Cerclage, evolution and potential of a Cinderella Technology : an overview with reference to periprosthetic fractures

Periprosthetic fractures are increasingly frequent. The fracture may be located over the shaft of the prosthesis, at its tip or below (21). The treatment of explosion fractures is difficult because the shaft blocks the application of implants, like screws, which need to penetrate the medullary cavity. The cerclage, as a simple periosteal loop, made of wire or more recently cable, does not only avoid the medullary cavity. Its centripetal mode of action is well suited for reducing and maintaining radially displaced fractures. Furthermore, the cerclage lends itself well for minimally invasive internal fixation. New insight challenges the disrepute of which the cerclage technology suffered for decades. The outcome of cerclage fixation benefits from an improved understanding of its technology, mechano-biology and periosteal blood supply. Preconceived and generally accepted opinions like "strangulation of blood supply" need to be re-examined. Recent mechanical evaluations (22) demonstrate that the wire application may be improved but cable is superior in hand- ling, maintenance of tension and strength. Beside the classical concepts of absolute and relative stability a defined stability condition needs consideration. It is typical for cerclage. Called "loose-lock stability" it specifies the situation where a loosened implant allows first unimpeded displacement changing abruptly into a locked fixation preventing further dislocation.

Cement-in-cement revision for selected Vancouver Type B1 femoral periprosthetic fractures : A biomechanical analysis

The aim of this study was to perform a biomechanical analysis of the cement-in-cement (c-in-c) technique for fixation of selected Vancouver Type B1 femoral periprosthetic fractures and to assess the degree of cement interposition at the fracture site. Six embalmed cadaveric femora were implanted with a cemented femoral stem. Vancouver Type B1 fractures were created by applying a combined axial and rotational load to failure. The femora were repaired using the c-in-c technique and reloaded to failure. The mean primary fracture torque was 117 Nm (SD 16.6, range 89–133). The mean revision fracture torque was 50 Nm (SD 16.6, range 29–74), which is above the torque previously observed for activities of daily living. Cement interposition at the fracture site was found to be minimal.

Can larger cemented femoral components reduce periprosthetic fractures?

Introduction The risk for late periprosthetic fractures is higher in patients treated for a neck of femur fracture compared to those treated for osteoarthritis. It has been hypothesised that osteopenia and consequent decreased stiffness of the proximal femur are responsible for this. We investigated if a femoral component with a bigger body would increase the torque to failure in a biaxially loaded composite sawbone model. Method A biomechanical composite sawbone model was used. Two different body sizes (Exeter 44-1 vs 44-4) of a polished tapered cemented stem were implanted by an experienced surgeon, in 7 sawbones each and loaded at 40 deg/s internal rotation until failure. Torque to fracture and fracture energy were measured using a biaxial materials testing device (Instron 8874). Data are non-parametric and tested with Mann-Whitney U-test. Results The mean torque load to fracture was 154.1 NM (SD 4.4) for the 44-1 stem and 229 NM (SD10.9) for the 44-4 stem (p = 0.01). The mean fracture energy was 9.6 J (SD1.2) for the 44-1 stem and 17.2 J (SD2.0) for the 44-4 stem (p = 0.14). Conclusion the use of a large body polished tapered cemented stem for neck of femur fractures increases the torque to failure in a biomechanical model and therefore is likely to reduce late periprosthetic fracture risk in this vulnerable cohort.

Can larger-bodied cemented femoral components reduce periprosthetic fractures? A biomechanical study

Introduction: The risk for late periprosthetic femoral fractures is higher in patients treated for a neck of femur fracture compared to osteoarthritis. It has been hypothesised that osteopenia and consequent decreased stiffness of the proximal femur are responsible for this. We investigated whether a femoral component with a bigger body would increase the torque to failure in a biaxially loaded composite Sawbone model. Material and methods: A biomechanical bone analogue was used. Two different body sizes (Exeter 44-1 vs 44-4) of a polished tapered cemented femoral stem were implanted by an experienced surgeon in 7 bone analogues each and internally rotated at 40°/s until failure. Torque to fracture and fracture energy were measured using a biaxial materials testing device (Instron 8874, MI, USA). The data were non-parametric and therefore tested with the Mann-Whitney U-test. Results: The median torque to fracture was 156.7 Nm (IQR 19.7) for the 44-1 stem and 237.1 Nm (IQR 52.9) for the 44-4 stem (p=0.001). The median fracture energy was 8.5J (IQR 7.3) for the 44-1 stem and 19.5J (IQR 8.8) for the 44-4 stem (p=0.014). Conclusions: The use of a large body polished tapered cemented stems for neck of femur fractures increases the torque to failure in a biomechanical model and therefore is likely to reduce late periprosthetic fracture risk in this vulnerable cohort.

Fractures périprothétiques [Periprosthetic fractures]

A periprosthetic fracture is a fracture around or in proximity of a prosthetic implant. As more and more prostheses are implanted, the incidence of periprosthetic fractures also increases. Several risk factors have been outlined, some due to the patient, and some due to the implant itself. Key points in diagnosis are the case history and the imaging, as they allow the distinction between a well-fixed and a loose prosthesis. Correct classification is crucial for the treatment choice, which can be non-operative or consist in an osteosynthesis or in a revision arthroplasty, depending on the patient's general medical condition and the local status.

