EXPERIMENTAL AND THEORETICAL VALIDATION OF DOUBLE COLUMN INTERNAL FIXATION THEORY FOR DISTAL FEMORAL FRACTURES

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Abstract

Purpose of the study – to experimentally compare efficiency of lateral and bilateral (lateral and medial) plate fixation of distal femoral fractures and to validate the appropriateness of double column theory of distal femur anatomy for internal fixation for these fractures.

Material and methods. The authors performed a biomechanical study in two series on polyurethane models of right femur corresponding in dimensions to natural femur. After simulating a 33 C2 fracture type it was fixed by one lateral plate or two (lateral and medial) plates. After fixation the models were tested in six load ranges with maximal load from 20 to 120 kgf in cyclic mode.

Results. The authors obtained a significant difference in absolute values of fragments displacement amplitude depending on fixation method. In the first series of the experiment – one plate fixed on the lateral surface of the femur – under minimal load the displacement value was reported as0.3 mm and under maximal load —1.9 mm; in the second series of experiment – two plates fixed on the lateral and medial surfaces of the femur – displacement values were reported as0.35 mm and0.95 mm respectively.

 Conclusion. The presence or absence of medial support after internal fixation has a profound impact on ensuring stability in cases of comminuted fractures of distal femoral fractures. In this context the use of double column theory of distal femur anatomy for internal fixation can significantly improve the treatment outcomes for such patients. After trials of minimally invasive fixation method on anatomical specimen the described theory can be implemented into the clinical practice.

About the authors

I. G. Belenky

Pavlov First Saint Petersburg State Medical University

Author for correspondence.
Email: belenkiy.trauma@mail.ru

Igor G. Belenky – Dr. Sci. (Med.), Associate Professor of Department of Traumatology and Orthopedics 

6-8, ul. L’va Tolstogo, St. Petersburg, 197022

Россия

G. D. Sergeev

Pavlov First Saint Petersburg State Medical University

Email: fake@neicon.ru

Gennady D. Sergeev — Orthopedic Surgeon, Department of Traumatology and Orthopedics 

