{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T18:37:52Z","timestamp":1767033472564,"version":"3.41.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:sec>\n            <jats:title>OBJECTIVES:<\/jats:title>\n            <jats:p>To assess the biomechanical differences between linked and unlinked constructs in young and osteoporotic cadavers in addition to osteoporotic sawbones.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>Intraarticular distal femur fractures with comminuted metaphyseal regions were created in three young matched pair cadavers, three osteoporotic matched pair cadavers, and six osteoporotic sawbones. Precontoured distal femur locking plates were placed in addition to a standardized retrograde nail, with unitized constructs having one 4.5 mm locking screw placed distally through the nail. Nonunitized constructs had seven 4.5 mm locking screws placed through the plate around the nail, with one 5 mm distal interlock placed through the nail alone. Cadaveric specimens were subjected to axial fatigue loads between 150 and 1500 N (R Ratio = 10) with 1 Hx frequency for 10,000 cycles. Sawbones were axially loaded at 50% of the ultimate load for fatigue testing to achieve runout, with testing performed with 30 and 300 N (R Ratio = 10) loads with 1 Hz frequency for 10,000 cycles.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>In young cadavers, there was no difference in the mean cyclic displacement of the unitized constructs (1.51 \u00b1 0.62mm) compared to the non-unitized constructs (1.34 \u00b1 0.47mm) (Figure 4A), (<jats:italic toggle=\"yes\">p<\/jats:italic> = 0.722). In osteoporotic cadavers, there was no difference in the mean cyclic displacement of the unitized constructs (2.46 \u00b1 0.47mm) compared to the non-unitized constructs (2.91 \u00b1 1.49mm) (<jats:italic toggle=\"yes\">p<\/jats:italic> =0.639). There was statistically no significant difference in cyclic displacement between the unitized and non-unitized groups in osteoporotic sawbones(<jats:italic toggle=\"yes\">p<\/jats:italic> = 0.181).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Linked constructs did not demonstrate increased axial stiffness or decreased cyclical displacement in comparison to unlinked constructs in young cadaveric specimens, osteoporotic cadaveric specimens, or osteoporotic sawbones.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000002839","type":"journal-article","created":{"date-parts":[[2024,5,7]],"date-time":"2024-05-07T16:02:17Z","timestamp":1715097737000},"page":"435-440","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["The Effects of Unitizing Nail\u2013Plate Constructs in Distal Femur Fractures: A Biomechanical Study"],"prefix":"10.1097","volume":"38","author":[{"given":"Erik","family":"Mayer","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matin","family":"Lendhey","sequence":"additional","affiliation":[{"name":"Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, PA ."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Kelley","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brendan","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Upfill-Brown","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sai K.","family":"Devana","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dane","family":"Brodke","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akash","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Troy","family":"Sekimura","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Varun","family":"Gudapati","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Zukotynski","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeannie","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amber R.","family":"Witt","sequence":"additional","affiliation":[{"name":"Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, PA ."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mara","family":"Marciante","sequence":"additional","affiliation":[{"name":"Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, PA ."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan M.","family":"Mahoney","sequence":"additional","affiliation":[{"name":"Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, PA ."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandon S.","family":"Bucklen","sequence":"additional","affiliation":[{"name":"Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc., Audubon, PA ."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-20250614","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s00264-017-3665-1","article-title":"Population-based epidemiology and incidence of distal femur fractures","volume":"42","author":"Elsoe","year":"2018","journal-title":"Int Orthop"},{"key":"R2-20250614","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1097\/BOT.0000000000002516","article-title":"Risk factors for reoperation to promote union in 1111 distal femur fractures","volume":"37","author":"Lee","year":"2023","journal-title":"J Orthop Trauma"},{"key":"R3-20250614","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/BOT.0b013e31829e6dd0","article-title":"Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases","volume":"28","author":"Ricci","year":"2014","journal-title":"J Orthop Trauma"},{"key":"R4-20250614","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1097\/00005131-200603000-00005","article-title":"Locked plates combined with minimally invasive insertion technique for the treatment of periprosthetic supracondylar femur fractures above a total knee arthroplasty","volume":"20","author":"Ricci","year":"2006","journal-title":"J Orthop Trauma"},{"key":"R5-20250614","doi-asserted-by":"crossref","first-page":"1757","DOI":"10.1007\/s11999-011-1870-6","article-title":"2010 mid-America Orthopaedic Association Physician in Training Award: healing complications are common after locked plating for distal femur fractures","volume":"469","author":"Henderson","year":"2011","journal-title":"Clin Orthop Relat Res"},{"key":"R6-20250614","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1097\/00005131-200409000-00005","article-title":"Early results of the less invasive stabilization system for mechanically unstable fractures of the distal femur (AO\/OTA types A2, A3, C2, and C3)","volume":"18","author":"Weight","year":"2004","journal-title":"J Orthop Trauma"},{"key":"R7-20250614","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1302\/0301-620X.92B3.22996","article-title":"Are extreme distal periporsthetic supracondylar fractures of the femur too distal to fix using a lateral locked plate?","volume":"92","author":"Streubel","year":"2010","journal-title":"J Bone Joint Surg Br"},{"key":"R8-20250614","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1016\/j.injury.2012.01.025","article-title":"Outcome of periprosthetic distal femoral fractures following knee arthroplasty","volume":"43","author":"Hoffmann","year":"2012","journal-title":"Injury"},{"key":"R9-20250614","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/j.arth.2011.08.007","article-title":"High