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Journal of Orthopaedic Surgery and Research
Published in: Journal of Orthopaedic Surgery and Research 1/2023

Open Access 01-12-2023 | Acetabular Fracture | Research article

Simulated full weight bearing following posterior column acetabular fracture fixation: a biomechanical comparability study

Authors: Till Berk, Ivan Zderic, Peter Schwarzenberg, Torsten Pastor, Roman Pfeifer, Sascha Halvachizadeh, Geoff Richards, Boyko Gueorguiev, Hans-Christoph Pape

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2023

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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.
Literature
1.
Liu S, Brewer RD, MoMokdad AH, Serdula M. Prevalence of alcohol-impaired: results from a national self-reported of health behaviors. JAMA. 1997;277(2):122–5.PubMedCrossRef
2.
Ochs BG, Marintschev I, Hoyer H, Rolauffs B, Culemann U, Pohlemann T, et al. Changes in the treatment of acetabular fractures over 15 years: analysis of 1266 cases treated by the German Pelvic Multicentre Study Group (DAO/DGU). Injury. 2010;41(8):839–51.PubMedCrossRef
3.
Herath SC, Pott H, Rollmann MF, Braun BJ, Holstein JH, Höch A, et al. Geriatric acetabular surgery: Letournel’s contraindications then and now—data from the German pelvic registry. J Orthop Trauma. 2019;33:S8–13.PubMedCrossRef
4.
Boudissa M, Francony F, Kerschbaumer G, Ruatti S, Milaire M, Merloz P, et al. Epidemiology and treatment of acetabular fractures in a level-1 trauma centre: retrospective study of 414 patients over 10 years. Orthop Traumatol Surg Res. 2017;103(3):335–9.PubMedCrossRef
5.
Firoozabadi R, Cross WW, Krieg JC, Milton L. Acetabular fractures in the senior population–epidemiology, mortality and treatments. Arch Bone Joint Surg. 2017;5(2):96.PubMedPubMedCentral
6.
Mears DC, Velyvis JH. Acute total hip arthroplasty for selected displaced acetabular fractures: two to twelve-year results. JBJS. 2002;84(1):1–9.CrossRef
7.
Boelch SP, Jordan MC, Meffert RH, Jansen H. Comparison of open reduction and internal fixation and primary total hip replacement for osteoporotic acetabular fractures: a retrospective clinical study. Int Orthop. 2017;41(9):1831–7.PubMedCrossRef
8.
Jimenez ML, Tile M, Schenk RS. Total hip replacement after acetabular fracture. Orthopedic Clinics. 1997;28(3):435–46.PubMed
9.
Mears DC. Surgical treatment of acetabular fractures in elderly patients with osteoporotic bone. JAAOS-J Am Acad Orthopaedic Surg. 1999;7(2):128–41.CrossRef
10.
Hustedt JW, Blizzard DJ, Baumgaertner MR, Leslie MP, Grauer JN. Is it possible to train patients to limit weight bearing on a lower extremity? Orthopedics. 2012;35(1):e31–7.PubMedCrossRef
11.
Rüedi TP, Murphy WM, Colton CL, Fackelman GE, Harder Y. AO principles of fracture management. Thieme Stuttgart; 2000.
12.
Tropp H, Norlin R. Ankle performance after ankle fracture—a randomized study of early mobilization. Foot Ankle Int. 1995;16(2):79–83.PubMedCrossRef
13.
Egol KA, Dolan R, Koval KJ. Functional outcome of surgery for fractures of the ankle—a prospective, randomised comparison of management in a cast or a functional brace. J Bone Joint Surg-Br Vol. 2000;82B(2):246–9.CrossRef
14.
Sanguineti VA, Wild JR, Fain MJ. Management of postoperative complications: general approach. Clin Geriatr Med. 2014;30(2):261–70.PubMedCrossRef
15.
Morri M, Forni C, Marchioni M, Bonetti E, Marseglia F, Cotti A. Which factors are independent predictors of early recovery of mobility in the older adults’ population after hip fracture? A cohort prognostic study. Arch Orthop Traum Su. 2018;138(1):35–41.CrossRef
16.
Letournel E. Acetabulum fractures: classification and management. Orthopedic Trauma Direct. 2007;5(05):27–33.CrossRef
17.
Nambiar M, West LR, Bingham R. AO Surgery Reference: a comprehensive guide for management of fractures. Br J Sports Med. 2017;51(6):545–6.CrossRef
18.