6-8, ul. L’va Tolstogo, St. Petersburg, 197022

Россия

B. A. Mayorov

Pavlov First Saint Petersburg State Medical University

Email: fake@neicon.ru

A. Mayorov — Junior Lecturer, Department of Traumatology and Orthopedics 

6-8, ul. L’va Tolstogo, St. Petersburg, 197022

Россия

S. G. Semenov

Emperor Alexander I St. Petersburg State Transport University

Email: fake@neicon.ru

Sergey G. Semenov — Head of Dynamic Test Group 

9, Moskovskii pr., St. Petersburg, 190031

Россия

A. V. Benin

Emperor Alexander I St. Petersburg State Transport University

Email: fake@neicon.ru

Andrey V. Benin — Head of Research Department 

9, Moskovskii pr., St. Petersburg, 190031

Россия

References

  1. Барабаш А.П., Шпиняк С.П., Барабаш Ю.А. Cравнительная характеристика методов остеосинтеза у пациентов с оскольчатыми переломами диафиза бедренной кости. Травматология и ортопедия России. 2013;(2):116-124. doi: 10.21823/2311-2905-2013-2-116-124. Barabash A.P., Shpinyak S.P., Barabash J.A. [Comparative characteristics of osteosynthesis techniques in patients with comminuted diaphyseal femoral fractures]. Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2013;(2):116-124. (in Russian). doi: 10.21823/2311-2905-2013-2-116-124.
  2. Kolmert L., Wulff K. Epidemiology and treatment of distal femoral fractures in adults. Acta Orthop Scand. 1982;53(6):957-962. doi: 10.3109/17453678208992855.
  3. Martinet O., Cordey J., Harder Y. The epidemiology of fractures of the distal femur. Injury. 2000;31(3):62-63. doi: 10.1016/s0020-1383(00)80034-0.
  4. Ali M.A., Shafique M., Shoaib M. Fixation of femoral supracondylar fractures by dynamic condylar screw. Med Channel. 2004;10:65-67.
  5. Iftikhar A. Surgical outcome of supracondylar and intercondylar fractures femur in adults treated with dynamic condylar screw. JPMI. 2011;25(1):49-55.
  6. Ehlinger M, Ducrot G, Adam P, Bonnomet F. Distal femur fractures. Surgical techniques and a review of the literature. Orthop Traumatol Surg Res. 2013;99(3):353-360. doi: 10.1016/j.otsr.2012.10.014.
  7. Crist D.B., Della Rocca J.G., Murtha M.Y. Treatment of Acute Distal Femur Fractures. Orthopedics. 2008;31(7): 681-690. doi: 10.3928/01477447-20080701-04.
  8. Virk J.S., Garg S.K., Gupta P., Jangira V., Singh J., Rana S. Distal Femur Locking Plate: The Answer to All Distal Femoral Fractures. J Clin Diagn Res. 2016;10(10):RC01RC05. doi: 10.7860/jcdr/2016/22071.8759.
  9. Pietu G., Lebaron M., Flecher X., Hulet C., Vandenbussche E.; SOFCOT. Epidemiology of distal femur fractures in France in 2011-12. Orthop Traumatol Surg Res. 2014;100(5):545-548. doi: 10.1016/j.otsr.2014.06.004.
  10. Соколов В.А., Бялик Е.И., Такиев А.Т., Бояршинова О.И. Оперативное лечение переломов дистального отдела бедра у пострадавших с сочетанной и множественной травмой. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2004;(1):20-26. Sokolov V.A., Byalik E.I., Takiev A.T., Boyarshinova O.I. [Surgical treatment of distal femur fractures in patients with concomitant and multiple injury]. Vestnik travmatologii i ortopedii im. N.N. Priorova [Reporter of Traumatology and Orthopedics named Priorov]. 2004;(1):20-26.
  11. Zlowodzki M., Bhandari M., Marek D.J., Cole P.A., Kregor P.J. Operative Treatment of Acute Distal Femur Fractures: Systematic Review of 2 Comparative Studies and 45 Case Series (1989 to 2005). J Orthop Trauma. 2006;20(5):366-371. doi: 10.1097/00005131-200605000-00013.
  12. Дулаев А.К., Дыдыкин А.В., Заяц В.В., Бобрин М.И., Рефицкий Ю.В., Джусоев И.Г. Интрамедуллярный остеосинтез штифтами с блокированием при около- и внутрисуставных переломах длинных костей конечностей в комплексном лечении пострадавших с тяжелой травмой. Cкорая медицинская помощь. 2013;(1):69-73. Dulaev A.А., Dydykin A.V., Zayats V.V., Bobrin M.I., Refickiy J.V., Dzhusoev I.G. [Intramedullary periarticular and intraarticular fractures internal fixation in patients with severe trauma]. Skoraya meditsinskaya pomoshch [Emergency Medical Care]. 2013;(1):69-73.
