vendex and Fractures--Comminuted

To evaluate axial fracture obliquity and posterior inferior comminution in vertically oriented femoral neck fractures (FNFs) in the physiologically young patient. A biomechanical investigation was designed to evaluate the impact of these fracture elements on torque to failure using cannulated screw (CS) and sliding hip screw fixation.. Four Pauwels III FNF models were established in synthetic femurs: (1) vertically oriented in the coronal plane (COR), (2) coronal plane with axial obliquity (AX), (3) coronal plane with posterior inferior comminution (CCOM), and (4) coronal plane with axial obliquity and posterior inferior comminution (ACOM). In each group (n = 10), specimens were fixed using either 3 CSs or a sliding hip screw with supplemental antirotation screw (SHS). Quasistatic cyclic ramp-loading to failure was performed using a custom testing jig combining axial preloading and torsional ramp-loading. The primary outcome was torque to failure, defined as angular displacement ≥5 degrees.. In the CS group, torque to failure was 40.2 ± 2.6 Nm, 35.0 ± 1.4 Nm, 29.8 ± 1.5 Nm, and 31.8 ± 2.2 Nm for the COR, AX, CCOM, and ACOM fracture groups, respectively (P < 0.05). In the SHS group, torque to failure was 28.6 ± 1.3 Nm, 24.2 ± 1.4 Nm, 21.4 ± 1.2 Nm, and 21.0 ± 0.9 Nm for the COR, AX, CCOM, and ACOM fracture groups, respectively (P < 0.05). In both constructs, groups with posterior inferior comminution demonstrated significantly lower torque to failure compared to the COR group (P < 0.05). The CS construct demonstrated higher torque to failure in all groups when compared to the SHS construct (P < 0.01).. Posterior inferior comminution significantly affects torque to failure in vertically oriented FNFs. Three peripherally placed CSs may resist combined axial and torsional loading better than a sliding hip screw construct.

Topics: Biomechanical Phenomena; Femoral Fractures; Femoral Neck Fractures; Fracture Fixation, Internal; Fractures, Comminuted; Humans; Torque

To evaluate the effect of locking hole inserts (LHIs) and their insertion torque on locking plate fatigue life.. Eighteen standard 3.5-mm locking plates were instrumented with LHIs (Smith & Nephew, Memphis, TN) of 1.70 or 3.96 Nm insertion torque, or without LHIs, whereas eleven 4.5-mm locking plates were instrumented with LHIs at 3.96 Nm insertion torque or without LHIs. Plates were cyclically loaded to failure (ie, plate fracture) in four-point bending. Number of cycles to plate failure were measured.. The 3.5-mm plates with 1.70 Nm LHI insertion torque had a 52% increase in cycles to failure compared with plates without LHIs (114,300 ± 23,680 vs. 75,487 ± 15,746 cycles; P = 0.01). Increasing insertion torque to 3.96 Nm led to a further increase of 36% in fatigue life (155,177 ± 32,493 cycles; P = 0.02) and a 106% increase compared with plates without LHIs (P = 0.001). The 4.5-mm plates with 3.96 Nm insertion torque had a 48% increase in cycles to failure when compared with plates without LHIs (74,369 ± 10,181 vs. 50,214 ± 5544 cycles; P = 0.001).. LHIs significantly extend plate fatigue length, which would be advantageous in the setting of delayed fracture healing. We recommend the use of LHIs in round locking holes over bony gaps whenever possible; however, we recognize that these findings are limited to implants manufactured by Smith & Nephew.

Topics: Biomechanical Phenomena; Bone Plates; Equipment Failure Analysis; Fracture Fixation, Internal; Fracture Healing; Fractures, Comminuted; Materials Testing; Prosthesis Failure; Stress, Mechanical; Torque

The aim of this study was to compare the fixation rigidity of anterior, anterosuperior, and superior plates in the treatment of comminuted midshaft clavicle fractures.. Six-hole titanium alloy plates were produced according to anatomic features of fourth-generation artificial clavicle models for anterior (group I; n = 14), anterosuperior (group II; n = 14), and superior (group III; n = 14) fixation. After plate fixation, 5-mm segments were resected from the middle third of each clavicle to create comminuted fracture models. Half the models from each group were tested under rotational forces; the other half were tested under 3-point bending forces. Failure modes, stiffness values, and failure loads were recorded.. All models fractured at the level of the distalmost screw during the failure torque, whereas several failure modes were observed in 3-point bending tests. The mean stiffness values of groups I to III were 636 ± 78, 767 ± 72, and 745 ± 214 N ∙ mm/deg (P = .171), respectively, for the torsional tests and 38 ± 5, 20 ± 3, and 13 ± 2 N/mm, respectively, for the bending tests (P < .001 for group I vs. groups II and III; P = .015 for group II vs. group III). The mean failure torque values of groups I to III were 8248 ± 2325, 12,638 ± 1749, and 10,643 ± 1838 N ∙ mm (P = .02 for group I vs. II), respectively, and the mean failure loads were 409 ± 81, 360 ± 122, and 271 ± 87 N, respectively (P = .108).. In the surgical treatment of comminuted midshaft clavicle fractures, the fixation strength of anterosuperior plating was greater than that of anterior plating under rotational forces and similar to that of superior plating.

