Biomechanical evaluation of a biodegradable composite as an adjunct to internal fixation of proximal femur fractures

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Abstract
Internal fixation of comminuted unstable fractures of the severely osteoporotic proximal femur is sometimes supplemented with polymethyl-methacrylate (PMMA). We here report an in vitro biomechanical evaluation of a biodegradable particulate composite that might be used for similar purposes. The composite includes a matrix phase consisting of a hydrolyzable prepolymer [polypropylene fumarate (PPF)] cross-linked with methacrylate monomer, and a particulate phase consisting of tricalcium phosphate and calcium carbonate. We implanted dynamic hip screws in 22 cadaveric proximal femora and measured the yield load for an oblique force applied to the femoral head. The hip screws were then reinforced with either PMMA or the PPF composite and tested again. On the basis of analysis of variance, the average increases in yield load for PMMA and PPF reinforcement of 1, 750 and 1,130 N were statistically significant (p < 0.00005), suggesting that both materials enhance congruence between implant and bone and thereby increase the projected load-bearing area of the implant. The increase in yield force with PMMA was slightly higher than the increase with PPF (p < 0.05), but both values after reinforcement were close (3,790 ± 561 N for PMMA vs. 3,240 ± 669 N for PPF). If we can demonstrate that appropriate rates of degradation, bony ingrowth, and static and fatigue properties can be achieved in vivo with this system, our data suggest that this PPF composite may have potential as an adjunct to the internal fixation of unstable fractures of the osteoporotic hip.