Highlights
- •Intraoperative calcar fractures compromise implant stability.
- •Classic calcar fracture fixation method not optimal for direct anterior approach.
- •No difference in stability gained from screw versus cable in synthetic bone models.
Abstract
Background
During primary total hip arthroplasty, intra-operative calcar fractures have been
historically treated with cerclage wires. However, interfragmentary screw fixation
technique can possibly achieve the same results with technical advantages. The aim
of this biomechanical study was to assess stability of calcar fractures fixed using
interfragmentary screw technique compared to a traditional cerclage system specifically
in context of total hip arthroplasty.
Methods
Thirty-two periprosthetic fractures were reduced using either a single cerclage cable
or an intracortical positional screw perpendicular to the fracture line. Axial and
torsional load testing was terminated after experimental model failure.
Findings
No significant difference was obtained for all output parameters when comparing cerclage
wires versus interfragmentary screw fixation respectively. Load at failure: 8043 ± 712 N
vs 7425 ± 854 N (p = 0.115). Load at calcar fracture propagation: 6240 ± 2207 N versus 6220 ± 966 N
(p = 0.668). Maximum stiffness before failure: 617 ± 115 N/mm vs 839 ± 175 N/mm (p = 0.100) and stiffness at calcar fracture propagation reached 771 ± 153 Nmm vs 886 ± 129 N/mm
(p = 0.197). Torque to failure levels obtained were 59.4 ± 7.1 N*m vs 60.9 ± 12.0 N*m
(p = 0.908). Torque to calcar fracture propagation, 51.6 ± 6.1 N*m vs 48.5 ± 9.8 N*m
(p = 0.298). Torsional stiffness at failure, 0.38 ± 0.03 N*m\deg. vs 0.43 ± 0.13 N*m\deg.
(p = 0.465). Torsional stiffness at calcar fracture propagation were 0.37 ± 0.03 N*m\deg.
vs 0.45 ± 0.17 N*m\deg. (p = 0.462).
Interpretation
The strength of fixation and stability of the implant were similar for both techniques.
In the synthetic bone model tested, using an interfragmentary screw conveyed similar
stability to the constructs in the management of an intra-operative medial calcar
fractures. Thus, potentially giving surgeons an alternative option for intraoperative
fracture fixation during primary total hip arthroplasty.
Keywords
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Article info
Publication history
Published online: December 03, 2022
Accepted:
November 29,
2022
Received:
August 10,
2022
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier Ltd. All rights reserved.
