Strength reduction and the effects of treatment of long bones with diaphyseal defects involving 50% of the cortex

R. E. Leggon, Ronald Lindsey, M. M. Panjabi

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Abstract

Currently, three criteria are accepted as indications for prophylactic internal fixation of metastatic disease in long bone, including lesions (a) destroying 50% or more of the cortex; (b) 2.5 cm or greater in diameter; or (c) with pain unrelieved by radiation therapy. Using an oblong defect configuration in which one half of the cross-sectional area was destroyed, canine femora were torsion-tested at high speed to determine (a) the actual strength reduction incurred by a lesion destroying 50% of the cortical circumference, and (b) the effects and benefits of internal fixation using polymethylmethacrylate and/or a six-hole compression plate on such a defect. The femurs with a 50% circumferential cortical defect demonstrated only 12.7 ± 3.8% of intact strength. Defects treated with a combination of plating (all screws bicortical) and polymethylmethacrylate (torque to failure 4.39 ± 0.90 times greater than the defect alone or T(E)/T(D) = 4.39 ± 0.90) were statistically stronger than defects treated with polymethylmethacrylate alone (T(E)/T(D) = 2.48 ± 0.66; p < 0.025) or by plating alone (T(E)/T(D) = 2.61 ± 0.91; p < 0.025), but torque-to-failure was only increased to approximately 56% of an intact bone. Plated intact bones (T(E)/T(D) = 5.33 ± 0.41) were significantly weaker than intact bones (T(E)/T(D) = 8.50 ± 2.52; p < 0.001). Our results substantiate the need for using polymethylmethacrylate and internal fixation in combination when prophylactically fixing pathologic lesions of this proportion.

Original languageEnglish (US)
Pages (from-to)540-546
Number of pages7
JournalJournal of Orthopaedic Research
Volume6
Issue number4
StatePublished - Jul 1988
Externally publishedYes

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Polymethyl Methacrylate
Bone and Bones
Torque
Femur
Therapeutics
Canidae
Radiotherapy
Pain

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Strength reduction and the effects of treatment of long bones with diaphyseal defects involving 50% of the cortex. / Leggon, R. E.; Lindsey, Ronald; Panjabi, M. M.

In: Journal of Orthopaedic Research, Vol. 6, No. 4, 07.1988, p. 540-546.

Research output: Contribution to journalArticle

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abstract = "Currently, three criteria are accepted as indications for prophylactic internal fixation of metastatic disease in long bone, including lesions (a) destroying 50{\%} or more of the cortex; (b) 2.5 cm or greater in diameter; or (c) with pain unrelieved by radiation therapy. Using an oblong defect configuration in which one half of the cross-sectional area was destroyed, canine femora were torsion-tested at high speed to determine (a) the actual strength reduction incurred by a lesion destroying 50{\%} of the cortical circumference, and (b) the effects and benefits of internal fixation using polymethylmethacrylate and/or a six-hole compression plate on such a defect. The femurs with a 50{\%} circumferential cortical defect demonstrated only 12.7 ± 3.8{\%} of intact strength. Defects treated with a combination of plating (all screws bicortical) and polymethylmethacrylate (torque to failure 4.39 ± 0.90 times greater than the defect alone or T(E)/T(D) = 4.39 ± 0.90) were statistically stronger than defects treated with polymethylmethacrylate alone (T(E)/T(D) = 2.48 ± 0.66; p < 0.025) or by plating alone (T(E)/T(D) = 2.61 ± 0.91; p < 0.025), but torque-to-failure was only increased to approximately 56{\%} of an intact bone. Plated intact bones (T(E)/T(D) = 5.33 ± 0.41) were significantly weaker than intact bones (T(E)/T(D) = 8.50 ± 2.52; p < 0.001). Our results substantiate the need for using polymethylmethacrylate and internal fixation in combination when prophylactically fixing pathologic lesions of this proportion.",
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