Anteroinferior 2.7-mm versus 3.5-mm plating of the clavicle: A biomechanical study

Pulos, Nicholas; Yoon, Richard S.; Shetye, Snehal S.; Hast, Michael W.; Liporace, Frank A.; Donegan, Derek J.

doi:10.1016/j.injury.2016.06.002

Cited by 16 publications

(9 citation statements)

References 21 publications

(41 reference statements)

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“…Despite the poorer biomechanical stability, 2.7 mm anteroinferior plating showed absolute values which easily withstood physiological forces. The cyclical test protocol used in the study led in neither of the 2 groups to implant failure [17].…”

Section: Claviclementioning

confidence: 99%

Biomechanics of Upper Extremity Double Plating

et al. 2019

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Double plating (DP) is an established treatment modality in traumatology. For certain indications, such as open reduction and internal fixation of bicondylar tibial plateau fractures and distal humeral fractures, DP is standard of care in the clinical routine. However, the principles of DP can be transferred to other anatomic regions and indications. In the past years, DP has been brought more and more into focus. For revision cases, such as the treatment of fracture non-unions, DP seems generally useful. In anatomical locations with high torsional stress and bending forces, but also in regions with traction forces by muscles and tendons DP provides multiplanar stability and therefore seems to have biomechanical advantages. Usually two smaller implants can replace one larger implant. Thus, the number of points of fixation can be increased, the stability can be improved and soft-tissue irritations by bulky implants can be minimized. Along with the established indication and application at the distal humerus, there is biomechanical evidence in the current literature for DP of clavicle fractures and humeral shaft fractures. Furthermore, DP provides mechanical advantages in the treatment of certain proximal humeral fractures and olecranon fractures. This review of the literature summarizes the published literature on biomechanics of upper extremity DP.

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Section: Claviclementioning

confidence: 99%

Biomechanics of Upper Extremity Double Plating

et al. 2019

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“…[5] As a result, open reduction internal fixation of midshaft clavicle fractures, through use of a plate or intramedullary device, has become a common treatment approach. [2,6]…”

Section: Introductionmentioning

confidence: 99%

Finite element analysis of spiral plate and Herbert screw fixation for treatment of midshaft clavicle fractures

et al. 2019

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Both spiral plate and Herbert screw fixations have been clinically adopted for treating midshaft displaced clavicle fractures. However, the biomechanical properties of the 2 implant fixations have not yet been thoroughly evaluated. Here we report the results of a finite element analysis of the biomechanical properties of midshaft clavicle fractures treated with Herbert screw and spiral plate fixation. Hebert screw fixation showed stress distribution similar to intact clavicle under all loading conditions, but provided less stability than did spiral plate fixation. Postoperatively, excessive shoulder activities and weight-bearing should be avoided. Spiral plate fixation provides greater stability, but is associated with stress shielding. These results demonstrate that Herbert screw fixation is suitable for the treatment of simple displaced clavicluar fractures, but excessive shoulder activity and weight-bearing should be avoided after the operation. Therefore, spiral plate fixation may be preferred for patients requiring an early return to activity.

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“…Previously, several biomechanical studies for distal clavicle fracture evaluated and compared the fixation strength between nonanatomical and anatomical plates and between locking head and nonlocking head screws. [26][27][28][29][30] previous studies reported that about 400-600 N strength is required for failure of fixation due to pull-out. 26,28,31 Considering the ultimate pullout strength of 235 N in this study, the distal clavicle locking plate can only be used in cases that allows three or more screws in lateral fixation, due to the significant possibility of failure with lateral fixation using only two screws.…”

Section: Discussionmentioning

confidence: 99%

Relation between diameter of a lateral screw and pull‐out strength in distal clavicle fracture in plates with different geometry: A cadaveric biomechanical study

Yoon

Choi

et al. 2021

Journal Orthopaedic Research

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Plate fixation has recently gained popularity among the various surgical methods used to treat Neer type II distal clavicle fractures. The use of a low‐profile distal clavicle locking plate is logically considered a better option when there is no significant difference in the fixation strength between insertions of 3.5‐ and 2.7‐mm diameter screws. Therefore, the purpose of this biomechanical study was to investigate any differences in fixation strength among varying sizes of screws that are used to treat distal clavicle fractures. The study was performed with 20 paired shoulder girdles from 10 fresh frozen cadavers. To create a type IIA fracture of Neer classification, osteotomy was performed perpendicularly to the longitudinal axis of the clavicle at the medial end point of the conoid ligament. Two custom‐made fixtures designed to be attached to both upper and lower sides of the Instron were fabricated for the evaluation. The mean maximum pull‐out strength for fixation using 3.5‐mm diameter screws was 241.9 ± 67.8 N, whereas the mean pull‐out strength in fixation with 2.7‐mm diameter screws was 228.1 ± 63.0 N. There was no statistically significant difference between the two groups. Distal fragment fixation with distal clavicle locking plates using two 2.7‐mm diameter screws showed comparable biomechanical pull‐out strength at the time‐zero setting to fixations with a hook plate using two 3.5‐mm diameter screws. Therefore, the fixation of the distal fragment with a low‐profile plate and 2.7‐mm screws may be preferred as an alternative option if the distal fragment of the fractured clavicle is not extremely small.

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Anteroinferior 2.7-mm versus 3.5-mm plating of the clavicle: A biomechanical study

Cited by 16 publications

References 21 publications

Biomechanics of Upper Extremity Double Plating

Biomechanics of Upper Extremity Double Plating

Finite element analysis of spiral plate and Herbert screw fixation for treatment of midshaft clavicle fractures

Relation between diameter of a lateral screw and pull‐out strength in distal clavicle fracture in plates with different geometry: A cadaveric biomechanical study

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