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      FIXATION OF SUPRACONDYLAR FEMORAL FRACTURES: A BIOMECHANICAL ANALYSIS COMPARING 95° BLADE PLATES AND DYNAMIC CONDYLAR SCREWS (DCS)

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          Abstract

          Objective: To determine, by means of comparative biomechanical tests, whether greater compressive load resistance and flexion is presented by 95° angled blade plates or by dynamic condylar screws (DCS), and to correlate the failure type presented during the tests with each type of plate. Methods: Sixty-five porcine femurs were subjected to 1 cm medial wedge osteotomy, in the metaphysis, to simulate an unstable supracondylar femoral fracture. Osteosynthesis was performed on these pieces: 35 were fixed using 95° lateral blade plates and 30 with DCS plates. Another variable studied was the failure type presented in each group, in an attempt to correlate this with the type of plate. Results: There were no statistically significant differences in biomechanical resistance between the two types of plates, or between the failure type and the plate type used for the osteosynthesis. Conclusion: The two types of plate behaved in a similar fashion. However, the angled blade plate proved to be superior to the DCS in the flexion test. No statistical difference in failure type or type of plate used was observed.

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          Most cited references 14

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          Double-plating of comminuted, unstable fractures of the distal part of the femur.

          The cases of nine patients who had a complex fracture of the distal part of the femur and a deficient medial-cortical buttress were reviewed. Stable fixation was not achieved with the lateral condylar buttress plate alone. Collapse of the distal fragment into varus angulation was noted intraoperatively, with the axis of rotation being the junction of the distal screws and the plate. Additional stabilization with a medial plate and a bone graft from the iliac crest was applied in all nine patients: in six, at the time of the index operation and in the remaining three, after the open wound and open fracture were considered clean. At an average duration of follow-up of twenty-six months (range, twenty-one to thirty-four months), all of the fractures had healed. Evaluation of the functional outcome revealed five good and four fair results. In three patients, less than 90 degrees of flexion of the knee was present and in six, the arc of flexion was limited to between 90 and 100 degrees. Additionally, four patients had an extensor lag of 5 degrees.
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            Distal femoral fixation: a biomechanical comparison of the standard condylar buttress plate, a locked buttress plate, and the 95-degree blade plate.

            This biomechanical cadaver study was performed to compare the fixation stability of a standard lateral condylar buttress plate with a similar condylar buttress plate with the distal screws locked to the plate. Then the study was repeated with six additional matched femoral pairs to compare the locked plate with a standard 95-degree blade plate. Six matched pairs of mildly osteopenic femurs were selected, and each side was assigned randomly to fixation with either a standard lateral condylar buttress plate or a modified lateral condylar buttress plate with locked distal screws. The experiment was repeated with six additional matched pairs of femurs instrumented with either a modified lateral condylar buttress plate with locked distal screws or a standard 95-degree blade plate. The femurs were instrumented, and a gap osteotomy was created at the distal femoral metaphysis. The instrumented femurs were then mechanically tested in axial compression and bending/torsional loading to determine fixation stability; then they were loaded at 1,000 newtons for 10(5) cycles and retested for stability. The displacement across the osteotomy gap at 100-newton and 1,000-newton axial loads was measured directly for each specimen before and after cycling. In addition, resistance to displacement in bending/torsional loading (newtons/centimeter) was determined from load/displacement curves, before and after cycling. The locked buttress plate provided significantly greater fixation stability than the standard plate both before and after cycling in axial loading. The locked buttress plate also proved significantly more stable in axial loading than the blade plate both before and after cycling. A condylar buttress plate with locked screws is a valid concept for improving fixation stability.
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              Mechanics of retrograde nail versus plate fixation for supracondylar femur fractures.

              Two common types of internal fixations for the supracondylar femur fractures--the retrograde intramedullary nail and the 95 degrees sideplate and screw--were mechanically tested in synthetic composite femur bones to determine the quantitative differences in their inherent rigidity. The medial and lateral femoral condyles were separated by a sagittal osteotomy, and a standardized medial segmental shaft defect was created at the distal shaft. The osteotomized specimens were stabilized using one of the two implants and were tested in different modes of loading. The bending stiffness of both constructs were not significantly different in varus compression, medial bending (pure varus), and bending in flexion. The plate and screw implant was three times stiffer in lateral bending (pure valgus) and 1.2 times stiffer in valgus compression than the retrograde supracondylar nail (p < 0.01). The torsional stiffness of the plate and screw implant was significantly higher, 1.6 times that of the nail. Clinically, the most important and common cause of implant failure is varus loadings due to loss of medial cortical contact. Although the retrograde nail was less rigid in other physiologically less critical modes of loading, it had a rigidity comparable to that of the plate in varus loading. Therefore, a supracondylar nail may be considered a mechanically possible alternative to plate fixation.
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                Author and article information

                Contributors
                Journal
                Rev Bras Ortop
                Rev Bras Ortop
                Revista Brasileira de Ortopedia
                Elsevier
                2255-4971
                16 November 2015
                January 2010
                16 November 2015
                : 45
                : 1
                : 84-88
                Affiliations
                [1 ]Head of the Orthopedics and Traumatology Service of Hospital das Clínicas, Federal University of Minas Gerais (UFMG). Adjunct Professor in the School of Medicine, UFMG
                [2 ]Orthopedist and Specialist in Hip Surgery. Member of the Clinical Staff of Risoleta Tolentino Neves University Hospital, UFMG
                [3 ]Former Resident at Hospital das Clínicas, Federal University of Minas Gerais (UFMG)
                Author notes
                [* ]Correspondence: André Soares Rodrigues - Rua Antonio de Albuquerque, 877, apto 1.102, Funcionarios - 30112-011 - Belo Horizonte, MGCorrespondence: André Soares Rodrigues - Rua Antonio de Albuquerque877, apto 1.102FuncionariosBelo HorizonteMG30112-011 andresoaresrodrigues@ 123456hotmail.com
                Article
                S2255-4971(15)30222-6
                10.1016/S2255-4971(15)30222-6
                4799141
                27022525
                © 2010 Sociedade Brasileira de Ortopedia e Traumatologia

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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