Finite element analysis of the stability of retrograde intramedullary nail and plate-screw combinations for periprosthetic femoral fractures following total knee replacement.

Abstract

Periprosthetic fractures following total knee replacement are rare but challenging. The goal of the treatment is to achieve the most stable fixation that allows early mobilization. Therefore, the aim of this study was to evaluate the biomechanical results of the use of different fixation systems in the treatment of distal femur periprosthetic fractures with finite element analysis. A total knee prosthesis was implanted in Sawbone femur models. A transverse fracture line was created in the supracondylar region and was fixed in four different groups. In group 1, fracture line fixation was fixed using retrograde intramedullary nailing. In group 2, fixation was applied using a lateral anatomic distal femoral. In group 3, in addition to the fixation made in group 1, a lateral anatomic distal femoral plate was used. In group 4, in addition to the fixation made in group 2, a 3.5 mm Limited Contact Dynamic Compression Plate (LC-DCP) was applied medially. Computed Tomography (CT) scans were taken of the created models and were converted to three-dimensional models. Axial and rotational loading forces were applied to all the created models. The least deformation with axial loading was observed in the double plate group. Group 3 was determined to be more advantageous against rotational forces. The greatest movement in the fracture line was found in group 2. The application of the medial plate was determined to reduce the tension on the lateral plate and increase stability in the fracture line. Combining a lateral anatomic plate with intramedullary nailing or a medial plate was seen to be biomechanically more advantageous than using a lateral plate or intramedullary nailing alone in the treatment of distal femoral periprosthetic fractures.