Biomechanical Evaluation of Fixation of Intra-Articular Fractures of the Distal Part of the Radius in Cadavera

Yetkinler, Duran N.; Ladd, Amy L.; Poser, Robert D.; Constantz, Brent R.; Carter, Dennis

doi:10.2106/00004623-199903000-00012

Cited by 94 publications

(49 citation statements)

References 18 publications

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“…Forces were consistent with previously published biomechanical testing of distal radius fixation and studies demonstrating that light active motion of the wrist and wrist with finger motion does not exceed 250N. (12,15,(17)(18)(19)(20)(21)(22)(23)(24) Gondusky et al and Weninger et al identified in prior distal radius mechanical testing that all changes attributable to cyclic loading occurred in the first 200-500 cycles, thus we deemed 1,000 cycles sufficient to condition the constructs. (11,(13)(14)(15)(16) Destructive testing was completed to determine load (N) to clinical failure which was defined as 2mm of displacement at the osteotomy gap, (10) and subsequent catastrophic failure, defined as complete closure of the 1 cm osteotomy gap and or fracture.…”

Section: Biomechanical Testingsupporting

confidence: 87%

The Effects of Screw Length on Stability of Simulated Osteoporotic Distal Radius Fractures Fixed with Volar Locking Plates

Wall¹,

Brodt²,

Silva³

2012

The Journal of Hand Surgery

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Purpose-Volar plating for distal radius fractures has caused extensor tendon ruptures secondary to dorsal screw prominence. This study was designed to determine the biomechanical impact of placing unicortical distal locking screws and pegs in an extra-articular fracture model.Methods-Volar-locking distal radius plates were applied to 30 osteoporotic distal radius models. Radii were divided into 5 groups based on distal locking fixation: bicortical locked screws, 3 lengths of unicortical locked screws (abutting the dorsal cortex [full length], 75% length, and 50% length to dorsal cortex), and unicortical locked pegs. Distal radius osteotomy simulated a dorsally comminuted, extra-articular, fracture. Each constructs stiffness was determined under physiologic loads (axial compression, dorsal bending volar bending) before and after 1000 cycles of axial conditioning and prior to axial loading to failure (2mm of displacement) and subsequent catastrophic failure.Results-Cyclic conditioning did not alter constructs stiffness. Stiffness to volar bending and dorsal bending forces were similar between groups. Final stiffness(N/mm) under axial load was statistically equivalent for all groups: bicortical screws(230), full-length unicortical screws(227), 75% length unicortical screws(226), 50% length unicortical screws(187), unicortical pegs(226). Force(N) at 2 mm displacement was significantly less for 50% length unicortical screws(311) compared to bicortical screws(460), full-length unicortical screws(464), 75% length unicortical screws(400), and unicortical pegs(356). Force(N) to catastrophic fracture was statistically equivalent between groups but mean values for pegs(749) and 50% length unicortical(702) screws were 16-21% less than means for bicortical(892), full-length unicortical(860), and 75% length(894) unicortical constructs.Discussion-Locked unicortical distal screws of at least 75% length produce construct stiffness similar to bicortical fixation. Unicortical distal fixation for extra-articular distal radius fractures should be entertained to avoid extensor tendon injury since it does not appear to compromise initial fixation. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access

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Section: Biomechanical Testingsupporting

confidence: 87%

The Effects of Screw Length on Stability of Simulated Osteoporotic Distal Radius Fractures Fixed with Volar Locking Plates

Wall¹,

Brodt²,

Silva³

2012

The Journal of Hand Surgery

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“…[6][7][8][9][10] Remodellable bone cements such as Norian SRS can be used in a similar way to provide immediate stability and to shorten the length of immobilisation, with the added advantages of availability, biological acceptance and high compressive strength. [15][16][17][18][19] The choice of conservative treatment for the control group in our study is debatable. Immobilisation in a cast is known to be unsuccessful for unstable fractures of the distal radius, 1 but other techniques including open bone grafting and bridging external fixation give similar functional results.…”

