Objective: The purpose of this study was to biomechanically compare cable, trochanteric grip plate, and locking plate techniques in Vancouver type AG fracture model in an in vitro test environment.Methods: Fifteen pieces of fourth-generation synthetic femora were separated into 3 groups of 5 models each. A greater trochanteric fracture model was created after femoral stem implantation. Group 1 was fixated with only cable, Group 2 with trochanteric grip plate, and Group 3 with locking plate. Horizontal stiffness, axial stiffness, and failure loads were compared between the groups.Results: In horizontal compression tests, Group 3 had the highest values, but the only statistically significant difference was between the locking plate group and cable group. Axial distraction test results showed that mean stiffness of Group 1 was 94.6±9.44 N/mm, that of Group 2 was 174.8±28.64 N/mm, and that of Group 3 was 185.6±71.64 N/mm. While locking plate versus cable fixation and grip plate fixation versus cable fixation showed statistically significant differences (p<0.05), comparison of locking plate versus grip plate fixation showed no statistically significant difference (p>0.05). In axial failure load test, Group 3 had the highest results. The only significant difference was between the locking plate and cable groups (p<0.05).Conclusion: In Vancouver type AG fractures stable fixation may be achieved with grip plate fixation and locking plates, with the former ensuring more stable osteosynthesis.
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Hendel D, Yasin M, Garti A, Weisbort M, Beloosesky Y. Fracture of the greater trochanter during hip replacement: a retrospective analysis of 21/372 cases. Acta Orthop Scand 2002;73:295-7.
Pritchett JW. Fracture of the greater trochanter after hip replacement. Clin Orthop Relat Res 2001;390:221-6.
Koyama K, Higuchi F, Kubo M, Okawa T, Inoue A. Re- attachment of the greater trochanter using the Dall-Miles cable grip system in revision hip arthroplasty. J Orthop Sci 2001;6:22-7.
Barrack RL, Butler RA. Current status of trochanteric re- attachment in complex total hip arthroplasty. Clin Orthop Relat Res 2005;441:237-42.
Bergmann G, Graichen F, Rohlmann A. Is staircase walk- ing a risk for the fixation of hip implants? J Biomech 1995;28:535-53.
Dall DM, Miles AW. Re-attachment of the greater tro- chanter. The use of the trochanter cable-grip system. J Bone Joint Surg Br 1983;65:55-9.
Bergmann G, Deuretzbacher G, Heller M, Graichen F, Rohlmann A, Strauss J, et al. Hip contact forces and gait patterns from routine activities. J Biomech 2001;34:859- 71.
Harris WH, Crothers OD. Reattachment of the greater trochanter in total hip-replacement arthroplasty. A new technique. J Bone Joint Surg Am 1978;60:211-3.
Jensen NF, Harris WH. A system for trochanteric oste- otomy and reattachment for total hip arthroplasty with a ninety-nine percent union rate. Clin Orthop Relat Res 1986;208:174-81.
Nercessian OA, Newton PM, Joshi RP, Sheikh B, Eft- ekhar NS. Trochanteric osteotomy and wire fixation: a comparison of 2 techniques. Clin Orthop Relat Res 1996;333:208-16.
Hamadouche M, Zniber B, Dumaine V, Kerboull M, Cour- pied JP. Reattachment of the ununited greater trochanter following total hip arthroplasty. The use of a trochanteric claw plate. J Bone Joint Surg Am 2003;85-A:1330-7.
Hodgkinson JP, Shelley P, Wroblewski BM. Re-attach- ment of the un-united trochanter in Charnley low friction arthroplasty. J Bone Joint Surg Br 1989;71:523-5.
Hersh CK, Williams RP, Trick LW, Lanctot D, Atha- nasiou K. Comparison of the mechanical performance of trochanteric fixation devices. Clin Orthop Relat Res 1996;329:317-25.
Ritter MA, Eizember LE, Keating EM, Faris PM. Tro- chanteric fixation by cable grip in hip replacement. J Bone Joint Surg Br 1991;73:580-1.
Silverton CD, Jacobs JJ, Rosenberg AG, Kull L, Conley A, Galante JO. Complications of a cable grip system. J Arthro- plasty 1996;11:400-4.
McCarthy JC, Bono JV, Turner RH, Kremchek T, Lee J. The outcome of trochanteric reattachment in revision total hip arthroplasty with a Cable Grip System: mean 6-year follow-up. J Arthroplasty 1999;14:810-4.
Cloutier LP, Laflamme GY, Petit Y. Biomechanical analysis of trochanteric fracture fixations using a Y-shaped locking plate. J Orthop Trauma 2013;27:702-7.
Laflamme GY, Leduc S, Petit Y. Reattachment of complex femoral greater trochanteric nonunions with dual locking plates. J Arthroplasty 2012;27:638-42.
Zarin JS, Zurakowski D, Burke DW. Claw plate fixation of the greater trochanter in revision total hip arthroplasty. J Arthroplasty 2009;24:272-80.
Jarit GJ, Sathappan SS, Panchal A, Strauss E, Di Cesare PE. Fixation systems of greater trochanteric osteotomies: biomechanical and clinical outcomes. J Am Acad Orthop Surg 2007;15:614-24.
Baril Y, Bourgeois Y, Brailovski V, Duke K, Laflamme GY, Petit Y. Improving greater trochanteric reattachment with a novel cable plate system. Med Eng Phys 2013;35:383-91.
Fulkerson E, Koval K, Preston CF, Iesaka K, Kummer FJ, Egol KA. Fixation of periprosthetic femoral shaft fractures associated with cemented femoral stems: a biomechanical comparison of locked plating and conventional cable plates. J Orthop Trauma 2006;20:89-93.
Kampshoff J, Stoffel KK, Yates PJ, Erhardt JB, Kuster MS. The treatment of periprosthetic fractures with lock- ing plates: effect of drill and screw type on cement man- tles: a biomechanical analysis. Arch Orthop Trauma Surg 2010;130:627-32.
Sariyilmaz K, Dikici F, Dikmen G, Bozdag E, Sunbuloglu E, Bekler B, et al. The effect of strut allograft and its posi- tion on Vancouver type B1 periprosthetic femoral fractures: a biomechanical study. J Arthroplasty 2014;29:1485-90.