Volar Plating of AO C3 Distal Radius Fractures: Biomechanical Evaluation of Locking Screw and Locking Smooth Peg Configurations

Martineau, Paul A.; Waitayawinyu, Thanapong; Malone, Kevin J.; Hanel, Douglas P.; Trumble, Thomas E.

doi:10.1016/j.jhsa.2008.01.006

Cited by 49 publications

(37 citation statements)

References 27 publications

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“…The Sawbone model has been used in previously published studies evaluating the biomechanics of distal radius fracture fixation techniques. (10)(11)(12)14,15) This osteoporotic model was chosen to best replicate the clinical situation when fixation stiffness is most reliant on subchondral locked support in fractures at risk for collapse. In this study, all specimen failures during catastrophic testing were by collapse of the bone, and not by either plate or screw failure.…”

Section: Discussionmentioning

confidence: 99%

“…This Sawbone has been employed in several prior mechanical studies of distal radius fracture fixation. (10)(11)(12) We chose the manufacturer's osteoporotic version (foam cortex, cancellous filling) to represent a common clinical scenario. Volar distal radius plates (Medartis, Basil, Switzerland -model #A-4750.17) were placed in a systematic and reproducible manner to ensure consistent subchondral screw (2.5mm) placement.…”

Section: Specimen Constructionmentioning

confidence: 99%

“…(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%

“…Based upon previous analyses, 6 specimens per experimental group were determined sufficient to adequately detect a 200 N difference in failure force between the constructs with 80% power. (10)(11)(12)18) Despite planning and conducting this study to be powered consistent with prior investigations, several analyses were underpowered. (10)(11)(12)(13)15,(25)(26)(27)(28) Post-hoc analysis demonstrated appropriate power when analyzing axial compression force at 2mm displacement; however, we would have needed 22 specimens per group to detect the difference between our most rigid and least rigid constructs for axial stiffness or force at fracture.…”

Section: Biomechanical Testingmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Specimen Constructionmentioning

confidence: 99%

Section: Biomechanical Testingmentioning

confidence: 99%

Section: Biomechanical Testingmentioning

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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show abstract

“…they can be replaced by smooth pegs that may allow closer placement into subchondral bone with less concern of screw head penetration into the joint. However,t hey do not provide as stable fixation of intra-articular C3 type fractures as threaded screws (42). the volar fixed angle plate has to be properly placed and fracturer eduction has to be precise in order to avoid the screw penetration into the joint.…”

Section: Abcmentioning

confidence: 99%

Operative Treatment of Distal Radius Fractures

Vasenius¹

2008

Scand J Surg

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the incidence of distal radius fractures is increasing together with the average age of population. intra-articular incongruity is the most probable cause of unsatisfactory outcome of distal radius fractures in younger and more active patients. thus, the main goal in the treatment of distal radius fractures should be restoration of articular congruence. acomputed tomography (ct) is recommended to help surgeon in preoperative planning in the treatment of comminuted intra-articular fractures. new implants have been designed to provide stable enough fixation fore arly mobilisation after surgery and to lower rather high complication rates related to conventional fixation methods such as external fixation and dorsal plating. the most common complications related to volar fixed angle plating such as flexor and extensor tendon problems, median nerve neuropathy,and screw diplacement into the radiocarpal joint are surgeon related and are avoidable with proper education. more randomized prospective studies are needed to prove superiority of any fixation method to another.Key words: Distal radius; fracture; operative treatment; plating; external fixation; malpractice; complications FaCtors aFFeCting outCome therei ss till some controversy about the factors affecting the outcome of distal radius fractures. Persistent intra-articular incongruity has been shown to cause a9,9-fold increased risk of radiological osteoarthritis and restriction of range of motion (rom) (7, 8). seventy-six to 91% of fractures of young adults with residual intra-articular incongruity showed arthritis 7y ears after the injury compared to 11%o f fractures with congruous joint (9, 10). Forwardetal. (7) reported that after 38 years follow up grade 0or1 arthritic changes weref ound in 65% of wrists after intra-articular fractures, grade 2i n3 0% and grade 3 in 5% of fractures. However,o steoarthritic changes do nota lways worsen the functional end result (8,11). Dorsal angulation of radiocarpal joint surface worsens functional outcome considerably when it exceeds 20 degrees (12, 13). thirty-eight years after the injury each ten degrees of dorsal angulation diminishes volar flexion by three degrees (7). Dorsal angulation exceeding 20 degrees caused a6a nd 8 degrees loss of volar flexion 30 and 7years after the injury (14, 15)respectively. radial shortening of more than 4mmassociates with decreased forearm rotation scandinavian Journal of surgery 97:

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Distal Radius Fractures

Zhang,

Strelzow

2024

Orthopaedic Sports Medicine

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Volar Plating of AO C3 Distal Radius Fractures: Biomechanical Evaluation of Locking Screw and Locking Smooth Peg Configurations

Cited by 49 publications

References 27 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

Operative Treatment of Distal Radius Fractures

Distal Radius Fractures

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