Simulated full weight bearing following posterior column acetabular fracture fixation: a biomechanical comparability study
Abstract Purpose The incidence of acetabular fractures (AFs) is increasing in all industrial nations, with posterior column fractures (PCFs) accounting for 18.5–22% of these cases. Treating displaced AFs in elderly patients is a known challenge. The optimal surgical strategy implementing open reduct...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-06-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-023-03879-2 |
| _version_ | 1797811352014684160 |
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| author | Till Berk Ivan Zderic Peter Schwarzenberg Torsten Pastor Roman Pfeifer Sascha Halvachizadeh Geoff Richards Boyko Gueorguiev Hans-Christoph Pape |
| author_facet | Till Berk Ivan Zderic Peter Schwarzenberg Torsten Pastor Roman Pfeifer Sascha Halvachizadeh Geoff Richards Boyko Gueorguiev Hans-Christoph Pape |
| author_sort | Till Berk |
| collection | DOAJ |
| description | Abstract Purpose The incidence of acetabular fractures (AFs) is increasing in all industrial nations, with posterior column fractures (PCFs) accounting for 18.5–22% of these cases. Treating displaced AFs in elderly patients is a known challenge. The optimal surgical strategy implementing open reduction and internal fixation (ORIF), total hip arthroplasty (THA), or percutaneous screw fixation (SF), remains debated. Additionally, with either of these treatment methods, the post-surgical weight bearing protocols are also ambiguous. The aim of this biomechanical study was to evaluate construct stiffness and failure load following a PCF fixation with either standard plate osteosynthesis, SF, or using a screwable cup for THA under full weight bearing conditions. Methods Twelve composite osteoporotic pelvises were used. A PCF according to the Letournel Classification was created in 24 hemi-pelvis constructs stratified into three groups (n = 8) as follows: (i) posterior column fracture with plate fixation (PCPF); (ii) posterior column fracture with SF (PCSF); (iii) posterior column fracture with screwable cup fixation (PCSC). All specimens were biomechanically tested under progressively increasing cyclic loading until failure, with monitoring of the interfragmentary movements via motion tracking. Results Initial construct stiffness (N/mm) was 154.8 ± 68.3 for PCPF, 107.3 ± 41.0 for PCSF, and 133.3 ± 27.5 for PCSC, with no significant differences among the groups, p = 0.173. Cycles to failure and failure load were 7822 ± 2281 and 982.2 ± 428.1 N for PCPF, 3662 ± 1664 and 566.2 ± 366.4 N for PCSF, and 5989 ± 3440 and 798.9 ± 544.0 N for PCSC, being significantly higher for PCPF versus PCSF, p = 0.012. Conclusion Standard ORIF of PCF with either plate osteosynthesis or using a screwable cup for THA demonstrated encouraging results for application of a post-surgical treatment concept with a full weight bearing approach. Further biomechanical cadaveric studies with larger sample size should be initiated for a better understanding of AF treatment with full weight bearing and its potential as a concept for PCF fixation. |
| first_indexed | 2024-03-13T07:22:26Z |
| format | Article |
| id | doaj.art-9289a271149341e69d2590415e5c0355 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-03-13T07:22:26Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-9289a271149341e69d2590415e5c03552023-06-04T11:34:32ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2023-06-011811910.1186/s13018-023-03879-2Simulated full weight bearing following posterior column acetabular fracture fixation: a biomechanical comparability studyTill Berk0Ivan Zderic1Peter Schwarzenberg2Torsten Pastor3Roman Pfeifer4Sascha Halvachizadeh5Geoff Richards6Boyko Gueorguiev7Hans-Christoph Pape8AO Research Institute DavosAO Research Institute DavosAO Research Institute DavosDepartment of Orthopaedic and Trauma Surgery, Cantonal Hospital LucerneDepartment of Trauma, University Hospital ZurichDepartment of Trauma, University Hospital ZurichAO Research Institute DavosAO Research Institute DavosDepartment of Trauma, University Hospital ZurichAbstract Purpose The incidence of acetabular fractures (AFs) is increasing in all industrial nations, with posterior column fractures (PCFs) accounting for 18.5–22% of these cases. Treating displaced AFs in elderly patients is a known challenge. The optimal surgical strategy implementing open reduction and internal fixation (ORIF), total hip arthroplasty (THA), or percutaneous screw fixation (SF), remains debated. Additionally, with either of these treatment methods, the post-surgical weight bearing protocols are also ambiguous. The aim of this biomechanical study was to evaluate construct stiffness and failure load following a PCF fixation with either standard plate osteosynthesis, SF, or using a screwable cup for THA under full weight bearing conditions. Methods Twelve composite osteoporotic pelvises were used. A PCF according to the Letournel Classification was created in 24 hemi-pelvis constructs stratified into three groups (n = 8) as follows: (i) posterior column fracture with plate fixation (PCPF); (ii) posterior column fracture with SF (PCSF); (iii) posterior column fracture with screwable cup fixation (PCSC). All specimens were biomechanically tested under progressively increasing cyclic loading until failure, with monitoring of the interfragmentary movements via motion tracking. Results Initial construct stiffness (N/mm) was 154.8 ± 68.3 for PCPF, 107.3 ± 41.0 for PCSF, and 133.3 ± 27.5 for PCSC, with no significant differences among the groups, p = 0.173. Cycles to failure and failure load were 7822 ± 2281 and 982.2 ± 428.1 N for PCPF, 3662 ± 1664 and 566.2 ± 366.4 N for PCSF, and 5989 ± 3440 and 798.9 ± 544.0 N for PCSC, being significantly higher for PCPF versus PCSF, p = 0.012. Conclusion Standard ORIF of PCF with either plate osteosynthesis or using a screwable cup for THA demonstrated encouraging results for application of a post-surgical treatment concept with a full weight bearing approach. Further biomechanical cadaveric studies with larger sample size should be initiated for a better understanding of AF treatment with full weight bearing and its potential as a concept for PCF fixation.https://doi.org/10.1186/s13018-023-03879-2Posterior column acetabulum fractureRevision cupPlatingScrew fixationArtificial bone modelBiomechanics |
| spellingShingle | Till Berk Ivan Zderic Peter Schwarzenberg Torsten Pastor Roman Pfeifer Sascha Halvachizadeh Geoff Richards Boyko Gueorguiev Hans-Christoph Pape Simulated full weight bearing following posterior column acetabular fracture fixation: a biomechanical comparability study Journal of Orthopaedic Surgery and Research Posterior column acetabulum fracture Revision cup Plating Screw fixation Artificial bone model Biomechanics |
| title | Simulated full weight bearing following posterior column acetabular fracture fixation: a biomechanical comparability study |
| title_full | Simulated full weight bearing following posterior column acetabular fracture fixation: a biomechanical comparability study |
| title_fullStr | Simulated full weight bearing following posterior column acetabular fracture fixation: a biomechanical comparability study |
| title_full_unstemmed | Simulated full weight bearing following posterior column acetabular fracture fixation: a biomechanical comparability study |
| title_short | Simulated full weight bearing following posterior column acetabular fracture fixation: a biomechanical comparability study |
| title_sort | simulated full weight bearing following posterior column acetabular fracture fixation a biomechanical comparability study |
| topic | Posterior column acetabulum fracture Revision cup Plating Screw fixation Artificial bone model Biomechanics |
| url | https://doi.org/10.1186/s13018-023-03879-2 |
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