Unicortical and bicortical plating in the fixation of comminuted fractures of the clavicle: a biomechanical study

Looft, John M.; Corrêa, Lincoln; Patel, Minoo; Rawlings, Mathew; Ackland, David C.

doi:10.1111/ans.14139

Cited by 6 publications

(2 citation statements)

References 33 publications

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“…However, bicortical fixation was significantly stiffer than unicortical fixation in torsion for the same plates. Looft et al compared the bending and torsional strength of a uni-, bicortical locking screw plate construct and a hybrid unicortical plate construct (with central locked and outer non-locked long oblique screws) for clavicle fracture fixation [ 34 ]. They also found no significant differences in bending stiffness or ultimate bending moment between all three plating techniques.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical and clinical evaluation of minimal invasive plate osteosynthesis for two-part clavicle shaft fractures

Schlüßler

Fehrenbacher

Richter

et al. 2023

BMC Musculoskelet Disord

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Background Many surgical treatment methods exist for clavicle shaft fractures. A locking compression plate (LCP) fixation with three screws per fracture side is commonly used. For certain fractures a stabilization with 2 screws per side is potentially suitable, offering the advantage of reduced soft tissue approach, while avoiding the disadvantages of minimally-invasive nailing at the same time. This hypothesis was evaluated biomechanically and clinically. Methods Four treatment procedures were investigated biomechanically using composite human clavicle specimens. A load-to-failure test was performed using a three-point cantilever test. In group 1, a simple shaft fracture was simulated and stabilized with 2 screws per fracture side (5-hole LCP). In the second group 3 screws per side (7-hole LCP) were used. In group 3, a non-reduced fracture zone was simulated and treated with 3 screws per side (7-hole LCP). In group 4, an anatomically reduced fracture zone was simulated and treated with 3 screws per side (7-hole LCP). Furthermore 27 patients treated with a short plate and 2 screws per side (similar to group 1) were assessed after a minimum follow-up of 12 months (Constant and DASH Score). Results The maximum load-to-failure of group 1 was 367N. We observed the highest load-to-failure in group 2 with 497N and the lowest in group 3 with 90N. In group 4 a maximum load-to-failure of 298N could be evaluated. There was no significant difference in load-to-failure between the treatment of a simple clavicle fracture using 5- or 7-hole LCP (p = 0.121). However, we found a significant difference of load-to-failure between the simple and anatomically reduced fracture using a 7-hole plate (p = 0.014). The mean constant score of the surgically treated patients was 95 and the DASH score 3.0. Fracture consolidation was observed in 96.3%. Conclusions For certain non-fragmented and well interlocking 2-part fractures, a plate osteosynthesis fixed with only 2 screws per fracture side might offer sufficient biomechanical stability, better soft tissue preservation and comparable fusion rates compared to the operative treatment with 3 screws per side. However, the maximum load-to-failure of the 7-hole LCP was higher than of the 5-hole LCP, but this difference was not statistically significant. Trial registration Approval from the ethics committee of the Technical University of Dresden was retrospectively obtained (EK 588122019).

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Section: Discussionmentioning

confidence: 99%

Biomechanical and clinical evaluation of minimal invasive plate osteosynthesis for two-part clavicle shaft fractures

Schlüßler

Fehrenbacher

Richter

et al. 2023

BMC Musculoskelet Disord

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“…Forearm fractures and clavicles have been modeled comparing unicortical and bicortical fixation. 16,17 Less resistance to torsion was noted, and this may be a concern in the distal radius.…”

Section: Discussionmentioning

confidence: 99%

Diaphyseal Screw Prominence in Distal Radius Volar Plating

2020

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Background Volar plating for distal radius fractures has become common. Screw prominence on the dorsal side from long screws can lead to tendon injury. Methods for detecting screws that penetrate the far cortex involve X-ray or ultrasound. These have focused on the distal row of screws. No studies have addressed screw penetration in the diaphysis. We describe two cases where diaphyseal screws caused symptoms. We then insert screws in the diaphysis of synbones 2 mm longer than measured and determine what angle of pronation or supination was best to detect this on X-ray. Methods Three synbones were plated using Synthes volar plate. The three diaphyseal screws were drilled perpendicular to the plate, and the depth measured. Cortical 2.4-mm screws were inserted, 2 mm longer than measured. The three synbones were then placed in a custom clamp to measure rotation. Lateral X-rays were taken at 0 degree rotation, and 5, 10, and 15 degrees of supination and pronation. The prominence of each screw was measured using the synapse digital ruler. Results For the screws that were placed at a neutral angle (perpendicular to the plate) the maximum visualization of the prominent tips occurred around 0 degree rotation. With screws angled 15 degrees ulna, maximum visualization was between 5 and 10 degrees of pronation. With screws angled 15 degrees radial, maximum visualization was between 5 and 10 degrees of supination. Every 5 degrees of rotation changes the profile of the screw by 0.4 mm. Discussion The diaphysis of the radius becomes approximately trapezoidal distally. Prominent screws that are placed below the “peak” of the trapezoid may appear to be the correct length. Rotating the wrist into pronation or supination to bring the relevant cortex as parallel to the X-ray beam as possible will help to identify if screws are of the correct length. Screws that are prominent in the second compartment may be particularly symptomatic as the tendons here are closely opposed to the bone. We recommend screening for 2 mm diaphyseal screw prominence in neutral, with 10 degrees of pronation and supination.

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Biomechanical Design Optimization of Clavicle Midshaft Fracture Plates: A Review

Zdero,

Brzozowski,

Schemitsch

2024

J. Med. Biol. Eng.

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Unicortical and bicortical plating in the fixation of comminuted fractures of the clavicle: a biomechanical study

Cited by 6 publications

References 33 publications

Biomechanical and clinical evaluation of minimal invasive plate osteosynthesis for two-part clavicle shaft fractures

Biomechanical and clinical evaluation of minimal invasive plate osteosynthesis for two-part clavicle shaft fractures

Diaphyseal Screw Prominence in Distal Radius Volar Plating

Biomechanical Design Optimization of Clavicle Midshaft Fracture Plates: A Review

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