Biomechanical Comparison of Locking versus Nonlocking Volar and Dorsal T-Plates for Fixation of Dorsally Comminuted Distal Radius Fractures

Gondusky, Joseph S; Carney, Joseph; Erpenbach, Jonathan; Robertson, Claire; Mahar, Andrew; Oka, Richard; Thompson, Mark J.; Mazurek, Michael T.

doi:10.1097/bot.0b013e3181d7a3a6

Cited by 27 publications

(21 citation statements)

References 34 publications

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“…This mode of failure has been observed following mechanical testing of elderly cadavera with fractures of the distal radius. (16,25) The values of stiffness under axial compression and loads to catastrophic failure obtained in this study were similar to those observed in elderly cadaveric models, further supporting the validity of our Sawbone model (Table 3). (13,16,25) While models such as the fourth generation Sawbones (Pacific Research Labs, Vashon, WA) have excellent reliability and uniform mechanical properties, they are manufactured to be comparable to young adult diaphyseal bone.…”

Section: Discussionsupporting

confidence: 74%

“…(12,15,(17)(18)(19)(20)(21)(22)(23)(24) Gondusky et al and Weninger et al identified in prior distal radius mechanical testing that all changes attributable to cyclic loading occurred in the first 200-500 cycles, thus we deemed 1,000 cycles sufficient to condition the constructs. (11,(13)(14)(15)(16) Destructive testing was completed to determine load (N) to clinical failure which was defined as 2mm of displacement at the osteotomy gap, (10) and subsequent catastrophic failure, defined as complete closure of the 1 cm osteotomy gap and or fracture.…”

Section: Biomechanical Testingmentioning

confidence: 99%

“…We chose this dorsal fracture gap model for consistency with prior mechanical evaluations of distal radius fixation. (11,(13)(14)(15)(16) Constructs were cut to 12.5 cm for potting. Prior to biomechanical testing the points of contact for load application were marked on all specimens in a systematic fashion to ensure identical load placement for all groups.…”

Section: Specimen Constructionmentioning

confidence: 99%

See 2 more Smart Citations

The Effects of Screw Length on Stability of Simulated Osteoporotic Distal Radius Fractures Fixed with Volar Locking Plates

Wall¹,

Brodt²,

Silva³

2012

The Journal of Hand Surgery

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Purpose-Volar plating for distal radius fractures has caused extensor tendon ruptures secondary to dorsal screw prominence. This study was designed to determine the biomechanical impact of placing unicortical distal locking screws and pegs in an extra-articular fracture model.Methods-Volar-locking distal radius plates were applied to 30 osteoporotic distal radius models. Radii were divided into 5 groups based on distal locking fixation: bicortical locked screws, 3 lengths of unicortical locked screws (abutting the dorsal cortex [full length], 75% length, and 50% length to dorsal cortex), and unicortical locked pegs. Distal radius osteotomy simulated a dorsally comminuted, extra-articular, fracture. Each constructs stiffness was determined under physiologic loads (axial compression, dorsal bending volar bending) before and after 1000 cycles of axial conditioning and prior to axial loading to failure (2mm of displacement) and subsequent catastrophic failure.Results-Cyclic conditioning did not alter constructs stiffness. Stiffness to volar bending and dorsal bending forces were similar between groups. Final stiffness(N/mm) under axial load was statistically equivalent for all groups: bicortical screws(230), full-length unicortical screws(227), 75% length unicortical screws(226), 50% length unicortical screws(187), unicortical pegs(226). Force(N) at 2 mm displacement was significantly less for 50% length unicortical screws(311) compared to bicortical screws(460), full-length unicortical screws(464), 75% length unicortical screws(400), and unicortical pegs(356). Force(N) to catastrophic fracture was statistically equivalent between groups but mean values for pegs(749) and 50% length unicortical(702) screws were 16-21% less than means for bicortical(892), full-length unicortical(860), and 75% length(894) unicortical constructs.Discussion-Locked unicortical distal screws of at least 75% length produce construct stiffness similar to bicortical fixation. Unicortical distal fixation for extra-articular distal radius fractures should be entertained to avoid extensor tendon injury since it does not appear to compromise initial fixation. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access

