Abstract
BackgroundInternal fixation is recommended for treating Vancouver B1 periprosthetic femoral fractures. Although several fixation procedures have been developed with high fixation stability and union rates, long-term weight-bearing constructs are still lacking. Therefore, the aim of the present study was to evaluate the stability of a double-plate procedure using reversed contralateral locking compression-distal femoral plates for fixation of Vancouver B1 periprosthetic femoral fractures under full weight-bearing.MethodsSingle- and double-plate fixation procedures for locking compression-distal femoral plates were analysed under an axial load of 1,500 N by finite element analysis and biomechanical loading tests. A vertical loading test was performed to the prosthetic head, and the displacements and strains were calculated based on load-displacement and load-strain curves generated by the static compression tests.ResultsThe finite element analysis revealed that double-plate fixation significantly reduced stress concentration at the lateral plate place on the fracture site. Under full weight-bearing, the maximum von Mises stress in the lateral plate was 268 MPa. On the other hand, the maximum stress in the single-plating method occurred at the defect level of the femur with a maximum stress value of 1,303 MPa. The principal strains of single- and double-plate fixation were 0.63 % and 0.058 %, respectively. Consistently, in the axial loading test, the strain values at a 1,500 N loading of the single- and double-plate fixation methods were 1,274.60 ± 11.53 and 317.33 ± 8.03 (× 10− 6), respectively.ConclusionsThe present study suggests that dual-plate fixation with reversed locking compression-distal femoral plates may be an excellent treatment procedure for patients with Vancouver B1 fractures, allowing for full weight-bearing in the early postoperative period.
Highlights
Internal fixation is recommended for treating Vancouver B1 periprosthetic femoral fractures
The maximum von Mises stress in the single-plating method occurred at the femoral defect level, and the stress areas were present at the centre of the locking compression-distal femoral plates (LCP-DF) plate, with a maximum stress value of 1, 303 MPa
The stress level at the defect level was much lower in the double-plating than in the single-plating method, and the stress level was high at the central part of both plates
Summary
Internal fixation is recommended for treating Vancouver B1 periprosthetic femoral fractures. The aim of the present study was to evaluate the stability of a doubleplate procedure using reversed contralateral locking compression-distal femoral plates for fixation of Vancouver B1 periprosthetic femoral fractures under full weight-bearing. Additional attachment of an anterior plate is suggested to improve fracture stability and has shown some satisfactory results in biomechanical studies [17, 18] In these studies, the lateral locking plates were too short and narrow, which may limit their clinical applications. Addition of an anterior locking plate to the reversed contralateral locking compression-distal femoral plates (LCP-DF) might be a good choice to improve fixation stability and overcome weight-bearing restrictions when using a single-plate system. The aim of the current study was to evaluate the potential advantages of a reversed contralateral LCP-DF double-plate fixation procedure for treatment of Vancouver B1 fractures under full weight-bearing using finite element analysis (FEA) and biomechanical testing
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