Comparison of the fixation ability of headless compression screws and locking plate for metacarpal shaft transverse fracture

Abstract Introduction Coronal plane fractures of the distal humerus are relatively rare and can be challenging to treat due to their complexity and intra-articular nature. There is no gold standard for surgical management of these complex fractures. The purpose of this study was to compare the biomechanical stability and strength of two different internal fixation techniques for complex coronal plane fractures of the capitellum with posterior comminution. Materials and methods Fourteen fresh frozen, age- and gender-matched cadaveric elbows were 3D-navigated osteotomized simulating a Dubberley type IIB fracture. Specimens were randomized into one of two treatment groups and stabilized with an anterior antiglide plate with additional anteroposterior cannulated headless compression screws (group antiGP + HCS) or a posterolateral distal humerus locking plate with lateral extension (group PLP). Cyclic testing was performed with 75 N over 2000 cycles and ultimately until construct failure. Data were analyzed for displacement, construct stiffness, and ultimate load to failure. Results There was no significant difference in displacement during 2000 cycles (p = 0.291), stiffness (310 vs. 347 N/mm; p = 0.612) or ultimate load to failure (649 ± 351 vs. 887 ± 187 N; p = 0.140) between the two groups. Conclusions Posterolateral distal humerus locking plate achieves equal biomechanical fixation strength as an anterior antiglide plate with additional anteroposterior cannulated headless compression screws for fracture fixation of complex coronal plane fractures of the capitellum. These results support the use of a posterolateral distal humerus locking plate considering the clinical advantages of less invasive surgery and extraarticular metalware. Level of evidence Biomechanical study.

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Four-corner fusion: Clinical and radiological outcome after fixation by headless compression screws or dorsal locking plate at minimum 5 years’ follow-up

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2021.102886 ◽

2021 ◽

pp. 102886

Author(s):

Marc-Antoine d’Almeida ◽

Nadine Sturbois-Nachef ◽

Thomas Amouyel ◽

Christophe Chantelot ◽

Marc Saab

Keyword(s):

Locking Plate ◽

Radiological Outcome ◽

Headless Compression Screws ◽

Clinical And Radiological Outcome

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Metacarpal shaft fixation: a biomechanical comparison of dorsal plating, lag screws, and headless compression screws

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04200-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Felix G. E. Dyrna ◽

Daniel M. Avery ◽

Ryu Yoshida ◽

David Lam ◽

Simon Oeckenpöhler ◽

...

Keyword(s):

Peak Load ◽

Rigid Fixation ◽

Advantages And Disadvantages ◽

Shaft Fractures ◽

Metacarpal Shaft ◽

Significant Difference ◽

Load To Failure ◽

Headless Compression Screws ◽

Diaphyseal Fractures ◽

Dorsal Plating

Abstract Background Metacarpal shaft fractures are common and can be treated nonoperatively. Shortening, angulation, and rotational deformity are indications for surgical treatment. Various forms of treatment with advantages and disadvantages have been documented. The purpose of the study was to determine the stability of fracture fixation with intramedullary headless compression screws in two types of metacarpal shaft fractures and compare them to other common forms of rigid fixation: dorsal plating and lag screw fixation. It was hypothesized that headless compression screws would demonstrate a biomechanical stronger construct. Methods Five matched paired hands (age 60.9 ± 4.6 years), utilizing non-thumb metacarpals, were used for comparative fixation in two fracture types created by an osteotomy. In transverse diaphyseal fractures, fixation by headless compression screws (n = 7) and plating (n = 8) were compared. In long oblique diaphyseal fractures, headless compression screws (n = 8) were compared with plating (n = 8) and lag screws (n = 7). Testing was performed using an MTS frame producing an apex dorsal, three point bending force. Peak load to failure and stiffness were calculated from the load-displacement curve generated. Results For transverse fractures, headless compression screws had a significantly higher stiffness and peak load to failure, means 249.4 N/mm and 584.8 N, than plates, means 129.02 N/mm and 303.9 N (both p < 0.001). For long oblique fractures, stiffness and peak load to failure for headless compression screws were means 209 N/mm and 758.4 N, for plates 258.7 N/mm and 518.5 N, and for lag screws 172.18 N/mm and 234.11 N. There was significance in peak load to failure for headless compression screws vs plates (p = 0.023), headless compression screws vs lag screws (p < 0.001), and plates vs lag screws (p = 0.009). There was no significant difference in stiffness between groups. Conclusion Intramedullary fixation of diaphyseal metacarpal fractures with a headless compression screw provides excellent biomechanical stability. Coupled with lower risks for adverse effects, headless compression screws may be a preferable option for those requiring rapid return to sport or work. Level of evidence Basic Science Study, Biomechanics.