complication rate in locking plate fixation of lower periprosthetic distal femur fractures in patients with total knee arthroplasties","volume":"27","author":"Ebraheim","year":"2012","journal-title":"J Arthroplasty"},{"key":"R10-20250614","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1097\/BOT.0000000000000593","article-title":"Mechanical construct characteristics predisposing to non-union after locked lateral plating of distal femur fractures","volume":"30","author":"Rodriguez","year":"2016","journal-title":"J Orthop Trauma"},{"key":"R11-20250614","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1016\/j.injury.2021.04.023","article-title":"Distal femur fractures have a higher mortality rate compared to hip fractures among the elderly: insights from the National Trauma Data Bank","volume":"52","author":"Tsai","year":"2021","journal-title":"Injury"},{"key":"R12-20250614","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/BOT.0000000000001078","article-title":"Patient mortality in geriatric distal femur fractures","volume":"32","author":"Myers","year":"2018","journal-title":"J Orthop Trauma"},{"key":"R13-20250614","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1007\/s11999-010-1530-2","article-title":"Mortality after distal femur fractures in elderly patients","volume":"469","author":"Streubel","year":"2011","journal-title":"Clin Orthop Relat Res"},{"issue":"suppl 4","key":"R14-20250614","doi-asserted-by":"crossref","first-page":"S71","DOI":"10.1016\/j.injury.2021.03.066","article-title":"Mortality after distal femur fractures in the elderly","volume":"52","author":"Merino-Rueda","year":"2021","journal-title":"Injury"},{"key":"R15-20250614","doi-asserted-by":"crossref","first-page":"e64","DOI":"10.1097\/BOT.0000000000001332","article-title":"Nail Plate combination technique for native and periprosthetic distal femur fractures","volume":"33","author":"Liporace","year":"2019","journal-title":"J Orthop Trauma"},{"key":"R16-20250614","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1097\/BOT.0000000000002594","article-title":"Effect of implant linkage on axial and rotational stiffness of Nail-Plate constructs for comminuted distal femoral fractures","volume":"37","author":"Lin","year":"2023","journal-title":"J Orthop Trauma"},{"key":"R17-20250614","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1097\/BOT.0000000000001749","article-title":"Supplemental fixation of supracondylar distal femur fractures: a biomechanical comparison of dual-plate and plate-nail constructs","volume":"34","author":"Wright","year":"2020","journal-title":"J Orthop Trauma"},{"key":"R18-20250614","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1097\/BOT.0000000000001591","article-title":"Supplementation of lateral locked plating for distal femur fractures: a biomechanical study","volume":"33","author":"Fontenot","year":"2019","journal-title":"J Orthop Trauma"},{"key":"R19-20250614","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/S0883-5403(98)90009-2","article-title":"The forces in the distal femur and the knee during walking and other activities measured by telemetry","volume":"13","author":"Taylor","year":"1998","journal-title":"J Arthroplasty"},{"key":"R20-20250614","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.jmbbm.2012.09.005","article-title":"Biomechanical properties of an intact, injured, repaired, and healed femur: an experimental and computational study","volume":"16","author":"Ebrahimi","year":"2012","journal-title":"J Mech Behav Biomed Mater"},{"key":"R21-20250614","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/00005131-200401000-00003","article-title":"Intramedullary fixation of unstable intertrochanteric hip fractures: one or two lag screws","volume":"18","author":"Kubiak","year":"2004","journal-title":"J Orthop Trauma"},{"key":"R22-20250614","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1097\/BOT.0000000000000391","article-title":"Early mechanical failures of the synthes variable angle locking distal femur plate","volume":"30","author":"Tank","year":"2016","journal-title":"J Orthop Trauma"},{"key":"R23-20250614","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1097\/BOT.0000000000001510","article-title":"Treatment of distal femur fractures with the DePuy-synthes variable angle locking compression plate","volume":"33","author":"McDonald","year":"2019","journal-title":"J Orthop Trauma"},{"key":"R24-20250614","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1016\/j.injury.2012.03.032","article-title":"Biomechanical femoral neck fracture experiments--a narrative review","volume":"43","author":"Basso","year":"2012","journal-title":"Injury"},{"key":"R25-20250614","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.jbiomech.2019.06.004","article-title":"Central screw use delays implant dislodgement in osteopenic bone but not synthetic surrogates: a comparison of reverse total shoulder models","volume":"93","author":"Hast","year":"2019","journal-title":"J Biomech"},{"key":"R26-20250614","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1016\/j.injury.2018.02.007","article-title":"Calcar screw position in proximal humerus fracture fixation: don't miss high","volume":"49","author":"Mehta","year":"2018","journal-title":"Injury"},{"key":"R27-20250614","doi-asserted-by":"crossref","first-page":"e411","DOI":"10.3928\/01477447-20150504-59","article-title":"Unicortical versus bicortical locked plate fixation in midshaft clavicle fractures","volume":"38","author":"Bravman","year":"2015","journal-title":"Orthopedics"},{"key":"R28-20250614","doi-asserted-by":"crossref","first-page":"105437","DOI":"10.1016\/j.clinbiomech.2021.105437","article-title":"Examining the novel use of continuous compression implants in clavicle reconstruction: a biomechanical study","volume":"88","author":"Schmidt","year":"2021","journal-title":"Clin Biomech (Bristol, Avon)"},{"key":"R29-20250614","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.injury.2022.11.035","article-title":"Nail plate combination in fractures of the distal femur in the elderly: a new paradigm for optimum fixation and early mobilization?","volume":"54","author":"Kontakis","year":"2023","journal-title":"Injury"}],"container-title":["Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/BOT.0000000000002839","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,14]],"date-time":"2025-06-14T18:00:57Z","timestamp":1749924057000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/BOT.0000000000002839"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8]]},"references-count":29,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.1097\/bot.0000000000002839","relation":{},"ISSN":["0890-5339"],"issn-type":[{"type":"print","value":"0890-5339"}],"subject":[],"published":{"date-parts":[[2024,8]]},"assertion":[{"value":"2024-04-30","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}