Topics: Biomechanical Phenomena; Bone Plates; Bone Screws; Clavicle; Diaphyses; Fracture Fixation, Internal; Fractures, Comminuted; Humans; Models, Anatomic; Pliability; Rotation; Torque

Screw stripping is a common situation in fracture fixation, particularly in osteopenic bone treatment. Surgeons' perception of screw stripping is relatively poor and the real number of loose screws in every plate-screw construct is unknown. The biomechanical and clinical implications of the different possible screw-stripping situations are also unidentified. In this study, construct stiffness in different scenarios of stripped screws is investigated.. A bone surrogate comminuted osteoporotic fracture was fixed with four screws in both sides of the fracture gap in 75 specimens. In four groups, one or two screws closest or distal to the gap were over-tightened and left in place in one part of the construct and the remaining screws were tightened with 0.3N m torque (four groups). In the fifth group (control), all the screws were tightened with 0.3N m torque. Construct stiffness was tested in terms of compression, bending, and torsion for 1000 cycles.. When one or two screws closest to the gap were stripped, stiffness only decreased by, respectively, 5.7% or 7.6% under compression and 4.7% or 6.7% under bending; however, stiffness in torsion was 15.1% or 32%, respectively, lower than the initial stiffness. When a screw distal to the gap was stripped, the stiffness decreased by 28% under bending and 10% under compression; no change was noted under torsion. When two screws distal to the gap were stripped, the stiffness decreased by 11% in compression, collapsed under bending, and decreased by 8% under torsion.. Position and number of stripped screws affect the biomechanical properties of a construct in different ways, depending on the acting forces.

Topics: Analysis of Variance; Biomechanical Phenomena; Bone and Bones; Bone Plates; Bone Screws; Equipment Design; Fracture Fixation, Internal; Fractures, Comminuted; Humans; Osteoporotic Fractures; Stress, Mechanical; Tensile Strength; Torque

Locked plates provide greater stiffness, possibly at the expense of fracture healing. The purpose of this study is to evaluate construct stiffness of distal femur plates as a function of unlocked screw position in cadaveric distal femur fractures.. Osteoporotic cadaveric femurs were used. Four diaphyseal bridge plate constructs were created using 13-hole distal femur locking plates, all with identical condylar fixation. Constructs included all locked (AL), all unlocked (AUL), proximal unlocked (PUL), and distally unlocked (DUL) groups. Constructs underwent cyclic axial loading with increasing force per interval. Data were gathered on axial stiffness, torsional stiffness, maximum torque required for 5-degree external rotation, and axial force to failure.. Twenty-one specimens were divided into AL, AUL, PUL, and DUL groups. Axial stiffness was not significantly different between the constructs. AL and PUL demonstrated greater torsional stiffness, maximum torque, and force to failure than AUL and AL showed greater final torsional stiffness and failure force than DUL (P < 0.05). AL and PUL had similar axial, torsion, and failure measures, as did AUL and DUL constructs. All but 2 specimens fractured before medial gap closure during failure tests. Drop-offs on load-displacement curves confirmed all failures.. Only the screw nearest the gap had significant effect on torsional and failure stiffness but not axial stiffness. Construct mechanics depended on the type of screw placed in this position. This screw nearest the fracture dictates working length stiffness when the working length itself is constant and in turn determines overall construct stiffness in osteoporotic bone.

Topics: Biomechanical Phenomena; Bone Plates; Bone Screws; Cadaver; Femoral Fractures; Fracture Fixation, Internal; Fractures, Comminuted; Humans; Osteoporosis; Torque