Wenzel L, Sandriesser S, Glowalla C, Gueorguiev B, Perl M, Stuby FM, et al. Biomechanical comparison of acetabular fracture fixation with stand-alone THA or in combination with plating. Eur J Trauma Emerg S. 2022:1–8.
19.
Morosato F, Traina F, Cristofolini L. Standardization of hemipelvis alignment for in vitro biomechanical testing. J Orthop Res®. 2018;36(6):1645–52.
20.
Bergmann G, Deuretzbacher G, Heller M, Graichen F, Rohlmann A, Strauss J, et al. Hip contact forces and gait patterns from routine activities. J Biomech. 2001;34(7):859–71.PubMedCrossRef
21.
Windolf M, Muths R, Braunstein V, Gueorguiev B, Hänni M, Schwieger K. Quantification of cancellous bone-compaction due to DHS® Blade insertion and influence upon cut-out resistance. Clin Biomech. 2009;24(1):53–8.CrossRef
22.
Gueorguiev B, Ockert B, Schwieger K, Wähnert D, Lawson-Smith M, Windolf M, et al. Angular stability potentially permits fewer locking screws compared with conventional locking in intramedullary nailed distal tibia fractures: a biomechanical study. J Orthop Trauma. 2011;25(6):340–6.PubMedCrossRef
23.
Meys G, Kalmet PH, Sanduleanu S, Van Horn YY, Maas GJ, Poeze M, et al. A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities. J Rehabil Med. 2019;51(4):290–7.PubMedCrossRef
24.
Yoshida H, Faust A, Wilckens J, Kitagawa M, Fetto J, Chao EY-S. Three-dimensional dynamic hip contact area and pressure distribution during activities of daily living. J Biomech. 2006;39(11):1996–2004.PubMedCrossRef
25.
von Rudena C, Augat P. Failure of fracture fixation in osteoporotic bone. Injury-Int J Care Injured. 2016;47:S3–10.CrossRef
26.
Templeton JE, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC. Revision of a cemented acetabular component to a cementless acetabular component—a ten to fourteen-year follow-up study. J Bone Joint Surg-Am Vol. 2001;83A(11):1706–11.CrossRef
27.
Della Valle CJ, Berger RA, Rosenberg AG, Galante JO. Cernentless acetabular reconstruction in revision total hip arthroplasty. Clin Orthop Relat Res. 2004;420:96–100.CrossRef
28.
Gaffey JL, Callaghan JJ, Pedersen DR, Goetz DD, Sullivan PM, Johnston RC. Cementless acetabular fixation at fifteen years—a comparison with the same surgeon’s results following acetabular fixation with cement. J Bone Joint Surg-Am Vol. 2004;86A(2):257–61.CrossRef
29.
Wasielewski RC, Cooperstein LA, Kruger MP, Rubash HE. Acetabular anatomy and the transacetabular fixation of screws in total hip-arthroplasty. J Bone Joint Surg Am Vol. 1990;72A(4):501–8.CrossRef
30.
Meldrum R, Johansen RL. Safe screw placement in acetabular revision surgery. J Arthroplasty. 2001;16(8):953–60.PubMedCrossRef
31.
Wasielewski R, Cooperstein L, Kruger M, Rubash H. Acetabular anatomy and the transacetabular fixation of screws in total. J Bone Joint Surg Am. 1990;72:501–8.PubMedCrossRef
32.
Mendes DG, Menachem A, Lieberson S. Fixation screws of the acetabular component in hip-replacement. Orthopedics. 1992;15(2):215–6.PubMedCrossRef
33.
Galat DD, Petrucci JA, Wasielewski RC. Radiographic evaluation of screw position in revision total hip arthroplasty. Clin Orthopaed Related Res (1976-2007). 2004;419:124–9.CrossRef
34.
Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthopaedics Related Res®. 2005;441:115–24.
35.
Epstein HC, Wiss DA, Cozen L. Posterior fracture dislocation of the hip with fractures of the femoral head. Clin Orthop Relat Res. 1985;201:9–17.CrossRef
36.
Rommens PM. The Kocher-Langenbeck approach for the treatment of acetabular fractures. Eur J Trauma. 2004;30(4):265–73.CrossRef
37.
Guo JJ, Tang N, Yang HL, Qin L, Leung KS. Impact of surgical approach on postoperative heterotopic ossification and avascular necrosis in femoral head fractures: a systematic review. Int Orthop. 2010;34(3):319–22.PubMedCrossRef
38.
Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013;28(9):1634–8.PubMedCrossRef
39.
Anglen JO, Burd TA, Hendricks KJ, Harrison P. The, “Gull Sign”: a harbinger of failure for internal fixation of geriatric acetabular fractures. J Orthop Trauma. 2003;17(9):625–34.PubMedCrossRef
