Highlights
- •Condyle-spanning construct may lower risks of refracture in osteoporotic femurs.
- •Multiple condylar screws avoided strain elevation caused by distal load transfer.
- •Combined testing and modeling protocol for pre-clinical femoral implant evaluation
Abstract
Background
Condyle-spanning plate-screw constructs have shown potential to lower the risks of
femoral refractures after the healing of a primary Vancouver type B1 periprosthetic
femoral fracture. Limited information exists to show how osteoporosis (a risk factor
for periprosthetic femoral fractures) may affect the plate fixation during activities
of daily living.
Methods
Using total hip arthroplasty and plate-implanted finite element models of three osteoporotic
femurs, this study simulated physiological loads of three activities of daily living,
as well as osteoporosis associated muscle weakening, and compared the calculated stress/strain,
load transfer and local stiffness with experimentally validated models of three healthy
femurs. Two plating systems and two construct lengths (a diaphyseal construct and
a condyle-spanning construct) were modeled.
Findings
Osteoporotic femurs showed higher bone strain (21.9%) and higher peak plate stress
(144.3%) as compared with healthy femurs. Compared with shorter diaphyseal constructs,
condyle-spanning constructs of two plating systems reduced bone strains in both healthy
and osteoporotic femurs (both applying ‘the normal’ and ‘the weakened muscle forces’)
around the most distal diaphyseal screw and in the distal metaphysis, both locations
where secondary fractures are typically reported. The lowered resultant compressive
force and the increased local compressive stiffness in the distal diaphysis and metaphysis
may be associated with strain reductions via condyle-spanning constructs.
Interpretation
Strain reductions in condyle-spanning constructs agreed with the clinically reported
lowered risks of femoral refractures in the distal diaphysis and metaphysis. Multiple
condylar screws may mitigate the concentrated strains in the lateral condyle, especially
in osteoporotic femurs.
Keywords
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Article info
Publication history
Published online: October 23, 2022
Accepted:
October 14,
2022
Received:
July 11,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
