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BMC Musculoskeletal Disorders

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Open Access 01-12-2022 | Femoral Fracture | Research article

Fixation of intraoperative proximal femoral fractures during THA using two versus three cerclage wires - a biomechanical study

Authors: Toni Wendler, Melanie Edel, Robert Möbius, Johannes Fakler, Georg Osterhoff, Dirk Zajonz

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Abstract

Background

Intraoperative proximal femoral fractures (IPFF) are relevant complications during total hip arthroplasty. Fixation using cerclage wires (CW) represents a minimally-invasive technique to address these fractures through the same surgical approach. The goal of treatment is to mobilise the patient as early as possible, which requires high primary stability. This study aimed to compare different cerclage wire configurations fixing IPFF with regard to biomechanical primary stability.

Methods

Standardised IPFF (type II, Modified Mallory Classification) were created in human fresh frozen femora and were fixed either by two or three CW (1.6 mm, stainless steel). All cadaveric specimens (n = 42) were randomised to different groups (quasi-static, dynamic) or subgroups (2 CW, 3 CW) stratified by bone mineral density determined by Dual Energy X-ray Absorptiometry. Using a biomechanical testing setup, quasi-static and dynamic cyclic failure tests were carried out. Cyclic loading started from 200 N to 500 N at 1 Hz with increasing peak load by 250 N every 100 cycles until failure occurred or maximum load (5250 N) reached. The change of fracture gap size was optically captured.

Results

No significant differences in failure load after quasi-static (p = 0.701) or dynamic cyclic loading (p = 0.132) were found between the experimental groups. In the quasi-static load testing, all constructs resisted 250% of the body weight (BW) of their corresponding body donor. In the dynamic cyclic load testing, all but one construct (treated by 3 CW) resisted 250% BW.

Conclusions

Based on this in vitro data, both two and three CW provided sufficient primary stability according to the predefined minimum failure load (250% BW) to resist. The authors recommend the treatment using two CW because it reduces the risk of vascular injury and shortens procedure time.

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Title: Fixation of intraoperative proximal femoral fractures during THA using two versus three cerclage wires - a biomechanical study
Authors: Toni Wendler
Melanie Edel
Robert Möbius
Johannes Fakler
Georg Osterhoff
Dirk Zajonz
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Femoral Fracture
Hip-TEP
Hip-TEP
Published in: BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-021-04956-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Fixation of intraoperative proximal femoral fractures during THA using two versus three cerclage wires - a biomechanical study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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