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The treatment of periprosthetic fractures with locking plates: effect of drill and screw type on cement mantles: a biomechanical analysis

Jorg Kampshoff, Karl K Stoffel, Piers J Yates, Johannes Erhardt & Markus Kuster

abstract INTRODUCTION: Periprosthetic fractures after cemented hip replacement are a challenging problem to manage. Biomechanical studies have suggested the benefit of using locking screws for plate fixation, but there are concerns whether screws damage the cement mantle and promote crack propagation leading to construct failure. METHOD: In this biomechanical study, different screw types were implanted into the cement mantle after pre-drilling holes of different sizes, in unicortical and bicortical configuration. The presence of cracks and the pull-out resistance of these screws were then evaluated. RESULTS: No unicortical screw induced cracks. Screws with a shortened tip, smaller flutes and double threads were significantly better for pull-out resistance. Bicortical screws were associated with a risk of local cement mantle damage, but also with a significantly greater holding power. By increasing the drill diameter, the onset of cracks decreased, but so does the pull-out resistance.
   
citation Kampshoff J, Stoffel K K, Yates P J, erhardt j, kuster m. The treatment of periprosthetic fractures with locking plates: effect of drill and screw type on cement mantles: a biomechanical analysis. Archives of orthopaedic and trauma surgery 2009;.
   
type journal paper/review (English)
date of publishing 14-8-2009
journal title Archives of orthopaedic and trauma surgery
ISSN electronic 1434-3916
PubMed 19685062
DOI 10.1007/s00402-009-0952-3