Section: Discussionmentioning

confidence: 87%

“…15 In a cadaver study, Norian SRS provided more stability than Kirschner wires for intraarticular fractures of the distal radius. 16 Two short clinical series have shown that this product can be safely used for these fractures 17,18 and one study has compared Norian SRS with external fixation. 19 A comparison of SRS with conservative treatment has not previously been reported.…”

mentioning

confidence: 99%

Treatment of fractures of the distal radius with a remodellable bone cement

Sánchez-Sotelo

Munuera

Madero

2000

The Journal of Bone and Joint Surgery. British volume

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We performed a prospective, randomised study on 110 patients more than 50 years old with fractures of the distal radius to compare the outcome of conservative treatment with that using remodellable bone cement (Norian skeletal repair system, SRS) and immobilisation in a cast for two weeks.Patients treated with SRS had less pain and earlier restoration of movement and grip strength. The results at one year were satisfactory in 81.54% of the SRS patients and 55.55% of the control group. The rates of malunion were 18.2% and 41.8%, respectively. There was a significant relationship between the functional and radiological results. Soft-tissue extrusion was present initially in 69.1% of the SRS patients; most deposits disappeared progressively, but persisted in 32.73% at one year.We conclude that the injection of a remodellable bone cement into the trabecular defect of fractures of the distal radius provides a better clinical and radiological result than conventional treatment.

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“…In a mechanical study by Stankewich et al (1996), augmentation with calcium phosphate cement provided enhanced stiffness, stability and strength of fixed femoral neck fractures. When resorbable substances are used, the idea is that the initial reinforcement will be followed by progressive resorption over timeassociated with a simultaneous increase in structural support provided by the healing bone (Witschger et al 1991, Constantz et al 1995, Kopylov et al 1996, Stankewich et al 1996, Mainil et al 1997, Moore et al 1997, Frankenburg et al 1998, Goodman et al 1998, Knaack et al 1998, Yetkinler et al 1999, Larsson and Bauer 2002.…”

mentioning

confidence: 99%

Calcium phosphate cement for augmentation did not improve results after internal fixation of displaced femoral neck fractures: A randomized study of 118 patients

Mattsson

Larsson

2006

Acta Orthopaedica

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Background We wanted to evaluate whether augmentation with calcium phosphate cement can improve clinical and functional outcome following internal fixation of displaced femoral neck fractures.Patients 118 patients aged 60-98 years (95 women) were included. All patients were physically active and ambulatory before the fracture. Patients were randomized to treatment with closed reduction and fixation with two cannulated screws alone (controls: 60 patients) or screws combined with injection of calcium phosphate for augmentation around the screw threads and at the fracture site (augmented: 58 patients). All patients were allowed free weight bearing. Clinical and radiographic examinations were done by a physiotherapist directly after surgery, at 1 and 6 weeks, and at 6, 12 and 24 months.Results 24 patients, 14 augmented and 10 controls, died during the follow-up. There was 1 deep infection (augmented). Another 34 patients were reoperated with a total arthroplasty (20 in the augmented group and 14 controls) due to loss of reduction, nonunion or avascular necrosis (p = 0.1). There was no difference in pain or muscle strength between groups. Some activities of daily living (ADLs) were slightly better in the augmented patients during the first weeks, while there were no differences between groups later on.Interpretation Due to a trend towards more reoperations in the augmented group, and only a temporary clinical improvement during the early rehabilitation, augmentation as we used it cannot be recommended.

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Biomechanical Evaluation of Fixation of Intra-Articular Fractures of the Distal Part of the Radius in Cadavera

Cited by 94 publications

References 18 publications

The Effects of Screw Length on Stability of Simulated Osteoporotic Distal Radius Fractures Fixed with Volar Locking Plates

The Effects of Screw Length on Stability of Simulated Osteoporotic Distal Radius Fractures Fixed with Volar Locking Plates

Treatment of fractures of the distal radius with a remodellable bone cement

Calcium phosphate cement for augmentation did not improve results after internal fixation of displaced femoral neck fractures: A randomized study of 118 patients

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