A Comparison of Plate Versus Screw Fixation for Segmental Scaphoid Fractures: A Biomechanical Study

Background: Volar locking plate fixation may offer several advantages over headless screw fixation for scaphoid nonunion, or segmental or comminuted fractures: (1) increased surface area for bony healing; (2) preserved vascularity; and (3) maintenance of a gap for graft insertion. The purpose of this study is to compare headless screw and locking plate fixation of segmental scaphoid fractures and to determine whether either fixation provides a greater mechanical advantage in osteoporotic versus nonosteoporotic bone. Methods: Sixteen matched-pair cadaver scaphoids were dissected from a range of osteoporotic and nonosteoporotic specimens. Scaphoids from each matched pair were randomly assigned to either volar locking plate or compression screw fixation. A 3-mm segment of bone was circumferentially excised from each scaphoid waist to simulate a segmental defect. Implants were applied, and each specimen was then loaded in axial compression. Load to failure was defined as the load required to achieve gap closure. Mechanism of failure, load to failure, and percent gap recovery were recorded for each trial. Results: Gap closure occurred in all trials. Difference in load to failure was not statistically significant between plate and screw fixation in either nonosteoporotic or osteoporotic cadaver specimens. However, percent gap recovery was significantly higher for plate fixation than for screw fixation. Conclusions: In scaphoid fractures with segmental defect, plate and screw fixation demonstrate similar loads to failure, but plate fixation performs superiorly to screw fixation for gap recovery after an applied load to failure.

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A Biomechanical Comparison of Screw and Plate Fixations for Scaphoid Fractures

Journal of Wrist Surgery ◽

10.1055/s-0037-1606123 ◽

2017 ◽

Vol 07 (01) ◽

pp. 077-080 ◽

Cited By ~ 6

Author(s):

Paulo Castañeda ◽

Patricia Drace ◽

Scott Edwards ◽

Jill Goodwin

Keyword(s):

Locking Plate ◽

Screw Fixation ◽

Plate Fixation ◽

Biomechanical Testing ◽

Osteoporotic Bone ◽

Segmental Defect ◽

Normal Density ◽

Compression Screw ◽

Scaphoid Fractures ◽

Load To Failure

Background Headless screw fixation is the current gold standard of surgical repair for scaphoid fractures. However, maintaining reduction of certain types of scaphoid fractures is challenging with a compression screw. Plate fixation may offer superior fixation in some scaphoid fractures, particularly those with comminution, nonunion, segmental bony defects, and osteopenic or osteoporotic bone. Purpose This study questions whether method of fixation is a determinant in load to failure in segmental scaphoid fractures, and whether any fixation provides a greater mechanical advantage in simulated normal versus osteoporotic bone. Materials and Methods Polyurethane models were fashioned to simulate scaphoids with 3-mm segmental defects. Defects were bridged by one of three constructs: a locking plate, a nonlocking plate, or a headless compression screw. Three models for each fixation construct were tested for both simulated normal and osteoporotic bone density. Load to failure was recorded as the load at which the 3-mm segmental defect was closed. Results Gap closure occurred in all trials. In simulated normal bone, there were no statistically significant differences in load to failure between fixation methods. In simulated osteoporotic bone, the locking plate had a 28% greater load to failure as compared with screw fixation. Conclusion While biomechanical testing shows that plate and screw fixations are equivalent in normal density bone for fixation of a segmental scaphoid defect, locking plates are superior to screw fixation in simulated osteoporotic bone models. Clinical Relevance Plate fixation may provide superior fixation for complex scaphoid fractures, particularly in osteopenic bone.

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Loss of radial height in extra-articular distal radial fracture following volar locking plate fixation

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2021.102842 ◽

2021 ◽

pp. 102842

Author(s):

Ming Fai Cheng ◽

Chao-Ching Chiang ◽

Chun-Cheng Lin ◽

Ming-Chau Chang ◽

Chien-Shun Wang

Keyword(s):

Locking Plate ◽

Plate Fixation ◽

Distal Radial Fracture ◽

Volar Locking Plate ◽

Radial Fracture ◽

Locking Plate Fixation

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Complications following volar locking plate fixation for distal radial fractures: a systematic review

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413511936 ◽

2013 ◽

Vol 39 (7) ◽

pp. 745-754 ◽

Cited By ~ 46

Author(s):

A. Bentohami ◽

K. de Burlet ◽

N. de Korte ◽

M. P. J. van den Bekerom ◽

J. C. Goslings ◽

...

Keyword(s):

Systematic Review ◽

Quality Assessment ◽

Locking Plate ◽

Assessment Tool ◽

Plate Fixation ◽

Assessment Tools ◽

Volar Locking Plate ◽

Locking Plate Fixation ◽

Distal Radial Fractures ◽

Level Of Evidence

The purpose of this systematic review is to assess the prevalence of complications following volar locking plate fixation of distal radial fractures. A computer-based search was carried out using EMBASE and PUBMED/MEDLINE. Only prospective comparative and prospective cohort studies that presented data concerning complications after treatment of distal radial fractures with a volar locking plate in human adults with a minimal follow-up of 6 months were included. Two quality assessment tools were used to assess the methodological quality of the studies (level of evidence rating according to the Oxford Centre of Evidence Based Medicine and the modified version of the Cochrane Bone, Joint and Muscle Trauma Group’s former quality assessment tool). Thirty three studies were eligible for final assessment. Most complications were problems with nerve and tendon function as well as complex regional pain syndrome. With an overall complication rate of 16.5%, most of which were ‘minor’ complications and low rates of nonunion and malunion, volar locking plate fixation can be considered a reasonably safe treatment option for patients with distal radial fractures.

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