40.
O’Toole RV, Hui E, Chandra A, Nascone JW. How often does open reduction and internal fixation of geriatric acetabular fractures lead to hip arthroplasty? J Orthop Trauma. 2014;28(3):148–53.PubMedCrossRef
41.
Weaver MJ, Smith RM, Lhowe DW, Vrahas MS. Does total hip arthroplasty reduce the risk of secondary surgery following the treatment of displaced acetabular fractures in the elderly compared to open reduction internal fixation? A pilot study. J Orthop Trauma. 2018;32:S40–5.PubMedCrossRef
42.
Daurka J, Pastides P, Lewis A, Rickman M, Bircher M. Acetabular fractures in patients aged> 55 years: a systematic review of the literature. Bone Joint J. 2014;96(2):157–63.PubMedCrossRef
43.
Ottesen T, McLynn R, Galivanche A, Bagi P, Zogg C, Rubin L, et al. Increased complications in geriatric patients with a fracture of the hip whose postoperative weight-bearing is restricted: an analysis of 4918 patients. Bone Joint J. 2018;100(10):1377–84.PubMedCrossRef
44.
Becker CA, Linhart C, Bruder J, Zeckey C, Greiner A, Kußmaul AC, et al. Cementless hip revision cup for the primary fixation of osteoporotic acetabular fractures in geriatric patients. Orthop Traumatol Surg Res. 2021;107(1): 102745.PubMedCrossRef
45.
Pastor T, Nagy L, Fürnstahl P, Roner S, Pastor T, Schweizer A. Three-dimensional planning and patient-specific instrumentation for the fixation of distal radius fractures. Medicina. 2022;58(6):744.PubMedPubMedCentralCrossRef
46.
Heiner AD. Structural properties of fourth-generation composite femurs and tibias. J Biomech. 2008;41(15):3282–4.PubMedCrossRef
47.
Zdero R, Olsen M, Bougherara H, Schemitsch E. Cancellous bone screw purchase: a comparison of synthetic femurs, human femurs, and finite element analysis. Proc Inst Mech Eng [H]. 2008;222(8):1175–83.CrossRef
48.
Gardner MP, Chong A, Pollock AG, Wooley PH. Mechanical evaluation of large-size fourth-generation composite femur and tibia models. Ann Biomed Eng. 2010;38(3):613–20.PubMedCrossRef
49.
Elfar J, Stanbury S, Menorca RMG, Reed JD. Composite bone models in orthopaedic surgery research and education. J Am Acad Orthop Surg. 2014;22(2):111.PubMedPubMedCentral
50.
Yinger K, Scalise J, Olson SA, Bay BK, Finkemeier CG. Biomechanical comparison of posterior pelvic ring fixation. J Orthop Trauma. 2003;17(7):481–7.PubMedCrossRef
51.
Gardner MJ, Kendoff D, Ostermeier S, Citak M, Hüfner T, Krettek C, et al. Sacroiliac joint compression using an anterior pelvic compressor: a mechanical study in synthetic bone. J Orthop Trauma. 2007;21(7):435–41.PubMedCrossRef
52.
Sahin O, Demirors H, Akgun R, Tuncay I. Internal fixation of bilateral sacroiliac dislocation with transiliac locked plate: a biomechanical study on pelvic models. Acta Orthop Traumatol Turc. 2013;47(6):411–6.PubMedCrossRef
53.
Camino Willhuber G, Zderic I, Gras F, Wahl D, Sancineto C, Barla J, et al. Analysis of sacro-iliac joint screw fixation: does quality of reduction and screw orientation influence joint stability? A biomechanical study. Int Orthop. 2016;40(7):1537–43.PubMedCrossRef
54.
Sagi H, Ordway N, DiPasquale T. Biomechanical analysis of fixation for vertically unstable sacroiliac dislocations with iliosacral screws and symphyseal plating. J Orthop Trauma. 2004;18(3):138–43.PubMedCrossRef
55.
Synbone A. Statement artificial vs. human bones, 2007.
56.
van Zwienen CMA, van den Bosch EW, van Dijke GAH, van Vugt AB. Cyclic loading of sacroiliac screws in tile C pelvic fractures. J Trauma-Injury Infect Crit Care. 2005;58(5):1029–34.CrossRef
Metadata
Title
Simulated full weight bearing following posterior column acetabular fracture fixation: a biomechanical comparability study
Authors
Till Berk
Ivan Zderic
Peter Schwarzenberg
Torsten Pastor
Roman Pfeifer
Sascha Halvachizadeh
Geoff Richards
Boyko Gueorguiev
Hans-Christoph Pape
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2023
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-023-03879-2

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