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Biomechanical consequences of secondary congruence after both-column acetabular fracture
Richard G Levine1, Regis Renard, Fred F Behrens
1Department of Orthopaedics, Union Memorial Hospital, Baltimore, Maryland 21218-2895, USA.
Objectives:
To create a both-column acetabular fracture model with secondary congruence and to determine the intraarticular loading characteristics present in simulated single-leg stance.
Hypothesis:
The normal contact pressures on the weight-bearing portion of the acetabulum in simulated single-leg stance are different from those present in a both-column fracture model exhibiting secondary congruence.
Design:
Cadaveric Biomechanical model.
Setting:
Biomechanical testing laboratory.
Specimens:
Nine fresh frozen cadaveric hemipelves.
Intervention:
Both-column fracture model with secondary congruence of the acetabular articular surface with respect to the femoral head was created and tested using Materials Testing Machine (MTS Systems Corp., Minneapolis, MN) and Fuji pressure-sensitive film (Sensor Products, Inc., East Hanover, NJ).
Outcome Measurements:
Testing data recorded and analyzed comparing the fractured and unfractured states.
Results:
With respect to the intact specimen, the contact area, mean pressure, and peak pressure in the dome region all increased (p < 0.003) in the both-column model. The contact area in the anterior articular region decreased (p < 0.02) as did the mean pressure (p < 0.032). The posterior articular region demonstrated a trend toward decreased contact area and increased mean and peak pressures. Descriptively, the stress concentration shifted toward the fracture in all cases with the most anterior and most posterior articular regions having little contact in the fracture model.
Conclusions:
In the authors' both-column model of secondary congruence, the stress concentration during simulated single-leg stance was increased significantly in the dome of the acetabulum adjacent to the fracture line.