur Fractures: A Biomechanical Study.
abstract: OBJECTIVE
  The biomechanical difficulty in fixation of a Vancouver B1 periprosthetic fracture is purchase of the proximal femoral segment in the presence of the hip stem. Several newer technologies provide the ability to place bicortical locking screws tangential to the hip stem with much longer lengths of screw purchase compared with unicortical screws. This biomechanical study compares the stability of 2 of these newer constructs to previous methods.
  
  
  METHODS
  Thirty composite synthetic femurs were prepared with cemented hip stems. The distal femur segment was osteotomized, and plates were fixed proximally with either (1) cerclage cables, (2) locked unicortical screws, (3) a composite of locked screws and cables, or tangentially directed bicortical locking screws using either (4) a stainless steel locking compression plate system with a Locking Attachment Plate (Synthes) or (5) a titanium alloy Non-Contact Bridging system (Zimmer). Specimens were tested to failure in either axial or torsional quasistatic loading modes (n = 3) after 20 moderate load preconditioning cycles. Stiffness, maximum force, and failure mechanism were determined.
  
  
  RESULTS
  Bicortical constructs resisted higher (by an average of at least 27%) maximum forces than the other 3 constructs in torsional loading (P < 0.05). Cables constructs exhibited lower maximum force than all other constructs, in both axial and torsional loading. The bicortical titanium construct was stiffer than the bicortical stainless steel construct in axial loading.
  
  
  CONCLUSIONS
  Proximal fixation stability is likely improved with the use of bicortical locking screws as compared with traditional unicortical screws and cable techniques. In this study with a limited sample size, we found the addition of cerclage cables to unicortical screws may not offer much improvement in biomechanical stability of unstable B1 fractures.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, M.S. Hershey Medical Center, Hershey, PA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Lewis
authors.forename: Cyrus T
authors.initials: CT
authors.lastname: Caroom
authors.forename: Hwabok
authors.initials: H
authors.lastname: Wee
authors.forename: Darin
authors.initials: D
authors.lastname: Jurgensmeier
authors.forename: Shane D
authors.initials: SD
authors.lastname: Rothermel
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Bramer
authors.forename: John Spence
authors.initials: JS
authors.lastname: Reid
mesh_terms: D001860:Bone Plates; D001863:Bone Screws; D019544:Equipment Failure Analysis; D005264:Femoral Fractures / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D011474:Prosthesis Design; D013314:Stress, Mechanical; D013718:Tensile Strength; D016896:Treatment Outcome