Steinmann pin augmentation versus locking plate constructs

Jeremy Ruskin,Richard S Yoon,John S Hwang,Sondra Corgan,Paolo Caravaggi,Linda Chen,Francis R Patterson,Kathleen S Beebe

doi:10.1007/s10195-016-0394-y

Abstract

BackgroundAggressive bone neoplasms, such as giant cell tumors, often affect the proximal tibia warranting bony resection via curettage leaving behind massive defects that require extensive reconstruction. Reconstruction is usually accomplished with poly(methyl methacrylate) (PMMA) packing supplemented with an internal fixation construct. The purpose of this study is to compare Steinmann pin augmentation to locking plate constructs to determine which offers the stiffer reconstruction option.Materials and methodsLarge defects were created below the lateral condyle of fresh frozen tibias. The defects extended for an average of 35 mm beneath the lateral plateau in the frontal plane, and from the anterior to posterior cortex in the sagittal plane. Distally the defect extended for an average of 35 mm to the metadiaphyseal junction. In the Pin group, the tibias were reconstructed with three 4-mm diameter Steinmann pins placed in the medullary canal and PMMA packing. In the Plate group, the tibias were reconstructed with a 6-hole 3.5-mm LCP Proximal locking plate fixed to the proximal−lateral tibia utilizing seven 3.5-mm screws and PMMA packing. The tibias were tested for stiffness on a MTS machine by applying up to 400 N to the tibial plateau in force control at 5 N/s. Fatigue properties were tested by applying a haversine loading waveform between 200 N and 1,200 N at 3 Hz simulating walking upstairs/downstairs.ResultsLocking plate constructs (801.8 ± 78 N/mm) had greater (p = 0.041) stiffness than tibial constructs fixed with Steinmann pins (646.5 ± 206.3 N/mm).ConclusionsPermanent deformation was similar between the Pin and Plate group; however, two tibia from the Pin group exhibited displacements >5 mm which we considered failure.Level of evidencen/a.

Highlights

Aggressive bone neoplasms, such as giant cell tumors, often affect the proximal tibia warranting bony resection via curettage that leaves behind massive defects that require extensive, stable reconstruction in order to maximize function [1]
One other published study looks at using locking plates to reconstruct giant cell tumor defects after resection, and this was performed for the distal femur [6]
The goal of this study was to evaluate the effect of using proximal tibia locking plates versus Steinmann pin augmentation on cemented proximal tibia defects

Summary

Introduction

Aggressive bone neoplasms, such as giant cell tumors, often affect the proximal tibia warranting bony resection via curettage that leaves behind massive defects that require extensive, stable reconstruction in order to maximize function [1]. Accomplishing stable, functional reconstruction in the proximal tibia with maintenance of long-term stability can be a challenging task. Such defects are packed with poly(methyl methacrylate) (PMMA) cement. Given the large size of the defect created by excision of a giant cell tumor, PMMA packing is generally supplemented with an internal fixation device. Aggressive bone neoplasms, such as giant cell tumors, often affect the proximal tibia warranting bony resection via curettage leaving behind massive defects that require extensive reconstruction. The tibias were tested for stiffness on a MTS machine by applying up to 400 N to the tibial plateau in force control at

Objectives

Results

Conclusion