Low-profile double plating of unstable osteoporotic olecranon fractures: a biomechanical comparative study

Wagner, Ferdinand C.; Jaeger, Martin; Friebis, Christof; Maier, Dirk; Ophoven, Christian; Yilmaz, Tayfun; Südkamp, Norbert P.; Reising, Kilian

doi:10.1016/j.jse.2020.11.008

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…Plate possesses strong and stable fixation properties and can provide long-lasting and effective fracture reduction. Particularly for the olecranon, the plate fixation can better achieve the biological adhesion to the bone, and thus, it is capable of performing effective fixation of various types of fractures [ 31 , 32 ]. In addition, biomechanical studies also confirmed that plate fixation had less fracture displacement than TBW fixation for the simple OF mode [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of tension band wire versus plate for Mayo II olecranon fractures: a systematic review and meta-analysis

et al. 2022

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Purpose For olecranon fractures, the choice of tension band wire (TBW) or plate fixation has long been controversial. Therefore, this study aimed to evaluate the efficacy and safety of TBW and plate in the treatment of patients with Mayo II olecranon fractures by Meta-analysis. Methods PubMed, Embase, Cochrane, the Web of Science, China National Knowledge Infrastructure, Wanfang, and China Biomedical Database were searched for randomized controlled trials (RCTs) and cohort studies (CSs) where TBW was compared with plate for Mayo II olecranon fractures (OF). Subsequently, the data were extracted by two reviewers independently and were analysed via RevMan5.4.1. Besides, mean difference (MD), risk ratio (RR), and 95% confidence intervals (CIs) were calculated. Furthermore, Cochrane Risk of Bias Tool 2.0 and Newcastle–Ottawa Scale were adopted for assessing the risk of bias. Results A total of 1RCT and 10 CSs were included, when 449 cases were treated with TBW and 378 with plate. The plate has favourable postoperative long-term (≥ 1 year) functional score in MEPS (MD: − 3.06; 95% CI − 5.50 to 0.62; P = 0.01; I2 = 41%) and Dash score (MD: 2.32; 95% CI 1.91, 2.73; P < 0.00001; I2 = 0%), also carrying fewer complications (RR: 2.13; 95% CI 1.48, 3.08; P < 0.0001; I2 = 58%). Besides, there exists no significant difference in postoperative long-term (≥ 1 year) elbow flexion (MD: − 1.82°; 95% CI − 8.54, 4.90; P = 0.60; I2 = 71%) and extension deficits (MD: 1.52°; 95% CI − 0.38, 3.42; P = 0.12; I2 = 92%). Moreover, TBW is featured with a shorter operation time (MD = − 5.87 min; 95% CI − 7.93, − 3.82; P < 0.00001; I2 = 0) and less intraoperative bleeding (MD: − 5.33 ml; 95% CI − 8.15, − 2.52; P = 0.0002; I2 = 0). In terms of fracture healing time, it is still controversial. Furthermore, the subgroup analysis has revealed that for Mayo IIA OF, the plate has a better outcome in the long-term (≥ 1 year) postoperative MEPS, the Dash score, and the incidence of postoperative complications than TBW, while there is no significant difference in the long-term (≥ 1 year) postoperative elbow motion between two groups. Conclusions Plate has better efficacy and safety for Mayo II OF. Considering that few studies are included in the meta-analysis, more high-quality RCTs are still required to confirm these findings. PROSPERO registration number: CRD42022313855.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of tension band wire versus plate for Mayo II olecranon fractures: a systematic review and meta-analysis

et al. 2022

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“…Hoelscher-Doht et al [ 15 ] concluded that when using 4 locking triceps screws, the low-profile double-plate had a comparable maximum load to the posterior plate. Wagner et al [ 25 ] reported that posterior plating with 3 locking triceps screws and double-plating with 4 locking triceps screws had similar stability when intramedullary screws were used in a study using an osteoporotic olecranon cadaver.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical comparison between double-plate fixation and posterior plate fixation for comminuted olecranon fracture using two triceps screws in synthetic bone model

