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Steinmann pin augmentation versus locking plate constructs

BACKGROUND: Aggressive bone neoplasms, such as giant cell tumors, often affect the proximal tibia warranting bony resection via curettage leaving behind massive defects that require extensive reconstruction. Reconstruction is usually accomplished with poly(methyl methacrylate) (PMMA) packing supplem...

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Autores principales: Ruskin, Jeremy, Caravaggi, Paolo, Beebe, Kathleen S., Corgan, Sondra, Chen, Linda, Yoon, Richard S., Patterson, Francis R., Hwang, John S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4999372/
https://www.ncbi.nlm.nih.gov/pubmed/26883439
http://dx.doi.org/10.1007/s10195-016-0394-y
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author Ruskin, Jeremy
Caravaggi, Paolo
Beebe, Kathleen S.
Corgan, Sondra
Chen, Linda
Yoon, Richard S.
Patterson, Francis R.
Hwang, John S.
author_facet Ruskin, Jeremy
Caravaggi, Paolo
Beebe, Kathleen S.
Corgan, Sondra
Chen, Linda
Yoon, Richard S.
Patterson, Francis R.
Hwang, John S.
author_sort Ruskin, Jeremy
collection PubMed
description BACKGROUND: Aggressive bone neoplasms, such as giant cell tumors, often affect the proximal tibia warranting bony resection via curettage leaving behind massive defects that require extensive reconstruction. Reconstruction is usually accomplished with poly(methyl methacrylate) (PMMA) packing supplemented with an internal fixation construct. The purpose of this study is to compare Steinmann pin augmentation to locking plate constructs to determine which offers the stiffer reconstruction option. MATERIALS AND METHODS: Large defects were created below the lateral condyle of fresh frozen tibias. The defects extended for an average of 35 mm beneath the lateral plateau in the frontal plane, and from the anterior to posterior cortex in the sagittal plane. Distally the defect extended for an average of 35 mm to the metadiaphyseal junction. In the Pin group, the tibias were reconstructed with three 4-mm diameter Steinmann pins placed in the medullary canal and PMMA packing. In the Plate group, the tibias were reconstructed with a 6-hole 3.5-mm LCP Proximal locking plate fixed to the proximal−lateral tibia utilizing seven 3.5-mm screws and PMMA packing. The tibias were tested for stiffness on a MTS machine by applying up to 400 N to the tibial plateau in force control at 5 N/s. Fatigue properties were tested by applying a haversine loading waveform between 200 N and 1,200 N at 3 Hz simulating walking upstairs/downstairs. RESULTS: Locking plate constructs (801.8 ± 78 N/mm) had greater (p = 0.041) stiffness than tibial constructs fixed with Steinmann pins (646.5 ± 206.3 N/mm). CONCLUSIONS: Permanent deformation was similar between the Pin and Plate group; however, two tibia from the Pin group exhibited displacements >5 mm which we considered failure. LEVEL OF EVIDENCE: n/a.
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spelling pubmed-49993722016-09-12 Steinmann pin augmentation versus locking plate constructs Ruskin, Jeremy Caravaggi, Paolo Beebe, Kathleen S. Corgan, Sondra Chen, Linda Yoon, Richard S. Patterson, Francis R. Hwang, John S. J Orthop Traumatol Original Article BACKGROUND: Aggressive bone neoplasms, such as giant cell tumors, often affect the proximal tibia warranting bony resection via curettage leaving behind massive defects that require extensive reconstruction. Reconstruction is usually accomplished with poly(methyl methacrylate) (PMMA) packing supplemented with an internal fixation construct. The purpose of this study is to compare Steinmann pin augmentation to locking plate constructs to determine which offers the stiffer reconstruction option. MATERIALS AND METHODS: Large defects were created below the lateral condyle of fresh frozen tibias. The defects extended for an average of 35 mm beneath the lateral plateau in the frontal plane, and from the anterior to posterior cortex in the sagittal plane. Distally the defect extended for an average of 35 mm to the metadiaphyseal junction. In the Pin group, the tibias were reconstructed with three 4-mm diameter Steinmann pins placed in the medullary canal and PMMA packing. In the Plate group, the tibias were reconstructed with a 6-hole 3.5-mm LCP Proximal locking plate fixed to the proximal−lateral tibia utilizing seven 3.5-mm screws and PMMA packing. The tibias were tested for stiffness on a MTS machine by applying up to 400 N to the tibial plateau in force control at 5 N/s. Fatigue properties were tested by applying a haversine loading waveform between 200 N and 1,200 N at 3 Hz simulating walking upstairs/downstairs. RESULTS: Locking plate constructs (801.8 ± 78 N/mm) had greater (p = 0.041) stiffness than tibial constructs fixed with Steinmann pins (646.5 ± 206.3 N/mm). CONCLUSIONS: Permanent deformation was similar between the Pin and Plate group; however, two tibia from the Pin group exhibited displacements >5 mm which we considered failure. LEVEL OF EVIDENCE: n/a. Springer International Publishing 2016-02-16 2016-09 /pmc/articles/PMC4999372/ /pubmed/26883439 http://dx.doi.org/10.1007/s10195-016-0394-y Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Ruskin, Jeremy
Caravaggi, Paolo
Beebe, Kathleen S.
Corgan, Sondra
Chen, Linda
Yoon, Richard S.
Patterson, Francis R.
Hwang, John S.
Steinmann pin augmentation versus locking plate constructs
title Steinmann pin augmentation versus locking plate constructs
title_full Steinmann pin augmentation versus locking plate constructs
title_fullStr Steinmann pin augmentation versus locking plate constructs
title_full_unstemmed Steinmann pin augmentation versus locking plate constructs
title_short Steinmann pin augmentation versus locking plate constructs
title_sort steinmann pin augmentation versus locking plate constructs
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4999372/
https://www.ncbi.nlm.nih.gov/pubmed/26883439
http://dx.doi.org/10.1007/s10195-016-0394-y
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