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Bone plate fixation ability on the dorsal and lateral sides of a metacarpal shaft transverse fracture

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02575-3 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yung-Cheng Chiu ◽

Cheng-En Hsu ◽

Tsung-Yu Ho ◽

Yen-Nien Ting ◽

Ming-Tzu Tsai ◽

...

Keyword(s):

Mechanical Strength ◽

Locking Plate ◽

Plate Fixation ◽

Shaft Fracture ◽

Bone Plate ◽

Lateral Side ◽

Lateral Plate ◽

Fracture Force ◽

Shaft Fractures ◽

Metacarpal Shaft

Abstract Background Metacarpal shaft fractures are a common hand trauma. The current surgical fixation options for such fractures include percutaneous Kirschner wire pinning and nonlocking and locking plate fixation. Although bone plate fixation, compared with Kirschner wire pinning, has superior fixation ability, a consensus has not been reached on whether the bone plate is better placed on the dorsal or lateral side. Objective The purpose of this study was to evaluate the fixation of locking and regular bone plates on the dorsal and lateral sides of a metacarpal shaft fracture. Materials and methods Thirty-five artificial metacarpal bones were used in the experiment. Metacarpal shaft fractures were created using a saw blade, which were then treated with four types of fixation as follows: (1) a locking plate with four locking bicortical screws on the dorsal side (LP_D); (2) a locking plate with four locking bicortical screws on the lateral side (LP_L); (3) a regular plate with four regular bicortical screws on the dorsal side (RP_D); (4) a regular plate with four regular bicortical screws on the lateral side (RP_D); and (5) two K-wires (KWs). All specimens were tested through cantilever bending tests on a material testing system. The maximum fracture force and stiffness of the five fixation types were determined based on the force–displacement data. The maximum fracture force and stiffness of the specimens with metacarpal shaft fractures were first analyzed using one-way analysis of variance and Tukey’s test. Results The maximum fracture force results of the five types of metacarpal shaft fracture were as follows: LP_D group (230.1 ± 22.8 N, mean ± SD) ≅ RP_D group (228.2 ± 13.4 N) > KW group (94.0 ± 17.4 N) > LP_L group (59.0 ± 7.9 N) ≅ RP_L group (44.5 ± 3.4 N). In addition, the stiffness results of the five types of metacarpal shaft fracture were as follows: LP_D group (68.7 ± 14.0 N/mm) > RP_D group (54.9 ± 3.2 N/mm) > KW group (20.7 ± 5.8 N/mm) ≅ LP_L group (10.6 ± 1.7 N/mm) ≅ RP_L group (9.4 ± 1.2 N/mm). Conclusion According to our results, the mechanical strength offered by lateral plate fixation of a metacarpal shaft fracture is so low that even KW fixation can offer relatively superior mechanical strength; this is regardless of whether a locking or nonlocking plate is used for lateral plate fixation. Such fixation can reduce the probability of extensor tendon adhesion. Nevertheless, our results indicated that when lateral plate fixation is used for fixating a metacarpal shaft fracture in a clinical setting, whether the mechanical strength offered by such fixation would be strong enough to support bone union remains questionable.

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Comparison of low-profile locking plate fixation versus antegrade intramedullary nailing for unstable metacarpal shaft fractures––A prospective comparative study

Injury ◽

10.1016/j.injury.2019.10.018 ◽

2019 ◽

Vol 50 (12) ◽

pp. 2252-2258 ◽

Cited By ~ 4

Author(s):

Soo Min Cha ◽

Hyun Dae Shin ◽

Yun Ki Kim

Keyword(s):

Comparative Study ◽

Intramedullary Nailing ◽

Locking Plate ◽

Plate Fixation ◽

Locking Plate Fixation ◽

Shaft Fractures ◽

Low Profile ◽

Metacarpal Shaft ◽

Prospective Comparative Study

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Comparison of Dorsal Plate Fixation Versus Intramedullary Headless Screw Fixation of Unstable Metacarpal Shaft Fractures

Hand ◽

10.1177/1558944716628485 ◽

2016 ◽

Vol 11 (4) ◽

pp. 421-426 ◽

Cited By ~ 5

Author(s):

Eitan Melamed ◽

Richard M. Hinds ◽

Michael B. Gottschalk ◽

Oran D. Kennedy ◽

John T. Capo

Keyword(s):