Combustibility of electrical wire and cable for rail rapid transit systems.

Mode of access: Internet.

Underneath the cerclage: an ex vivo study on the cerclage-bone interface mechanics

Cerclages regain interest due to a rising number of periprosthetic fractures. The contact distribution at the circumferential cerclage-bone interface is still unknown. Local interface pressure depends on the amount of contact area. Cortical damage at the interface would provoke cerclage loosening. Therefore, the contact area, the bone pressure along the interface and the cortical resistance underneath loaded cerclages were determined in an ex vivo model.

Studies on polymer blends with special reference to NBR/PVC and CR/PVC blends

The study is undertaken on PVC blends because of their all-round importance-One of the most prominent needs of PVC in application end-use is permanent plasticizationlo. Butadiene-acrylonitrile rubber (NBR) has been utilized as permanent plasticizer for PVC since the 1940s for wire and cable insulation, food contact, and pondliners used for oil containment23'24. Also plasticized PVC has been added to vulcanizable nitrile rubber, to yield improved ozone, thermal ageing, and chemical resistance resulting in applications including fuel hose covers, gaskets, conveyor belt covers, and printing roll covers. This blend is miscible in the range of 23 to 45 per cent acrylonitrile content in the butadiene-acrylqnitrile copolymerzs. The first phase of the study was directed towards modification blends. These blends, in addition to the polymers, require a host of additives like curatives for the NBR phase and stabilizers for the PVC phase26of the existing PVC blends, especially NBR/PVC. The second phase of the study was directed towards the development of novel PVC based blends. Chloroprene rubber (polychloroprene) (CR) is structurally similar to PVC and hence is likely to form successful blends with PVC32.

Análise da influência dos solutos Zr e Ti sobre as propriedades mecânica, elétrica e de termorresistência de uma liga Al-Cu-Fe-Si destinada a Tx e a Dx de energia elétrica

O contexto energético mundial apresenta um aumento constante do consumo de energia elétrica no último século, desta forma exigindo a pesquisa de novos materiais para a aplicação em cabos e fios condutores de eletricidade. A partir destas demandas por novos materiais, desenvolveu-se uma análise da influência dos solutos zircônio e titânio na modificação de características importantes de uma liga Al-Cu-Fe-Si, destinada a ser o meio condutor de energia elétrica, almejando obter propriedades termorresistentes. Para a realização deste estudo, as ligas foram obtidas por fundição direta em lingoteira metálica em formato “U”, a partir do Al-EC, fixando-se na liga-base os teores de 0,05% Cu, [0,24 a 0,28]% Fe e 0,7% de Si, e em seguida, inserindo-se os teores de 0,26% Zr e 0,26% Ti. O experimento foi dividido em duas etapas, ETAPA A e ETAPA B, respectivamente, com o intuito de se avaliar as características mecânicas, elétricas e estruturais das ligas. Os corpos de prova após laminação a frio (nos diâmetros 2,7; 3,0; 3,8 e 4,0 mm) foram analisados sem tratamento térmico (STT) e com tratamento térmico (CTT): 230 ºC por uma hora, de acordo com o protocolo COPEL, 310 ºC e 390 ºC por uma hora, visando avaliar a ermorresistência em temperaturas mais elevadas, a estabilidade térmica e analisar as microestruturas desenvolvidas em tais tratamentos térmicos (TT). Verificou-se que o Ti tem maior capacidade de refinar o grão em relação ao Zr, que apresenta grãos menos refinados, porém com melhores propriedades físicas e apresentando-se termorresistente.

Extracortical plate fixation with new plate inserts and cerclage wires for the treatment of periprosthetic hip fractures

PURPOSE Fixation of periprosthetic hip fractures with intracortical anchorage might not be feasible in cases with bulky implants and/or poor bone stock. METHODS Rotational stability of new plate inserts with extracortical anchorage for cerclage fixation was measured and compared to the stability found using a standard technique in a biomechanical setup using a torsion testing machine. In a synthetic PUR bone model, transverse fractures were fixed distally using screws and proximally by wire cerclages attached to the plates using "new" (extracortical anchorage) or "standard" (intracortical anchorage) plate inserts. Time to fracture consolidation and complications were assessed in a consecutive series of 18 patients (18 female; mean age 81 years, range 55-92) with periprosthetic hip fractures (ten type B1, eight type C-Vancouver) treated with the new device between July 2003 and July 2010. RESULTS The "new" device showed a higher rotational stability than the "standard" technique (p < 0.001). Fractures showed radiographic consolidation after 14 ± 5 weeks (mean ± SD) postoperatively in patients. Revision surgery was necessary in four patients, unrelated to the new technique. CONCLUSION In periprosthetic hip fractures in which fixation with intracortical anchorage using conventional means might be difficult due to bulky revision stems and/or poor bone stock, the new device may be an addition to the range of existing implants.