et al. 2022

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Background: Although preventing triceps fragment displacement is essential for treating an olecranon fracture, we frequently encounter situations in which only a few screws can be fixed to the triceps fragment. The aim of this study was to compare the stability of double-plate fixation and posterior plate fixation for olecranon fractures when the triceps fragment was small and only 2 screws could be inserted. Methods: A composite ulna model was used to simulate olecranon fracture. Four groups were formed consisting of double-plate and posterior plates with cortical and locking screws. The cyclic loading test was conducted for 500 cyclic loads of 5 to 50 N on a specimen to measure micromotion and displacement of the gap caused by light exercise. The load-to-failure test was performed by applying a load until fixation loss, defined as when the fracture gap increased by 2 mm or more or catastrophic failure occurred, to measure the maximum load. Results: Eight samples per group were tested through the pilot study. All groups were stable with a micromotion of <0.5 mm. However, the mean micromotion showed significant differences between the 4 groups ( P < .001, Table 1 Table 1 Mean gapping and displacement in the cyclic loading test. Displacement after the test Group Gapping during the test (range) Anterior cortex (range) Posterior cortex (range) Double-cortical 0.42 ± 0.11 (0.25–0.58) ∗ 0.02 ± 0.18 (−0.78–0.31) 0.14 ± 0.14 (−0.13–0.16) † Double-locking 0.17 ± 0.03 (0.12–0.21) ∗ 0.05 ± 0.10 (−0.16–0.16) 0.08 ± 0.14 (−0.17–0.11) Posterior-cortical 0.09 ± 0.02 (0.05–0.12) ∗ 0.03 ± 0.13 (−0.37–0.22) 0.03 ± 0.19 (−0.14–0.28) Posterior-locking 0.12 ± 0.04 (0.07–0.17) ∗ 0.04 ± 0.10 (−0.12–0.22) −0.03 ± 0.22 (−0.44–0.20) ). In the mean micromotion during exercise, posterior plating with cortical screws was the most stable (0.09 ± 0.02 mm) while double-plating with cortical screws was the most unstable (0.42 ± 0.11 mm). At the maximum load, posterior plating with locking screws was the strongest (205.3 ± 2.8 N) while double-plating with cortical screws was the weakest (143.3 ± 27.1 N). There was no significant difference in displacement after light exercise between the groups. Conclusions: This study...

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“…Loading the triceps' tendon in a 90°position of the elbow joint is a common simplification in biomechanical evaluation of olecranon fractures. 16,21,[27][28][29][30] Undisputedly, in contrast to biomechanical studies with dynamic loading protocols, 31,32 this simplification fails to analyze the weightless passive range of motion during early postoperative care but pulling with 500 N aims to simulate the forces acting while pushing up from a chair. 30,33 This force approximately represents 40% of the triceps' maximum pulling force of 1266 N in a 90°elbow position.…”

Section: Discussionmentioning

confidence: 99%

“…The test setup is shown in Figure 2. Based on previous research, 16 load changes between 10 and 300 N were applied for 50,000 cycles at 4 Hz. Afterward, peak loads were raised by 0.02 N/cycle until construct failure, which was defined as sudden catastrophic failure or fragment displacement >2 mm.…”

Section: Methodsmentioning

confidence: 99%

Lag screw osteosynthesis of simple olecranon fractures: A biomechanical comparative study

Wagner

Hamann

Maier

et al. 2022

Proc Inst Mech Eng H

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Olecranon fractures are most frequently stabilized by tension band wiring (TBW), which unfortunately leads to relevant implant removal rates due to K-wire migration and soft tissue irritation. As lag screw osteosynthesis (LSO) might be a gentle and effective alternative in simple fracture patterns, the goal of the present study was to biomechanically compare LSO with TBW in simple olecranon fractures at a cadaver model. A simple olecranon fracture (Mayo type IIA) was created in eight pairs of human cadaver elbows, which were pairwise fixed by either TBW or two transcortical 4.0 mm lag screws. Biomechanical testing was conducted as a pulling force, applied to the triceps tendon in a 90° position. First, cyclic loading between 10 and 300 N was performed for 50,000 cycles. Afterward, maximum load was raised by 0.02 N/cycle until construct failure, what was defined as displacement >2 mm. Besides fracture displacement, failure cycle and failure load, the modes of failure were analyzed. Within the first five cycles, there was no significant difference in displacement (median TBW: 0.2 mm; LSO: 0.5 mm; p = 0.091). Both after 2000 (median TBW: 0.2 mm; LSO: 0.6 mm; p = 0.042) and after 20,000 cycles (median TBW: 0.4 mm; LSO: 0.9 mm; p = 0.027), the difference was significant. Failure cycle (median TBW: 72,639 cycles; LSO: 43,429 cycles; p = 0.017) and failure load (median TBW: 702 N; LSO: 303 N; p = 0.025) differed significantly as well. TBW mostly (6/8) failed at the lock of the cerclage wire, whereas most LSO constructs (5/8) failed as a pullout of the proximal fragment. In conclusion, to our biomechanical findings at human cadaver specimens, simple olecranon fractures treated by LSO show higher dislocation rates and lower failure loads compared to conventional TBW and mostly fail by pullout of the proximal fragment.

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Low-profile double plating of unstable osteoporotic olecranon fractures: a biomechanical comparative study

Cited by 4 publications

References 22 publications

Efficacy and safety of tension band wire versus plate for Mayo II olecranon fractures: a systematic review and meta-analysis

Efficacy and safety of tension band wire versus plate for Mayo II olecranon fractures: a systematic review and meta-analysis

Biomechanical comparison between double-plate fixation and posterior plate fixation for comminuted olecranon fracture using two triceps screws in synthetic bone model

Lag screw osteosynthesis of simple olecranon fractures: A biomechanical comparative study

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