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

Hand ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. 421-426 ◽  
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.

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

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.

scholarly journals Comparing biomechanical strength of unicortical locking plate versus bicortical compression plate for transverse midshaft metacarpal fracture

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880251
Author(s):  
Rukmanikanthan Shanmugam ◽  
Chong Yin Chyi@ Chong Shyh Jian ◽  
Amber Haseeb ◽  
Saw Aik
Keyword(s):  
Locking Plate ◽  
Flexor Tendon ◽  
Plate Fixation ◽  
Metacarpal Fracture ◽  
Three Point Bending ◽  
Plate Group ◽  
Compression Plate ◽  
Load To Failure ◽  
Cyclical Loading ◽  
Biomechanical Strength

Purpose: Metacarpal bone fractures constitute 10% of all fractures. Unstable metacarpal fractures require surgical intervention, which poses danger to flexor tendon either due to bicortical drilling or construct of the implant. Unicortical locking plate fixation may be the solution to preventing flexor tendon injury. Studies have compared locking and compression plates. However, in these studies, the biomechanical properties were tested using the static loading method. This study looks into cyclical loading that is more representative of in vivo conditions, particularly for early rehabilitation. We compared the biomechanical strength of the unicortical locking plate and bicortical compression plate system in a transverse metacarpal fracture, tested with cyclical loading and torsion. Method: Twenty pieces of fourth-generation, biomechanical testing grade, left third metacarpal composite bones were used. Resin was used to create the holding block at both ends of the bone. An oscillating saw with 0.8 mm thick saw blade was used to osteotomize the metacarpal sawbones to create a midshaft transverse metacarpal fracture model. Ten pieces were fixed with a 2.0 mm titanium locking plate via unicortical screw purchase and 10 were fixed with a 2.0 mm, four holes, titanium dynamic compression plate, bicortical purchase of screws. They were subjected to cyclic load to failure testing three-point bending and torsion. Results: There were no significant difference in stiffness and cyclic three-point bending to failure between the unicortical locking plate group and the bicortical compression plate group. The bicortical compression plate group is stiffer and has a higher cyclic bending load to failure as compared to the unicortical locking plate group. Conclusion: Unicortical locking plate fixation of metacarpal fracture can be reliably applied clinically to produce a strong and stable construct that allows early mobilization of the joints. This will not only reduce the complication rate of metacarpal plating, but also improve the functional outcome of the hand.

scholarly journals A Comparison of Locking Plates and Intramedullary Pinning for Fixation of Metacarpal Shaft Fractures

Hand ◽  
2018 ◽  
Vol 14 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Daniel Dreyfuss ◽  
Raviv Allon ◽  
Nufar Izacson ◽  
Dan Hutt
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Dash Score ◽  
Locking Plates ◽  
Shaft Fractures ◽  
Plate Group ◽  
Radiographic Measurements ◽  
Metacarpal Shaft ◽  
Intramedullary Pinning ◽  
Contralateral Hand

Background: Metacarpal shaft fractures that necessitate surgery are frequently fixated with either intramedullary pins or plates and screws. This study compared outcome measurements of these two techniques. Methods: Patients operated on for closed shaft fractures of metacarpals 2-5 were examined at least 1 year after injury. All fractures were fixated by pinning between years 2013 and 2015 and by locking plates and screws between 2016 and 2017. Evaluation included range of motion measurements for all fingers compared with the contralateral hand; comparison of grip strength; finger alignment and rotation; Disabilities of the Arm, Shoulder and Hand (DASH) score; and radiographic measurements of fracture reduction and healing. Results: Thirty patients with 39 fractured metacarpals treated by pinning were compared with 29 patients with 35 fractured metacarpals treated by locking plate and screws. Both groups had similar characteristics and preoperative fracture patterns on radiograph. Patients in the plate group were found to have significantly improved outcomes in total range of motion of the operated digits (loss of 4° extension, 10° flexion, and 14° total vs 10° extension, 19° flexion, and 29° total), grip strength (93% vs 83% of contralateral hand), rotational deformity (5 digits, 1° vs 15 digits, 6°), and DASH score (10.5 vs 15.6). Radiographic bone healing time (59 vs 50 days) and operative time (58 vs 41 minutes) were both significantly longer in fractures fixated by plates. Conclusions: Fixation with locking plates allows earlier mobilization without need for splinting. Our study supports the use of this method over intramedullary pinning for metacarpal shaft fractures.

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

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.

Intramedullary screw fixation for metacarpal shaft fractures: a biomechanical human cadaver study

2020 ◽  
Vol 45 (6) ◽  
pp. 595-600
Author(s):  
Raffael Labèr ◽  
David Jann ◽  
Pascal Behm ◽  
Stephen J. Ferguson ◽  
Florian S. Frueh ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Cadaver Study ◽  
Human Cadaver ◽  
Active Motion ◽  
Shaft Fractures ◽  
Metacarpal Shaft ◽  
Lower Load ◽  
Strength And Stiffness ◽  
Increasing Cyclic Loading ◽  
Intramedullary Screw

Intramedullary cannulated compression screws have been introduced for the fixation of unstable metacarpal fractures. In the present study, this technique was compared with dorsal compression plating to evaluate its biomechanical performance in stabilizing metacarpal shaft fractures. In a first set of experiments, the biomechanical characteristics of the screws were analysed in an artificial bone model. In subsequent experiments, midshaft osteotomies were performed in human cadaver metacarpals, followed by plating or intramedullary screw osteosynthesis. The metacarpals were tested to failure in cantilever bending, following a stepwise increasing cyclic loading protocol. We found a significantly lower load at failure and a significantly lower number of cycles to failure in the intramedullary screw group, but both methods offered sufficient stability under these loads. With reference to published loads on the metacarpals during use of the hand, we conclude that intramedullary osteosynthesis yields sufficient strength and stiffness for early active motion. A difference in its fixation stability is noted compared with plate fixation, which may not be clinically relevant.

