Background: Surgical fixation of comminuted mid-shaft clavicle fractures commonly employs intramedullary devices; however, pins with smooth surfaces are prone to migration, whilst threaded pins can be challenging to remove post-operatively. The aim of this study was to evaluate the biomechanical performance of fractured clavicles repaired using a novel intramedullary Echidna pin device and a non-threaded Knowles pin. The Echidna pin features retractable spines that engage with the bone to minimize migration and facilitate ease of device removal. Methods: A total of 28 cadaveric clavicle specimens were harvested and a mid-shaft wedge-shaped osteotomy was performed to simulate a comminuted butterfly fragment. Specimens were allocated randomly to either the Echidna pin or Knowles pin fracture repair groups. Following surgery, eight specimens in each group underwent 200 cycles of fourpoint bending, whilst six specimens in each group underwent torsional testing and pull-out. Cyclic construct bending stiffness, torsional stiffness and ultimate strength were recorded. Results: Echidna pin intramedullary repair constructs showed significantly greater bending stiffness (mean difference 0.55 N.m/ , 95% confidence interval −0.96, −0.14, P = 0.01) and pull-out strength (mean difference 146.03 N, 95% confidence interval 29.14, 262.92, P = 0.019) in comparison to Knowles pin constructs. There was no significant difference in torsional stiffness between Echidna pin and Knowles pin repair constructs (P > 0.05). Conclusion: The intramedullary Echidna pin device, which exhibits greater bending strength and pull-out strength than that of the Knowles pin, may produce a more stable clavicle fracture reduction compared to that of commercially available threadless intramedullary pins.
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