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Section: Discussionsupporting

confidence: 74%

Section: Biomechanical Testingmentioning

confidence: 99%

Section: Specimen Constructionmentioning

confidence: 99%

See 1 more Smart Citation

The Effects of Screw Length on Stability of Simulated Osteoporotic Distal Radius Fractures Fixed with Volar Locking Plates

Wall¹,

Brodt²,

Silva³

2012

The Journal of Hand Surgery

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“…Significant controversy exists about whether dorsal or volar plating is superior for fixation of dorsally comminuted distal radial fractures [11–13]. …”

Section: Discussionmentioning

confidence: 99%

“…In a biomechanical study on dorsally comminuted extra-articular distal radial fractures comparing dorsal T-plate with volar locking plate, it was inferred that there was no difference in any of the biomechanical parameters, namely, stiffness, fragment displacement at 500 cycle-intervals, and axial load to failure between these constructs [13]. …”

Section: Discussionmentioning

confidence: 99%

Dorsally Comminuted Fractures of the Distal End of the Radius: Osteosynthesis with Volar Fixed Angle Locking Plates

et al. 2013

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Background. Dorsally comminuted distal radius fractures are unstable fractures and represent a treatment challenge. The objective of this study was to evaluate the functional and radiological outcome of dorsally comminuted fractures of the distal radius fixed with a volar locking plate. Patients and Methods. Thirty-three consecutive patients with dorsally comminuted fractures of the distal end of the radius were treated by open reduction and internal fixation with AO 2.4 mm (n = 19)/3.5 mm (n = 14) volar locking distal radius plate (Synthes, Switzerland, marketed by Synthes India Pvt. Ltd.). There were 7 type A3, 8 type C2, and 18 type C3 fractures. The patients were followed up at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Subjective assessment was done as per Disabilities Arm, Shoulder, and Hand (DASH) questionnaire. Functional evaluation was done by measuring grip strength and range of motion around the wrist; the radiological determinants were radial angle, radial length, volar angle, and ulnar variance. The final assessment was done as per Demerit point system of Saito. Results. There were 23 males and 10 females with an average age of 44.12 ± 18.63 years (18–61 years). Clinicoradiological consolidation of the fracture was observed in all cases at a mean of 9.6 weeks (range 7–12 weeks). The average final extension was 58.15° ± 7.83°, flexion was 54.62° ± 11.23°, supination was 84.23° ± 6.02°, and pronation was 80.92° ± 5.54°. Demerit point system of Saito yielded excellent results in 79% (n = 26), good in 18% (n = 6), and fair in 3% (n = 1) patients. Three patients had loss of reduction but none of the patients had tendon irritation or ruptures, implant failure, or nonunion at the end of an one-year followup. Conclusion. Volar locking plate fixation for dorsally comminuted distal radius fractures results in good to excellent functional outcomes despite a high incidence of loss of reduction and fracture collapse.

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Distal Radius Fractures

Eglseder

2017

Atlas of Upper Extremity Trauma

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Biomechanical Comparison of Locking versus Nonlocking Volar and Dorsal T-Plates for Fixation of Dorsally Comminuted Distal Radius Fractures

Cited by 27 publications

References 34 publications

The Effects of Screw Length on Stability of Simulated Osteoporotic Distal Radius Fractures Fixed with Volar Locking Plates

The Effects of Screw Length on Stability of Simulated Osteoporotic Distal Radius Fractures Fixed with Volar Locking Plates

Dorsally Comminuted Fractures of the Distal End of the Radius: Osteosynthesis with Volar Fixed Angle Locking Plates

Distal Radius Fractures

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