Biomechanical Evaluation of Different Plate Configurations for Midshaft Clavicle Fracture Fixation
Background:. Dual-plate constructs have become an increasingly common fixation technique for midshaft clavicle fractures and typically involve the use of mini-fragment plates. The goal of this technique is to reduce plate prominence and implant irritation. However, limited biomechanical data exist f...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2022-03-01
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| Series: | JBJS Open Access |
| Online Access: | http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.21.00123 |
| _version_ | 1811188343231217664 |
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| author | Joep Kitzen, MD, PhD Kent Paulson, MSc Robert Korley, MD, FRCSC Paul Duffy, MD, FRCSC C. Ryan Martin, MD, FRCSC Prism S. Schneider, MD, PhD, FRCSC |
| author_facet | Joep Kitzen, MD, PhD Kent Paulson, MSc Robert Korley, MD, FRCSC Paul Duffy, MD, FRCSC C. Ryan Martin, MD, FRCSC Prism S. Schneider, MD, PhD, FRCSC |
| author_sort | Joep Kitzen, MD, PhD |
| collection | DOAJ |
| description | Background:. Dual-plate constructs have become an increasingly common fixation technique for midshaft clavicle fractures and typically involve the use of mini-fragment plates. The goal of this technique is to reduce plate prominence and implant irritation. However, limited biomechanical data exist for these lower-profile constructs. The study aim was to compare dual mini-fragment orthogonal plating with small-fragment clavicle plates for biomechanical noninferiority and to determine if an optimal plate configuration could be identified using a cadaveric model.
Methods:. Twenty-four cadaveric clavicles were randomized to 1 of 6 groups, stratified by computed tomography-based bone mineral content (BMC): precontoured superior or anterior fixation using a single 3.5-mm Locking Compression Plate (LCP), and 4 different dual-plating constructs utilizing 2.4-mm and 2.7-mm Adaptation plates or LCPs. An inferior butterfly fracture was created. Axial, torsional, and bending (anterior and superior surface loading) stiffnesses were determined through nondestructive cyclic testing, followed by a load-to-failure test in 3-point superior surface bending.
Results:. For axial stiffness, the 2 dual-plate constructs with a superior 2.4-mm and anterior 2.7-mm plate (either Adaptation or LCP) were significantly stiffer than the other 4 constructs (p = 0.021 and p = 0.034). For both superior and anterior bending, the superior 2.4-mm and anterior 2.7-mm plate constructs were significantly stiffer when compared with the 3.5-mm superior plate (p = 0.043). No significant differences were found in torsional stiffness or load to failure between the different constructs.
Conclusions:. Dual plating using mini-fragment plates is biomechanically superior for the fixation of midshaft clavicle fractures when compared with a single, superior, 3.5-mm plate and has biomechanical properties similar to those of a 3.5-mm plate placed anteriorly. With the exception of axial stiffness, no significant differences were found when different dual-plating constructs were compared with each other.
Clinical Relevance:. This study validates the use of dual plating for midshaft clavicle fractures. |
| first_indexed | 2024-04-11T14:18:42Z |
| format | Article |
| id | doaj.art-2a0c88cd66d64d90a03d3075a20b8210 |
| institution | Directory Open Access Journal |
| issn | 2472-7245 |
| language | English |
| last_indexed | 2024-04-11T14:18:42Z |
| publishDate | 2022-03-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | JBJS Open Access |
| spelling | doaj.art-2a0c88cd66d64d90a03d3075a20b82102022-12-22T04:19:08ZengWolters KluwerJBJS Open Access2472-72452022-03-017110.2106/JBJS.OA.21.00123JBJSOA2100123Biomechanical Evaluation of Different Plate Configurations for Midshaft Clavicle Fracture FixationJoep Kitzen, MD, PhD0Kent Paulson, MSc1Robert Korley, MD, FRCSC2Paul Duffy, MD, FRCSC3C. Ryan Martin, MD, FRCSC4Prism S. Schneider, MD, PhD, FRCSC51 Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada2 McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada1 Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada1 Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada1 Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada1 Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, CanadaBackground:. Dual-plate constructs have become an increasingly common fixation technique for midshaft clavicle fractures and typically involve the use of mini-fragment plates. The goal of this technique is to reduce plate prominence and implant irritation. However, limited biomechanical data exist for these lower-profile constructs. The study aim was to compare dual mini-fragment orthogonal plating with small-fragment clavicle plates for biomechanical noninferiority and to determine if an optimal plate configuration could be identified using a cadaveric model. Methods:. Twenty-four cadaveric clavicles were randomized to 1 of 6 groups, stratified by computed tomography-based bone mineral content (BMC): precontoured superior or anterior fixation using a single 3.5-mm Locking Compression Plate (LCP), and 4 different dual-plating constructs utilizing 2.4-mm and 2.7-mm Adaptation plates or LCPs. An inferior butterfly fracture was created. Axial, torsional, and bending (anterior and superior surface loading) stiffnesses were determined through nondestructive cyclic testing, followed by a load-to-failure test in 3-point superior surface bending. Results:. For axial stiffness, the 2 dual-plate constructs with a superior 2.4-mm and anterior 2.7-mm plate (either Adaptation or LCP) were significantly stiffer than the other 4 constructs (p = 0.021 and p = 0.034). For both superior and anterior bending, the superior 2.4-mm and anterior 2.7-mm plate constructs were significantly stiffer when compared with the 3.5-mm superior plate (p = 0.043). No significant differences were found in torsional stiffness or load to failure between the different constructs. Conclusions:. Dual plating using mini-fragment plates is biomechanically superior for the fixation of midshaft clavicle fractures when compared with a single, superior, 3.5-mm plate and has biomechanical properties similar to those of a 3.5-mm plate placed anteriorly. With the exception of axial stiffness, no significant differences were found when different dual-plating constructs were compared with each other. Clinical Relevance:. This study validates the use of dual plating for midshaft clavicle fractures.http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.21.00123 |
| spellingShingle | Joep Kitzen, MD, PhD Kent Paulson, MSc Robert Korley, MD, FRCSC Paul Duffy, MD, FRCSC C. Ryan Martin, MD, FRCSC Prism S. Schneider, MD, PhD, FRCSC Biomechanical Evaluation of Different Plate Configurations for Midshaft Clavicle Fracture Fixation JBJS Open Access |
| title | Biomechanical Evaluation of Different Plate Configurations for Midshaft Clavicle Fracture Fixation |
| title_full | Biomechanical Evaluation of Different Plate Configurations for Midshaft Clavicle Fracture Fixation |
| title_fullStr | Biomechanical Evaluation of Different Plate Configurations for Midshaft Clavicle Fracture Fixation |
| title_full_unstemmed | Biomechanical Evaluation of Different Plate Configurations for Midshaft Clavicle Fracture Fixation |
| title_short | Biomechanical Evaluation of Different Plate Configurations for Midshaft Clavicle Fracture Fixation |
| title_sort | biomechanical evaluation of different plate configurations for midshaft clavicle fracture fixation |
| url | http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.21.00123 |
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