Biomechanical analysis of impending femoral neck fractures: the role of percutaneous cement augmentation for osteolytic lesions.
Clin Biomech (Bristol, Avon)
; 29(3): 289-95, 2014 Mar.
Article
em En
| MEDLINE
| ID: mdl-24461558
ABSTRACT
BACKGROUND:
Management of impending pathologic femoral neck fractures includes internal fixation, arthroplasty and megaprostheses. The study aim was to determine the augmentative effect of cement injection for minimally invasive treatment of femoral neck lesions.METHODS:
Twenty-seven cadaveric femora received a simulated osteolytic lesion previously shown to decrease the femur's failure load by 50%. Specimens were allocated to three groups of nine and loaded to failure in simulated single-leg stance (1) percutaneous cementation + internal fixation (PCIF); (2) percutaneous cementation (PC); and (3) internal fixation (IF). Lesion-only and augmented finite element models were virtually loaded and stresses were queried adjacent to the lesion.FINDINGS:
PCIF resulted in the largest failure load though the increase was not significantly greater than the PC or IF groups. Inspection of the PC and PCIF specimens indicated that the generation of a cement column that spanned the superior and inferior cortices of the femoral neck increased failure loads significantly. Finite element analysis indicated that IF and PCIF constructs decreased the stress adjacent to the lesion to intact femur levels. Cementation without superior-to-inferior femoral neck cortical contact did not restore proximal femoral stress toward the intact condition.INTERPRETATION:
Internal fixation alone and internal fixation with or without cementation produce similar levels of mechanical augmentation in femora containing a high-risk lesion of impending fracture. A cement injection technique that produces a cement column contacting the superior and inferior femoral neck cortices confers the highest degree of biomechanical stability, should percutaneous cementation alone be performed.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Cimentos Ósseos
/
Cimentação
/
Fraturas do Colo Femoral
/
Fixação Interna de Fraturas
Tipo de estudo:
Prognostic_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2014
Tipo de documento:
Article