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Nonvascularized fibular graft with locking screw fixation for metaphyseal bone loss of distal femur: biomechanical assessment validated by a clinical case series

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

The optimal modality to surgically treat significant bone loss of distal femur remains inconclusive. The objectives of the present study were to assess the mechanical performance of nonvascularized fibular graft (NVFG) with locking screw fixation in distal femur fixation construct by finite element analysis and to retrospectively describe the outcomes of the present technique in clinical cases.

Methods

Four constructs which the fractured femur was stabilized by LCP-DF alone, dual plating, LCP-DF combined with NVFG, and LCP-DF combined with NVFG (LCP-DF-NVFG-S) with locking screw were assessed the biomechanical performance under physiological loads. For the clinical case series, 12 patients with open intercondylar fracture with metaphyseal bone loss of distal femur were operated by LCP-DF-NVFG-S. The collected data included fracture consolidation, length of NVFG, perioperative complications and objective clinical results.

Results

LCP-DF-NVFG-S demonstrated lower implant equivalent von Mises stress (EQV) stress and better fracture stability than other constructs. A locking screw presented its essence in maintaining the NVFG in the required position and subsequently enhancing the fracture stability. In regard to the clinical series, all fractures were consolidated with an average duration of 27.8 weeks (range 20–32). An average NVFG length was 7.8 cm (range 6–12). No perioperative complication was demonstrated. By the Knee Society score, 1 was considered to be excellent, 9 to be good and 2 to be poor.

Conclusion

Based on the results of mechanical assessment and case series, LCP-DF-NVFG-S can be an effective technique in the management of metaphyseal bone loss of distal femur.

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Data availability

The datasets generated during the current study are available from the corresponding author on reasonable request.

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Funding

There was no source of funding for this research.

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Authors and Affiliations

  1. Department of Orthopedics, Buddhachinaraj Hospital, Phitsanulok, Thailand

    Surasak Jitprapaikulsarn, Arthit Gromprasit, Kritsada Sukha & Ployphailin Rungsakaolert

  2. Department of Mechanical Engineering, Faculty of Engineering at Sriracha, Kasetsart University, Sriracha, Chonburi, Thailand

    Nattapon Chantarapanich

  3. Golden Jubilee Medical Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Chantas Mahaisavariya

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  1. Surasak Jitprapaikulsarn
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Contributions

SJ and NC were involved in drafting and revising the manuscript for content, including the medical writing for the content, the study concept and design, the analysis and interpretation of the data, and the acquisition of the data. AG, CM, KS and PR were involved in revising the manuscript for content and the analysis and interpretation of the data.

Corresponding author

Correspondence to Nattapon Chantarapanich.

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Conflicts of interest

S. Jitprapaikulsarn, N. Chantarapanich, A. Gromprasit, C. Mahaisavariya, K. Sukha and P. Rungsakaolert declare that they have no conflict of interest.

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This study has been approved by the ethical committees of Buddhachinaraj Hospital in accordance with the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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Jitprapaikulsarn, S., Chantarapanich, N., Gromprasit, A. et al. Nonvascularized fibular graft with locking screw fixation for metaphyseal bone loss of distal femur: biomechanical assessment validated by a clinical case series. Eur J Orthop Surg Traumatol 34, 659–671 (2024). https://doi.org/10.1007/s00590-023-03710-y

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