Frederick J. Kummer

A biomechanical cadaver study was performed to compare the stability of three standard distal femoral fixation techniques. Eighteen mildly osteoporotic femurs were selected, based on a dual-energy x-ray absorption scanning bone density of 0.3-0.5 g/cm2 and a Singh index of III-IV. After initial mechanical characterization of these intact femurs, a distal femoral osteotomy was created, reduced, and stabilized under compression using random assignment to one of three methods of fixation: (a) six-hole 95 degrees supracondylar plate, (b) retrograde inserted statically locked supracondylar intramedullary nail, and (c) antegrade inserted statically locked Russell-Taylor nail. The instrumented femurs were mechanically tested, a 1-cm gap created, and the femurs retested. The specimens were finally loaded to failure in A-P three-point bending. The 95 degrees plate provided significantly stiffer fixation than the supracondylar intramedullary nail or Russell-Taylor nail in both a compressed transverse and gap distal femoral osteotomy model. The Russell-Taylor nail provided the least rigid fixation. The 95 degrees plate and Russell-Taylor nail had statistically significant greater loads to failure than the supracondylar intramedullary nail. These results support the use of a 95 degrees plate when maximum rigidity of fixation or maximum compression is desired.

Cyclic loading of Ti-6-4 and Co-Cr-Mo (cast) test samples with grit-blasted or waffle-textured surfaces coated with a plasma-sprayed 50-mum HA layer was performed in air, Ringer's solution (5% dextrose), 0.9% NaCl (Tris buffer, pH 7.40), and balanced Hank's solution. Maximum interfacial stresses in bending of 40 ksi (280 MPa) and 20 ksi (140 MPa) were utilized, and the specimens tested to 10 6 cycles at 5 Hz with a MTS servohydraulic machine. Tested samples were examined by optical microscopy to determine coating integrity and thickness and by scanning electron microscopy (electron backscatter mode and EDAX) to determine surface morphology and chemical changes. The following observations were made: (1) Samples cyclically tested in solutions showed a general thinning of the coating, accentuated in the higher-stressed regions. (2) Samples tested with an equivalent static load in the solutions did not show this centralization. (3) Bare metal interface surfaces were noted on most of the edges of highly stressed central specimen regions, in several entire central regions, and on the upper surfaces of some of the waffled samples. (4) The specimens tested in Ringer's solution (pH 4.70 initially) demonstrated the most dramatic coating deterioration. (5) The coatings on titanium appeared more stable than these on Co-Cr as tested in all solution environments for both surface types. The HA coating evaluated in this experiment demonstrated increased instability when cyclically loaded in in vitro solutions of lowered pH and depleted cations (Ca 2+) at stress levels of 280 MPa.(ABSTRACT TRUNCATED AT 250 WORDS)