{"title":"Cementless long-stem fixation in periprosthetic clamshell fracture: a biomechanical investigation.","authors":"Lingqi Zhu, Li Xie, Mingchang He, Jianyun Miao, Liang Zhou, Lianshui Huang, Hui Liu, Wei Xie, Wenliang Zhai","doi":"10.3389/fbioe.2025.1604441","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To investigate the biomechanical strength of cementless long-stem fixation for the treatment of periprosthetic clamshell fracture.</p><p><strong>Methods: </strong>Eighteen Sawbones artificial femur models were used and divided into three groups. Group A had an intact medial wall. Group B, the proximal periprosthetic femoral medial wall was osteotomized to simulate periprosthetic clamshell fractures. Group C, following identical osteotomy to Group B, cerclage wiring was applied to fix the medial wall fracture fragment. After molding, the cementless long-stem were implanted in all models, which were then evaluated through axial compression tests, torsion tests, and axial failure tests. The axial stiffness, axial displacement, torsional stiffness, torque, and maximum failure load were recorded and statistically analyzed.</p><p><strong>Results: </strong>In the axial compression tests, no statistically significant differences were observed among Groups A, B, and C in terms of axial displacement, axial stiffness, or maximum failure load (the displacement greater than 3 mm). However, in the torsional tests, Group B showed significantly lower torsional stiffness or torque compared to Groups A and C (<i>p</i> < 0.05). No significant differences in torsional stiffness or torque were detected between Groups A and C.</p><p><strong>Conclusion: </strong>The integrity of the femoral medial wall is crucial for femoral stem stability. In case of medial wall fracture, while cementless long-stem implantation can achieve satisfactory axial stability, its torsional stability remains inadequate. The application of supplemental cerclage wiring for medial wall fragment fixation provides reliable improvement in torsional stability of the stem.</p>","PeriodicalId":12444,"journal":{"name":"Frontiers in Bioengineering and Biotechnology","volume":"13 ","pages":"1604441"},"PeriodicalIF":4.3000,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137322/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Bioengineering and Biotechnology","FirstCategoryId":"5","ListUrlMain":"https://doi.org/10.3389/fbioe.2025.1604441","RegionNum":3,"RegionCategory":"工程技术","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"BIOTECHNOLOGY & APPLIED MICROBIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To investigate the biomechanical strength of cementless long-stem fixation for the treatment of periprosthetic clamshell fracture.
Methods: Eighteen Sawbones artificial femur models were used and divided into three groups. Group A had an intact medial wall. Group B, the proximal periprosthetic femoral medial wall was osteotomized to simulate periprosthetic clamshell fractures. Group C, following identical osteotomy to Group B, cerclage wiring was applied to fix the medial wall fracture fragment. After molding, the cementless long-stem were implanted in all models, which were then evaluated through axial compression tests, torsion tests, and axial failure tests. The axial stiffness, axial displacement, torsional stiffness, torque, and maximum failure load were recorded and statistically analyzed.
Results: In the axial compression tests, no statistically significant differences were observed among Groups A, B, and C in terms of axial displacement, axial stiffness, or maximum failure load (the displacement greater than 3 mm). However, in the torsional tests, Group B showed significantly lower torsional stiffness or torque compared to Groups A and C (p < 0.05). No significant differences in torsional stiffness or torque were detected between Groups A and C.
Conclusion: The integrity of the femoral medial wall is crucial for femoral stem stability. In case of medial wall fracture, while cementless long-stem implantation can achieve satisfactory axial stability, its torsional stability remains inadequate. The application of supplemental cerclage wiring for medial wall fragment fixation provides reliable improvement in torsional stability of the stem.
期刊介绍:
The translation of new discoveries in medicine to clinical routine has never been easy. During the second half of the last century, thanks to the progress in chemistry, biochemistry and pharmacology, we have seen the development and the application of a large number of drugs and devices aimed at the treatment of symptoms, blocking unwanted pathways and, in the case of infectious diseases, fighting the micro-organisms responsible. However, we are facing, today, a dramatic change in the therapeutic approach to pathologies and diseases. Indeed, the challenge of the present and the next decade is to fully restore the physiological status of the diseased organism and to completely regenerate tissue and organs when they are so seriously affected that treatments cannot be limited to the repression of symptoms or to the repair of damage. This is being made possible thanks to the major developments made in basic cell and molecular biology, including stem cell science, growth factor delivery, gene isolation and transfection, the advances in bioengineering and nanotechnology, including development of new biomaterials, biofabrication technologies and use of bioreactors, and the big improvements in diagnostic tools and imaging of cells, tissues and organs.
In today`s world, an enhancement of communication between multidisciplinary experts, together with the promotion of joint projects and close collaborations among scientists, engineers, industry people, regulatory agencies and physicians are absolute requirements for the success of any attempt to develop and clinically apply a new biological therapy or an innovative device involving the collective use of biomaterials, cells and/or bioactive molecules. “Frontiers in Bioengineering and Biotechnology” aspires to be a forum for all people involved in the process by bridging the gap too often existing between a discovery in the basic sciences and its clinical application.