scholarly journals A Biomechanical Evaluation of a Next-Generation Integrated and Modular ACDF Device Possessing Full-Plate, Half-Plate, and No-Profile Fixation Iterations

2019 ◽  
Vol 9 (8) ◽  
pp. 826-833
Author(s):  
Ripul Panchal ◽  
Anup Gandhi ◽  
Chris Ferry ◽  
Sam Farmer ◽  
Jeremy Hansmann ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Testing Machine ◽  
Axial Rotation ◽  
Biomechanical Study ◽  
The Novel ◽  
Novel Device ◽  
Plate Group ◽  
Flexion Extension ◽  
Group 2

Study Design: In vitro biomechanical study. Objectives: The objective of this in vitro biomechanical range-of-motion (ROM) study was to evaluate spinal segmental stability following fixation with a novel anterior cervical discectomy and fusion (ACDF) device (“novel device”) that possesses integrated and modular no-profile, half-plate, and full-plate fixation capabilities. Methods: Human cadaveric (n = 18, C3-T1) specimens were divided into 3 groups (n = 6/group). Each group would receive one novel device iteration. Specimen terminal ends were potted. Each specimen was first tested in an intact state, followed by anterior discectomy (C5/C6) and iterative instrumentation. Testing order: (1) novel device (group 1, no-profile; group 2, half-plate; group 3, full-plate); (2) novel device (all groups) with lateral mass screws (LMS); (3) traditional ACDF plate + cage; (4) traditional ACDF plate + cage + LMS. A 2 N·m moment was applied in flexion/extension (FE), lateral bending (LB), and axial rotation (AR) via a kinematic testing machine. Segmental ROM was tracked and normalized to intact conditions. Comparative statistical analyses were performed. Results: Key findings: (1) the novel half- and full-plate constructs provided comparable reduction in FE and LB ROM to that of traditional plated ACDF ( P ≥ .05); (2) the novel full-plate construct significantly exceeded all other anterior-only constructs ( P ≤ .05) in AR ROM reduction; and (3) the novel half-plate construct significantly exceeded the no-profile construct in FE ( P < .05). Conclusions: The novel ACDF device may be a versatile alternative to traditional no-profile and independent plating techniques, as it provides comparable ROM reduction in all principle motion directions, across all device iterations.

scholarly journals Biomechanical Analysis of the Efficacy of Locking Plates during Cyclic Loading in Metacarpal Fractures

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Stefanie Doht ◽  
Rainer H. Meffert ◽  
Michael J. Raschke ◽  
Torsten Blunk ◽  
Sabine Ochman
Keyword(s):  
Cyclic Loading ◽  
Locking Plate ◽  
Screw Fixation ◽  
Maximum Load ◽  
Biomechanical Analysis ◽  
Locking Plates ◽  
Functional Rehabilitation ◽  
Metacarpal Bones ◽  
Load To Failure ◽  
Bicortical Screw

Purpose.To analyse the biomechanical characteristics of locking plates under cyclic loading compared to a nonlocking plate in a diaphyseal metacarpal fracture.Methods.Oblique diaphyseal shaft fractures in porcine metacarpal bones were created in a biomechanical fracture model. An anatomical reduction and stabilization with a nonlocking and a comparable locking plate in mono- or bicortical screw fixation followed. Under cyclic loading, the displacement, and in subsequent load-to-failure tests, the maximum load and stiffness were measured.Results.For the monocortical screw fixation of the locking plate, a similar displacement, maximum load, and stiffness could be demonstrated compared to the bicortical screw fixation of the nonlocking plate.Conclusions.Locking plates in monocortical configuration may function as a useful alternative to the currently common treatment with bicortical fixations. Thereby, irritation of the flexor tendons would be avoided without compromising the stability, thus enabling the necessary early functional rehabilitation.

scholarly journals Fixation of proximal humerus fracture in adult by locking plate: Clinical study

2020 ◽  
Vol 6 (5) ◽  
pp. 325-332
Author(s):  
Dr. Vivek Amritbhai Patel ◽  
◽  
Dr. Vishal A. Pushkarna ◽  
Dr. Dhruvin J. Patel ◽  
◽  
...  
Keyword(s):  
Functional Outcome ◽  
Proximal Humerus Fracture ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Plate Fixation ◽  
Humeral Fracture ◽  
Humerus Fracture ◽  
Functional Evaluation ◽  
Locking Plates ◽  
Radiological Union

p>Aim: The present study aimed to examine the functional outcome of the locking plate in theproximal humerus fracture treatment. Material and Methods: The study consists of 20 patientsdiagnosed with NEER’s 2 – part, 3- part, and 4 – part proximal humerus fracture. All the includedpatients were treated with internal locking plates. Based on the functional evaluation by Constant-Murley shoulder score and the assessment of radiological union foundation. Results: Excellentresults were obtained in 45% of the patients, a good result was seen in 25%, 20% of the patientshad fair results and the poor result was seen in 10% of the patients. The mean Constant-Murleyshoulder score that was obtained in the present study was 75.04. Conclusion: It’s concluded thatthere is a satisfactory functional outcome with the fixation of the proximal humerus fracture withlocking plates. While using the plate fixation for fracture the plate position is of the utmostimportance. Due to angular stability, the locking plates are the advantageous implants in case ofproximal humeral fracture.

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