[Translated article] Comparative clinical and biomechanical study of different types of osteosynthesis in the treatment of distal femur fractures

• Published in: Revista española de cirugía ortopédica y traumatología Vol. 67; no. 3; pp. T216 - 225
• Main Authors: Redondo-Trasobares, B, Sarasa-Roca, M, Rosell-Pradas, J, Calvo-Tapies, J, Gracia-Villa, L, Albareda-Albareda, J
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01.05.2023
• Subjects: Finite elements; Biomechanic; Osteosíntesis; Fractura fémur distal; Elementos finitos; Osteosynthesis; Biomecánica; Intramdullary nail; Plate; Enclavado intramedular; Nail; Clavo; Placa de estabilidad angular; Placa; Angular stable plate; Distal femur fractures
• ISSN: 1988-8856
• DOI: 10.1016/j.recot.2023.01.003

Distal femoral fractures represent a problem due to their high number of complications. The aim was to compare the results, complications and stability achieved with retrograde intramedullary nailing and the angular stable plate in the treatment of distal femoral diaphyseal fractures. A clinical and experimental biomechanical study was carried out using finite elements. The results of the simulations allowed us to obtain the main results related to the stability of osteosynthesis. For clinical follow-up data, frequencies were used for qualitative variables, and Fisher's exact test and χ test were used to evaluate the significance of the different factors, with the condition of P<.05. In the biomechanical study, the retrograde intramedullar nails demonstrated superiority, obtaining lower values in terms of global displacement, maximum tension, torsion resistance, and bending resistance. In the clinical study, the rate of consolidation of the plates was lower than nails (77% vs. 96%, P=.02). The factor that most influenced the healing of fractures treated with plate were the central cortical thickness (P=.019). The factor that most influenced the healing of nail-treated fractures was the difference between the diameter of the medullary canal and the nail. Our biomechanical study shows that both osteosynthesis provide sufficient stability, but biomechanically behaves differently. Nails provide greater overall stability being preferable the use of long nails adjusted to the diameter of the canal. Plates form less rigid osteosynthesis, with little resistance to bending.