Surgical fixation of midshaft clavicle fractures: A systematic review of biomechanical studies

Hulsmans, Martijn; Heijl, Mark van; Houwert, Roderick M.; Burger, Bart J.; Verleisdonk, E. J. M. M.; Veeger, Dirk Jan; Meijden, Olivier A. van der

doi:10.1016/j.injury.2018.02.017

Cited by 46 publications

(39 citation statements)

References 44 publications

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“…With regard to plate location, some studies found advantages associated with superior placement of the plate [15]. However, it seems that the stability achieved with an anterior-inferior plate position is also sufficient [16].…”

Section: Claviclementioning

confidence: 99%

Biomechanics of Upper Extremity Double Plating

et al. 2019

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Double plating (DP) is an established treatment modality in traumatology. For certain indications, such as open reduction and internal fixation of bicondylar tibial plateau fractures and distal humeral fractures, DP is standard of care in the clinical routine. However, the principles of DP can be transferred to other anatomic regions and indications. In the past years, DP has been brought more and more into focus. For revision cases, such as the treatment of fracture non-unions, DP seems generally useful. In anatomical locations with high torsional stress and bending forces, but also in regions with traction forces by muscles and tendons DP provides multiplanar stability and therefore seems to have biomechanical advantages. Usually two smaller implants can replace one larger implant. Thus, the number of points of fixation can be increased, the stability can be improved and soft-tissue irritations by bulky implants can be minimized. Along with the established indication and application at the distal humerus, there is biomechanical evidence in the current literature for DP of clavicle fractures and humeral shaft fractures. Furthermore, DP provides mechanical advantages in the treatment of certain proximal humeral fractures and olecranon fractures. This review of the literature summarizes the published literature on biomechanics of upper extremity DP.

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Section: Claviclementioning

confidence: 99%

Biomechanics of Upper Extremity Double Plating

et al. 2019

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“…Intramedullary fixation of mid‐shaft clavicular fractures has been shown to reduce refracture rate and improved cosmetic outcomes compared to plate fixation; however, smooth profile pins such as the Steinmann and Knowles pin risk migration, while post‐operative removal of threaded devices such as the Herbert screw present technical challenges and risk of bone fracture . The Echidna pin was designed to anchor into bone surrounding the intramedullary canal using retractable spines, reducing the risk of migration and increasing construct stability, whilst allowing for ease of device removal .…”

Section: Discussionmentioning

confidence: 99%

“…These findings corroborate those of Ackland et al ., where the Echidna pin repair constructs showed significantly greater cantilever bending stiffness in comparison to that of the Herbert cannulated bone screw. Clinically, implants that display high resistance to bending at the fracture site may reduce malunion, improve stabilization of fracture fragments and contribute to improved healing …”

Section: Discussionmentioning

confidence: 99%

“…Intramedullary clavicle fracture fixation bridges clavicle fragments via small incisions on the lateral aspect of the shoulder and over the fracture site, which can decrease wound infection risk, reduce pain and improve healing times compared with plated fixation . This has been shown to reduce operating times, and has decrease refracture rates compared to those of plated fixation due to the absence of fixation screw holes . Titanium elastic nails, Rockwood pins and non‐threaded Knowles pins can be easily placed intraoperatively, safely removed after healing and have been employed with good clinical, functional and cosmetic outcomes; however, smooth intramedullary devices are prone to migration, which can ultimately risk injury of adjacent neurovascular structures and viscera .…”

Section: Introductionmentioning

confidence: 99%

“…Biomechanical studies have demonstrated that clavicles repaired with Rockwood pins perform similarly in bending to those fixed with plates . Torsional testing of repair constructs, which simulates the loads incurred by the clavicle during mid‐late flexion, has shown that locking intramedullary devices are more resistant to torsional loads than their non‐locking equivalents, but are outperformed by traditional plated repair …”

Section: Introductionmentioning

confidence: 99%

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Biomechanical performance of an intramedullary Echidna pin for fixation of comminuted mid‐shaft clavicle fractures

Sidhu

Huntington

Richardson

et al. 2019

ANZ Journal of Surgery

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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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45° helical plates are a valid alternative to straight plates for treatment of proximal humeral shaft fractures

Pastor,

Zderic,

Beeres

et al. 2024

Journal Orthopaedic Research

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Helical plates used for proximal humeral shaft fracture fixation avoid the radial nerve distally as compared to straight plates. To investigate in a human cadaveric model the biomechanical competence of straight lateral plates versus 45° helical plates used for fixation of proximal comminuted humeral shaft fractures, eight pairs of human cadaveric humeri were instrumented using either a long straight PHILOS plate (Group 1) or a 45° helical plate (Group 2) for treatment of an unstable proximal humeral shaft fracture. All specimens were tested under non‐destructive quasi‐static loading in axial compression, internal and external rotation, and bending in four directions. Subsequently, progressively increasing cyclic loading in internal rotation was applied until failure and interfragmentary movements were monitored by motion tracking. Axial displacement (mm) was 3.13 ± 0.31 in Group 1 and 2.60 ± 0.42 in Group 2, p = 0.015. Flexion/extension deformation (°) in Group 1 and Group 2 was 0.56 ± 0.42 and 0.43 ± 0.23, p = 0.551. Varus/valgus deformation (°) was 6.39 ± 0.44 in Group 1 and 5.13 ± 0.87 in Group 2, p = 0.012. Shear (mm) and torsional (°) displacement were 5.36 ± 0.76 and 17.75 ± 1.06 in Group 1, and 5.03 ± 0.46 and 16.79 ± 1.36 in Group 2, p ≥ 0.090. Cycles to catastrophic failure were 10000 ± 1401 in Group 1 and 9082 ± 1933 in Group 2, p = 0.708. From a biomechanical perspective, 45° helical plating is associated with lower axial and varus/valgus displacement under axial loading and demonstrates comparable resistance to failure versus straight plating. Therefore, 45° helical plates can be considered as a valid alternative to straight plates for treatment of proximal humeral shaft fractures.

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Surgical fixation of midshaft clavicle fractures: A systematic review of biomechanical studies

Cited by 46 publications

References 44 publications

Biomechanics of Upper Extremity Double Plating

Biomechanics of Upper Extremity Double Plating

Biomechanical performance of an intramedullary Echidna pin for fixation of comminuted mid‐shaft clavicle fractures

45° helical plates are a valid alternative to straight plates for treatment of proximal humeral shaft fractures

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