Locking Plate ◽

Plate Fixation ◽

Dorsal Plate ◽

Locking Plates ◽

Shaft Fractures ◽

Plate Group ◽

Metacarpal Shaft ◽

Load To Failure ◽

Group 5 ◽

Group 2

Background: Recently, intramedullary headless screw (IMHS) has shown promise as an alternative to dorsal plate fixation of metacarpal fractures. The purpose of this study was to assess the biomechanical performance of IMHS versus plating. We hypothesized that IMHS fixation provides inferior stability to plating. Methods: Metacarpal fracture model with 3-mm of volar gapping in forty-four human cadaveric metacarpals was created. The specimens were divided into 5 groups: Group 1, 1.5-mm non-locking plate; Group 2, 1.5-mm locking plate; Group 3, 2.0-mm non-locking plate; Group 4, 2.0-mm locking plate; and Group 5, 2.4-mm short cannulated IMHS. A 4-point bending model was used to assess load-to failure (LTF) and stiffness. Results: Mean LTF was 364 ± 130 N for 1.5-mm non-locking plates, 218 ± 94 N for 1.5-mm locking plates, 421 ± 86 N for 2.0-mm non-locking plates, 351 ± 71 N for 2.0-mm locking plates, and 75 ± 20 N for IMHS. Mean stiffness was 91 ± 12 N/mm for 1.5-mm non-locking plates, 110 ± 77 N/mm for 1.5-mm locking plates, 94 ± 20 N/mm for 2.0-mm non-locking plates, 135 ± 16 N/mm for 2.0-mm locking plates, and 55 ± 15 N/mm for IMHS. IMHS demonstrated significantly lower LTF and stiffness than plates. Conclusions: IMHS fixation of unstable metacarpal shaft fractures offers less stability compared to plating when loaded in bending. The LTF and stiffness of IMHS versus plating of metacarpal shaft fractures has not been previously quantified. Our results reveal that IMHS fixation is less favorable biomechanically and should be carefully chosen in regards to fracture stability.

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Four-Corner Fusion with Locking Dorsal Circular Plate versus Headless Compression Screws: A Clinico-Radiological Comparative Study

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0041-1739239 ◽

2021 ◽

Vol 49 (02) ◽

pp. e105-e114

Author(s):

Francisco R. Melibosky ◽

Rene A. Jorquera ◽

Felipe Z. Saxton ◽

Pablo Orellana ◽

Diego Junqueras ◽

...

Keyword(s):

Surgical Technique ◽

Comparative Study ◽

Range Of Motion ◽

Circular Plate ◽

Locking Plate ◽

Plate Versus ◽

Fixation Method ◽

Union Rate ◽

Non Union ◽

Headless Compression Screws

Abstract Introduction Four-corner fusion is a technique for the treatment of carpal advanced collapse. It consists of scaphoid excision and arthrodesis of the lunate, triquetrum, hamate, and capitate bones. This can be accomplished with different kinds of osteosynthesis. In the first reports of the use of a circular plate, poor outcomes are described, with high rates of non-union, which decreased in later studies, which highlight certain aspects of the surgical technique. Objective To report our experience with four-corner fusion with the use of a dorsal locking plate (Xpode, Trimed Inc., Santa Clarita, CA, US), and compare it with another traditional fixation method (3.0-mm headless compression screws [HCSs], Synthes, Slothurn, Switzerland), with an emphasis on union, an assessment of the fincitonal outcomes, and the presence of complications. Material and Methods A comparative study of two prospective series of patients operated on through two fixation techniques for four-corner fusion using autologous bone graft from the iliac crest.The first group of patients, evaluated between 2010 and 2012, underwent osteosynthesis with 2 HCSs, with a minimum follow up of 18 months. The second group, evaluated between 2011 and 2014, underwent osteosynthesis with a dorsal locking plate, with a minimium foloow up of 12 months. The patients were operated on by four different surgeons in four centers.The patients were evaluated with radiographs to establish the presence of union and the time it took to occur. In case of doubt, union was confirmed through a computed tomography (CT) scan at 8 weeks postoperatrively. We also assessed the range of motion, the presence of complications, and function through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and a grip strength score. Results We achieved a union rate of 100% in both groups at similar times. In the dorsal locking plate group, we obtained better full range of motion, particularly in wrist extension, which was statistically significant (p = 0.0016), as well as lower DASH scores, which was also statistically significant (p = 0.0066). Complications were only present in two patients in the HCS group. Conclusion Both techniques are valid and reproducible for the treatment of wrists with scapholunate advanced collapse (SNAC) and scaphoid non-union advanced collapse (SLAC). Based on the outcomes, with the Xpode plate, the patients presented better ranges of motion and DASH scores; therefore it may be an excellent fixation option in the open four-corner fusion surgical technique. The entry point and configuration of the HCS are fundamental variables to analyze.The union rate of 100% obtained in the present study contrasts with the high rates of non-union reported in the literature published in the early 2000s.

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