The effect of surgeon-controlled variables on construct stiffness in lateral locked plating of distal femoral fractures
Abstract Background Nonunion following treatment of supracondylar femur fractures with lateral locked plates (LLP) has been reported to be as high as 21 %. Implant related and surgeon-controlled variables have been postulated to contribute to nonunion by modulating fracture-fixation construct stiffn...
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doaj-70bc97132f68459e8d2daeedd3f055d92021-06-06T11:19:47ZengBMCBMC Musculoskeletal Disorders1471-24742021-06-012211910.1186/s12891-021-04341-2The effect of surgeon-controlled variables on construct stiffness in lateral locked plating of distal femoral fracturesMichael J. Weaver0George W. Chaus1Aidin Masoudi2Kaveh Momenzadeh3Amin Mohamadi4Edward K Rodriguez5Mark S. Vrahas6Ara Nazarian7Department of Orthopaedic surgery, Brigham and Womens HospitalFrontrange Orthoaedics and SpineMusculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Isreal Deconess Medical CenterMusculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Isreal Deconess Medical CenterMusculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Isreal Deconess Medical CenterMusculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Isreal Deconess Medical CenterCedars-Sinai Medical CenterMusculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Isreal Deconess Medical CenterAbstract Background Nonunion following treatment of supracondylar femur fractures with lateral locked plates (LLP) has been reported to be as high as 21 %. Implant related and surgeon-controlled variables have been postulated to contribute to nonunion by modulating fracture-fixation construct stiffness. The purpose of this study is to evaluate the effect of surgeon-controlled factors on stiffness when treating supracondylar femur fractures with LLPs: 1. Does plate length affect construct stiffness given the same plate material, fracture working length and type of screws? 2. Does screw type (bicortical locking versus bicortical nonlocking or unicortical locking) and number of screws affect construct stiffness given the same material, fracture working length, and plate length? 3. Does fracture working length affect construct stiffness given the same plate material, length and type of screws? 4. Does plate material (titanium versus stainless steel) affect construct stiffness given the same fracture working length, plate length, type and number of screws? Methods Mechanical study of simulated supracondylar femur fractures treated with LLPs of varying lengths, screw types, fractureworking lenghts, and plate/screw material. Overall construct stiffness was evaluated using an Instron hydraulic testing apparatus. Results Stiffness was 15 % higher comparing 13-hole to the 5-hole plates (995 N/mm849N vs. /mm, p = 0.003). The use of bicortical nonlocking screws decreased overall construct stiffness by 18 % compared to bicortical locking screws (808 N/mm vs. 995 N/mm, p = 0.0001). The type of screw (unicortical locking vs. bicortical locking) and the number of screws in the diaphysis (3 vs. 10) did not appear to significantly influence construct stiffness (p = 0.76, p = 0.24). Similarly, fracture working length (5.4 cm vs. 9.4 cm, p = 0.24), and implant type (titanium vs. stainless steel, p = 0.12) did also not appear to effect stiffness. Discussion Using shorter plates and using bicortical nonlocking screws (vs. bicortical locking screws) reduced overall construct stiffness. Using more screws, using unicortical locking screws, increasing fracture working length and varying plate material (titanium vs. stainless steel) does not appear to significantly alter construct stiffness. Surgeons can adjust plate length and screw types to affect overall fracture-fixation construct stiffness; however, the optimal stiffness to promote healing remains unknown.https://doi.org/10.1186/s12891-021-04341-2Supracondylar FemurDistal FemurNonunionBiomechanicsLateral Locked PlatingFracture |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Michael J. Weaver George W. Chaus Aidin Masoudi Kaveh Momenzadeh Amin Mohamadi Edward K Rodriguez Mark S. Vrahas Ara Nazarian |
spellingShingle |
Michael J. Weaver George W. Chaus Aidin Masoudi Kaveh Momenzadeh Amin Mohamadi Edward K Rodriguez Mark S. Vrahas Ara Nazarian The effect of surgeon-controlled variables on construct stiffness in lateral locked plating of distal femoral fractures BMC Musculoskeletal Disorders Supracondylar Femur Distal Femur Nonunion Biomechanics Lateral Locked Plating Fracture |
author_facet |
Michael J. Weaver George W. Chaus Aidin Masoudi Kaveh Momenzadeh Amin Mohamadi Edward K Rodriguez Mark S. Vrahas Ara Nazarian |
author_sort |
Michael J. Weaver |
title |
The effect of surgeon-controlled variables on construct stiffness in lateral locked plating of distal femoral fractures |
title_short |
The effect of surgeon-controlled variables on construct stiffness in lateral locked plating of distal femoral fractures |
title_full |
The effect of surgeon-controlled variables on construct stiffness in lateral locked plating of distal femoral fractures |
title_fullStr |
The effect of surgeon-controlled variables on construct stiffness in lateral locked plating of distal femoral fractures |
title_full_unstemmed |
The effect of surgeon-controlled variables on construct stiffness in lateral locked plating of distal femoral fractures |
title_sort |
effect of surgeon-controlled variables on construct stiffness in lateral locked plating of distal femoral fractures |
publisher |
BMC |
series |
BMC Musculoskeletal Disorders |
issn |
1471-2474 |
publishDate |
2021-06-01 |
description |
Abstract Background Nonunion following treatment of supracondylar femur fractures with lateral locked plates (LLP) has been reported to be as high as 21 %. Implant related and surgeon-controlled variables have been postulated to contribute to nonunion by modulating fracture-fixation construct stiffness. The purpose of this study is to evaluate the effect of surgeon-controlled factors on stiffness when treating supracondylar femur fractures with LLPs: 1. Does plate length affect construct stiffness given the same plate material, fracture working length and type of screws? 2. Does screw type (bicortical locking versus bicortical nonlocking or unicortical locking) and number of screws affect construct stiffness given the same material, fracture working length, and plate length? 3. Does fracture working length affect construct stiffness given the same plate material, length and type of screws? 4. Does plate material (titanium versus stainless steel) affect construct stiffness given the same fracture working length, plate length, type and number of screws? Methods Mechanical study of simulated supracondylar femur fractures treated with LLPs of varying lengths, screw types, fractureworking lenghts, and plate/screw material. Overall construct stiffness was evaluated using an Instron hydraulic testing apparatus. Results Stiffness was 15 % higher comparing 13-hole to the 5-hole plates (995 N/mm849N vs. /mm, p = 0.003). The use of bicortical nonlocking screws decreased overall construct stiffness by 18 % compared to bicortical locking screws (808 N/mm vs. 995 N/mm, p = 0.0001). The type of screw (unicortical locking vs. bicortical locking) and the number of screws in the diaphysis (3 vs. 10) did not appear to significantly influence construct stiffness (p = 0.76, p = 0.24). Similarly, fracture working length (5.4 cm vs. 9.4 cm, p = 0.24), and implant type (titanium vs. stainless steel, p = 0.12) did also not appear to effect stiffness. Discussion Using shorter plates and using bicortical nonlocking screws (vs. bicortical locking screws) reduced overall construct stiffness. Using more screws, using unicortical locking screws, increasing fracture working length and varying plate material (titanium vs. stainless steel) does not appear to significantly alter construct stiffness. Surgeons can adjust plate length and screw types to affect overall fracture-fixation construct stiffness; however, the optimal stiffness to promote healing remains unknown. |
topic |
Supracondylar Femur Distal Femur Nonunion Biomechanics Lateral Locked Plating Fracture |
url |
https://doi.org/10.1186/s12891-021-04341-2 |
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