Proximal humeral fractures with substantial metaphyseal comminution are challenging to treat. In the elderly with osteoporotic bone, arthroplasty sometimes remains the only valuable option; however, the minimally required length of stem fixation is not known. The aim of this study was to investigate the primary stability of cemented short- and long-stem prostheses with different intramedullary fracture bypass lengths.. Osteoporotic composite bone models of the humerus (Synbone, Malans, Switzerland) with 3 different fracture levels (group A, 6 cm distal to surgical neck; group B, 7 cm distal to surgical neck; and group C, 8 cm distal to surgical neck) were prepared with a cemented standard short (S)- or long (L)-stem prosthesis and were tested for torque to failure. As a reference, we used models with intact bone (group R-O) and a short-stem prosthesis implanted at the surgical neck (group R-P). The radiographic bypass index (BI) was calculated before testing (fracture level to stem tip [in millimeters]/outer cortical diameter at fracture level [in millimeters]).. The resulting BIs of each group were as follows: 1.7 in group A-S, 3.4 in group A-L, 1.4 in group B-S, 3.2 in group B-L, 1.0 in group C-S, and 2.9 in group C-L. Compared with group R-O, the torques to failure of groups B-S and C-S were significantly lower, whereas only group C-S was significantly weaker than group R-P (P < .01). Comparing short- and long-stem bypasses of different fracture heights, we found that only group C-L showed a significantly higher resistance to torque (P < .01).. A short-stem bypass with a BI of 1.7 was sufficient for primary stability tested by torque to failure in this biomechanical setting. For smaller BIs, a long-stem prosthesis should be considered.. Basic science study, biomechanics.

Topics: Aged; Arthroplasty, Replacement; Biomechanical Phenomena; Female; Fractures, Comminuted; Humans; Humerus; Joint Prosthesis; Models, Biological; Osteoporosis; Radiography; Shoulder Fractures; Shoulder Joint; Torque

Plain lateral radiographs in a neutral position were studied in ten acute thoracolumbar burst fractures produced by high speed impact on three vertebrae human cadaveric spine segments. Six linear geometric parameters were measured on each film. The ratio of each value in the neutral injured to the intact condition was correlated linearly with the motion parameters obtained from post-traumatic three-dimensional flexibility data (neutral zone NZ; range of motion ROM). Anterior unit height (vertebra+adjacent discs) had the highest correlation with the neutral zone and flexibility in all directions, especially flexion-extension (NZ, R2 = 0.93; flexion ROM, R2 = 0.86; extension ROM, R2 = 0.79) lateral bending (NZ, R2 = 0.83; ROM, R2 = 0.90) and right axial rotation (NZ, R2 = 0.53; ROM, R2 = 0.86). The deformation ratio (average height to depth) correlated most with the neutral zone in left axial rotation (R2 = 0.91) and right lateral bending (R2 = 0.92). Due to the high correlations obtained, these parameters should be evaluated in clinical situations to assess their effectiveness in predicting the instability of burst fractures. Ultimately, prospective clinical studies are required to verify their clinical utility.

Topics: Acceleration; Acute Disease; Adult; Aged; Cadaver; Compressive Strength; Female; Fractures, Comminuted; Humans; Least-Squares Analysis; Linear Models; Lumbar Vertebrae; Male; Middle Aged; Pliability; Predictive Value of Tests; Radiography; Range of Motion, Articular; Spinal Fractures; Thoracic Vertebrae; Torque

Based upon magnetic resonance scans of five human tibiae a three-dimensional finite element model using eight nodal isoparametric elements was developed to analyze the biomechanical properties of fracture fixation by an unreamed interlocking nail. Tension phenomena and bone implant translations occurring in the borderlines of the fracture zone, bone-implant interface, and the fixation site of the interlocking screws were analyzed with the help of link elements. The proximal fracture segment was fixed with a link element so as to produce exclusively translatory shifts corresponding to the vector of the load applied. Under condition of static load F = 500 N or axial torsion MT = 15 Nm the biomechanical properties of a nailed horizontal fracture (42-A3), a three fragment lesion (42-B2), and a comminuted midshaft fracture (42-C3) were evaluated. On condition of axial load maximum dislocations of 0.1549 mm are induced in the direction of the x-axis due to the asymmetric geometry of the human tibia which promotes medially directed translations. Independent from the fracture type present a homogenous tension profile was calculated for the whole tibia diaphysis with a sigmaEQV ranging from 24.18 to 121.14 MPa due to the relative low elastic modulus of the cortical bone compared to material characteristics of the implant. However, application of a torsional moment MT = 15 Nm induces significantly increased tension maxima in the nail-interlocking screw interface with a sigmaEQV = 7, 626 MPa. Maximum translatory movements ux = 12.59 mm and uy = 23.53 mm in the x and y plane indicate that these load conditions bear a high risk of an implant failure.

Topics: Biomechanical Phenomena; Bone Nails; Bone Screws; Computer Simulation; Elasticity; Equipment Design; Equipment Failure; Fracture Fixation, Intramedullary; Fractures, Comminuted; Humans; Magnetic Resonance Imaging; Mathematics; Models, Biological; Stress, Mechanical; Surface Properties; Tibia; Tibial Fractures; Torque