Complex Distal Humerus Fractures—Comparison of Polyaxial Locking and Nonlocking Screw Configurations—A Preliminary Biomechanical Study

Hungerer, Sven; Wipf, Felix; Oldenburg, Geert von; Augat, Peter; Penzkofer, Rainer

doi:10.1097/bot.0b013e31829d19a4

Cited by 24 publications

(17 citation statements)

References 28 publications

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“…Considering the fact that the elbow will only be loaded carefully during the first weeks of post-operative fracture care, the median fatigue limit appears to be sufficient for all plate configurations to endure the time for normal fracture healing. The values for stiffness and fatigue are in good agreement with results from previous studies on similar implant configurations [5,14]. The design of recent locked plating systems provides the opportunity for poly-axial screw placement.…”

Section: Discussionsupporting

confidence: 80%

“…The fixation methods evolved into the present third generation of locking plates which include anatomical plate design and poly-axial locking screws. These features aim at rigid stability to allow early mobilization as well as adequate stiffness to stimulate fracture healing [5]. The preferred plating techniques for comminuted distal humeral fractures include the Mayo clinic configuration (180°between plates) with parallel plate fixation and medial and lateral plate positioning as well as the AO/ASIF configuration (90°angle between plates) with perpendicular plate fixation and medial and postero-lateral plate positioning [3,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical comparison of anatomical plating systems for comminuted distal humeral fractures

Varady

Rüden

Greinwald

et al. 2017

International Orthopaedics (SICOT)

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Purpose Six different mono-axial and poly-axial distal humeral plating systems with an anatomical plate design were compared. The aim of the biomechanical tests was to examine differences regarding system stiffness, median fatigue limit, and failure mechanisms. Methods Different configurations of two double plate fixation systems by two manufacturers for the treatment of complex distal humeral fractures (AO/OTA type C2.3) were biomechanically tested in a physiologically relevant setup. Results The 180°Stryker configuration presented itself as the system with the highest stiffness, being significantly stiffer (p < 0.001) than every system other than the poly-axial 180°aap system (p = 0.378). For the median fatigue limit the 180°S tryker and poly-axial aap systems were ranked first and second. The failure mechanism for all 90°systems was a fatigue breakage of the posterolateral plate. The 180°aap systems demonstrated breakage of the most distal screws of the lateral plate. The 180°Stryker system demonstrated screw breakage on both the medial and lateral plates. Discussion Breakage of the posterolateral plate as a failure mechanism for the 90°systems was expected. The 180°s ystems demonstrated a higher stiffness compared to the 90°c onstructs for the axial loading. In conclusion, both poly-axial anatomical plating systems provide sufficient stability in this scenario, and the 180°configurations demonstrated superior stiffness.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Biomechanical comparison of anatomical plating systems for comminuted distal humeral fractures

Varady

Rüden

Greinwald

et al. 2017

International Orthopaedics (SICOT)

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“…Dual plate fixation might be indicated in cases of osteoporosis and comminution. We used locking constructs since they have been shown to provide better stability for distal humerus fractures compared to nonlocking constructs 7). Schwartz et al8) compared 180° versus 90° dual plate constructs for segmental intra-articular distal humerus fractures.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Comparison of Fixed- versus Variable-Angle Locking Screws for Distal Humerus Comminuted Fractures

et al. 2019

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Background To compare the stability of fixed- versus variable-angle locking constructs for the comminuted distal humerus fracture (AO/OTA 13-A3). Methods Eight pairs of complete humeri harvested from eight fresh frozen cadavers were used for the study. We fixed the intact humeri using 2.7-mm/3.5-mm locking VA-LCP stainless steel distal humerus posterolateral (nine-hole) and medial (seven-hole) plates. An oscillating saw was used to cut a 1-cm gap above the olecranon fossa. The specimens were loaded in axial mode with the rate of 1 mm per 10 seconds to failure, and stress-strain curves were compared in each pair. The mode of failure was recorded as well as the load needed for 2- and 4-mm displacement at the lateral end of the gap. Results The stiffness of the constructs, based on the slope of the stress-strain curve, did not show any difference between the fixed- versus variable-angle constructs. Likewise, there was no difference between the force needed for 2- or 4-mm displacement at the lateral gap between the fixed- and variable-angle constructs. The mode of failure was bending of both plates in all specimens and screw pull-out in four specimen pairs in addition to the plate bending. Conclusions Our results did not show any difference in the biomechanical stability of the fixed- versus variable-angle constructs. There was not any screw breakage or failure of the plate-screw interface.

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“…Each specimen was loaded with cylinder in an adjustable metal clamp with 15°flexion [19] for the axial compressive loading (Fig. 2a) and 75°flexion [18][19][20] for the anterior-posterior bending load application in sagittal plane (Fig. 2b), representing the extension and flexion loading of arm.…”

Section: Biomechanical Testing and Analysismentioning

confidence: 99%

Does posterior configuration have similar strength as parallel configuration for treating comminuted distal humerus fractures? A cadaveric biomechanical study

Shih

Kuan

Hsu

et al. 2021

BMC Musculoskelet Disord

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Background The posterior plating technique could be used as a clinical alternative to parallel plating for treating comminuted distal humerus fractures (DHFs) successfully with good clinical results. However, the biomechanical characteristics for posterior fixation are still unclear. The purpose of this study is to evaluate the biomechanical properties of the posterior fixation and to make comparisons between the parallel and the posterior fixation systems. Materials and methods We performed a cadaveric biomechanical testing with two posterior plating systems (a posterior two plating and a single posterior pre-contoured Y plating system) and one parallel two plating system to treat AO/OTA type-C2.3 DHFs. Among three groups, we compared construct stiffness, failure strength, and intercondylar width changes after 5000-cycle fatigue loading and failure loads and failure modes after destructive tests in both the axial compression and (sagittal) posterior bending directions. The correlations between construct failure loads and bone marrow density (BMD) were also compared. Results In axial direction, there were no significant differences in the stiffness and failure load between the posterior and the parallel constructs. However, in sagittal direction, the two-plate groups (posterior two plating and parallel plating group) had significant higher stiffness and failure loads than the one-plate group (single posterior Y plating). There was no fixation failure after 5000-cyclic loading in both directions for all groups. Positive correlation was noted between BMD and failure loads on parallel fixation. Conclusions We found that when using two plates for treating comminuted DHFs, there were no significant differences in terms of most biomechanical measurements between posterior and parallel fixation. However, the single pre-contoured posterior Y plate construct was biomechanically weaker in the sagittal plane than the parallel and the posterior two-plate constructs, although there was no fixation failure after the fatigue test for all groups regardless of the fixation methods. Level of evidence Biomechanical study

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Complex Distal Humerus Fractures—Comparison of Polyaxial Locking and Nonlocking Screw Configurations—A Preliminary Biomechanical Study

Abstract: System stiffness increases with larger screw diameters and becomes significant with additional gap bridging screws in artificial bones. The use of polyaxial locking screws in anatomical adapted plates becomes more important in poor bone quality.

Cited by 24 publications

References 28 publications

Biomechanical comparison of anatomical plating systems for comminuted distal humeral fractures

Biomechanical comparison of anatomical plating systems for comminuted distal humeral fractures

Biomechanical Comparison of Fixed- versus Variable-Angle Locking Screws for Distal Humerus Comminuted Fractures

Does posterior configuration have similar strength as parallel configuration for treating comminuted distal humerus fractures? A cadaveric biomechanical study

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