  13. Schatzker J., Tile M. Supracondylar fractures of the femur (33-A, B, and C). In Schatzker J., Tile M., eds. The Rationale of Operative Fracture Care. 3rd ed. Berlin: Springer; 2005. pp. 409-439.
  14. Апагуни А. Э., Власов А. Ю. Анатомо-функциональные результаты различных методов лечения пациентов с повреждениями диафиза и дистальной трети бедренной кости. Кубанский научный медицинский вестник. 2009;(2):19-21. Apaguni A.E., Vlasov A.U. [Anatomo-functional results of different types of patients treatment with damage of diaphysis and distal third of femoral bone]. Kubanskij nauchnyj medicinskij vestnik [Kuban Scientific Medical Bulletin] 2009;(2):19-21.
  15. Ruedi T.P., Buckley R.E., Moran C.G. AO principles of fracture mamagement. 2th ed. Stuttgart etc: Thieme Medical Publishers; 2007. 947 p.
  16. Briffa N., Karthickeyan R., Jacob J., Khaleel A. Comminuted supracondylar femoral fractures: a biomechanical analysis comparing the stability of medial versus lateral plating in axial loading. Strategies Trauma Limb Reconstr. 2016;3(11):187-191. doi: 10.1007/s11751-016-0268-0.
  17. J iamton C., Apivatthakakul T. The safety and feasibility of minimally invasive plate osteosynthesis (MIPO) on the medial side of the femur: A cadaveric injection study. Injury. 2015;46(11):2170-2176. doi: 10.1016/j.injury.2015.08.032.
  18. Sanders R., Swiontkowski M., Rosen H., Helfet D. Doubleplating of comminuted, unstable fractures of the distal part of the femur. J Bone Joint Surg Am. 1991;73(3):341-346 doi: 10.2106/00004623-199173030-00004.
  19. Heiner A.D., Brown T.D. Structural properties of a new design of composite replicate femurs and tibias. J Biomech. 2001;34(6):773-781.
  20. Henderson C.E., Kuhl L.L., Fitzpatrick D.C., Marsh J.L. Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma. 2011;25(1):8-14. doi: 10.1097/bot.0b013e3182070127.
  21. J upiter J.B., Mehne D.K. Fractures of the distal humerus. Orthopedics. 1992;7(15):825-833.
  22. Rikli D.A., Regazzoni P. Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg Br. 1996;4(78):588-592.
  23. Luo C.F., Sun H., Zhang B., Zeng B.F. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010;11(24):683-692. doi: 10.1097/bot.0b013e3181d436f3.
  24. Cuellar V.G., Martinez D., Immerman I., Oh C., Walker P.S., Egol K.A. A biomechanical study of posteromedial tibial plateau fracture stability: do they all require fixation? J Orthop Trauma. 2015;29(7):325-330. doi: 10.1097/BOT.0000000000000277.
  25. Y ang P., Zhang Y., Liu J., Xiao J., Ma L.M., Zhu C.R. Biomechanical effect of medial cortical support and medial screw support on locking plate fixation in proximal humeral fractures with a medial gap: a finite element analysis. Acta Orthop Traumatol Turc. 2015;49(2):203-209. doi: 10.3944/aott.2015.14.0204.
  26. Zhang W., Zeng L., Liu Y., Pan Y., Zhang W., Zhang C., Zeng B., Chen Y. The mechanical benefit of medial support screws in locking plating of proximal humerus fractures. PLoS One. 2014;8(9):e103297. doi: 10.1371/journal.pone.0103297.
  27. J ung W.B., Moon E.S., Kim S.K., Kovacevic D., Kim M.S. Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate? BMC Musculoskelet Disord. 2013;14:102. doi: 10.1186/1471-2474-14-102.
  28. He Y., He J., Wang F., Zhou D., Wang Y., Wang B., Xu S. Application of Additional Medial Plate in Treatment of Proximal Humeral Fractures With Unstable Medial Column: A Finite Element Study and Clinical Practice. Medicine (Baltimore). 2015;94(41):e1775. doi: 10.1097/MD.0000000000001775.
  29. Marmor M., Liddle K., Pekmezci M., Buckley J., Matityahu A. The effect of fracture pattern stability on implant loading in OTA type 31-A2 proximal femur fractures. J Orthop Trauma. 2013;27(12):683-689. doi: 10.1097/bot.0b013e31828bacb4.
  30. Perren S.M. Physical and biological aspects of fracture healing with special reference to internal fixation. Clin Orthop Relat Res. 1979;138:175-196.
  31. Perren S.M., Fernandez A., Regazzoni P. Understanding Fracture Healing Biomechanics Based on the “Strain” Concept and its Clinical Applications. Acta Chir Orthop Traumatol Cech. 2015;4(82): 253-260.

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