The Comparative Stability of Screw Versus Plate Versus Screw and Plate Coronoid Fixation

Budoff, Jeffrey E.; Meyers, D. Nicole; Ambrose, Catherine G.

doi:10.1016/j.jhsa.2010.10.022

Cited by 22 publications

(8 citation statements)

References 45 publications

(80 reference statements)

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“…[1][2][3][4]11,12 A recent study compared the biomechanical characteristics of screws, plates, and combined screw and plate fixation for large coronoid fractures. 28 The results showed that although both screws and plates used on their own yielded a good level of stability, the combination of these 2 devices significantly increased stability. 28 The majority of the coronoid fractures in complex elbow instability are small, involving less than 50% of the coronoid height, and are frequently comminuted.…”

Section: Discussionmentioning

confidence: 98%

“…28 The results showed that although both screws and plates used on their own yielded a good level of stability, the combination of these 2 devices significantly increased stability. 28 The majority of the coronoid fractures in complex elbow instability are small, involving less than 50% of the coronoid height, and are frequently comminuted. [29][30][31] These small coronoid fractures always require surgical treatment, as reported in several anatomical, biomechanical, and clinical studies that have demonstrated the important role played by the coronoid tip in maintaining elbow stability.…”

Section: Discussionmentioning

confidence: 98%

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Use of Fine-threaded K-wires in the Treatment of Coronoid Fractures in Complex Elbow Instability

Giannicola¹,

Polimanti²,

Gumina³

et al. 2013

Orthopedics

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The coronoid process is one of the main elbow constraints that provides ulnohumeral joint stability. Coronoid fractures may be fixed using multiple techniques, including transosseous sutures, screws, and plates. The goal of this study was to analyze the clinical and radiographic outcomes in a series of patients with complex elbow instability in whom coronoid fractures were repaired using fine-threaded K-wires. Eight men and 10 women (mean age, 47 years) were followed prospectively for a mean of 26 months. Surgical treatment consisted of open reduction and internal fixation of all fractures; radial head replacement in Mason III injuries; lateral collateral ligament repair in all patients; and, in cases of persistent instability, medial collateral ligament repair, hinged fixator application, or both. Coronoid fixation was performed using 2 or more fine-threaded K-wires, depending on the fragment size, inserted from the posterior aspect of the ulna and directed toward the coronoid fragment using a 1-step fixation technique. At last follow-up, mean extension was 15°, mean flexion was 133°, mean pronation was 78°, and mean supination was 69°; mean Disabilities of the Arm, Shoulder and Hand score was 9.7, mean American Shoulder and Elbow Surgeons score was 85, and mean Mayo Elbow Performance Score was 89. According to the Mayo Elbow Performance Index, 10 excellent, 7 good, and 1 fair result were recorded. All but 1 patient had a stable elbow. Fracture healing was observed in all but 1 patient. No secondary coronoid fragment dislocation or implant failures were reported. This study shows that using fine-threaded K-wires provides easy, minimally invasive, stable, and successful 1-step fixation that can be used to obtain osteosynthesis of coronoid fractures in patients with complex elbow instability.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Use of Fine-threaded K-wires in the Treatment of Coronoid Fractures in Complex Elbow Instability

Giannicola¹,

Polimanti²,

Gumina³

et al. 2013

Orthopedics

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show abstract

“…Only few studies address biomechanical properties of different osteosynthetic techniques for fixation of the fragment [8,9,12,[18][19][20]. Hartzler et al investigated the stabilizing effect of the coronoid process under varus and valgus load in a cadaveric gravity stress model [12].…”

Section: Discussionmentioning

confidence: 99%

Biomechanical comparison of screw osteosyntheses and anatomical plating for coronoid shear fractures of the ulna

Rausch

Jettkant

Lotzien

et al. 2020

Arch Orthop Trauma Surg

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Introduction Among the few techniques described for the treatment of coronoid fractures, osteosynthesis techniques include screw osteosynthesis from anterior to posterior (AP) or from posterior to anterior (PA) and plate osteosynthesis. The aim of this study was to test the biomechanical stability of screw osteosynthesis and plate osteosynthesis using anatomical plates in coronoid process fractures. Materials and methods On a total of 25 biomechanical synthetical ulnae, a coronoid shear fracture including 70% of the coronoid height was simulated. Osteosynthesis was then performed using two 2.7 mm screws from anterior, posterior and with use of three different anatomical plates of the coronoid process. For the biomechanical testing, axial load was applied to the fragment with 1000 cycles from 5 to 250 N, load to failure and load at 100 µm displacement. Displacements were measured using a point-based three-dimensional motion analysis system. Results Osteosynthesis using the PA-screw showed significant more displacement during cyclic loading compared with all other osteosyntheses (0.99 mm), whereas AP-screw showed the smallest displacement (0.10 mm) during cyclic loading. The PA-screw technique showed a significant lower load to failure compared to all other osteosynthesis with the highest load in AP-screw osteosynthesis. The load for 100 µm displacement was the smallest in PA-screw with a significant difference to the AP-screw and one plate osteosynthesis. Conclusion Osteosynthesis of large coronoid shear fractures with two small-fragment screws from anterior allows stable fixation that is not inferior to anterior plate osteosynthesis and might be an alternative in specific fracture types. Posterior screw fixation was found as the weakest fixation method. Level of evidence Basic science study

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“…Interestingly, despite prior studies that have shown plate constructs to have higher stiffness than screws alone for upper extremity fractures, the volar plate had a comparatively lower stiffness (80.5 N/mm) relative to the various screw constructs (74.9-100.7 N/mm). 3 Although six 1.5-mm screws are utilized to secure the plate, it is possible that the 0.8-mm low-profile thickness of the plate bridging the simulated fracture site was too low to resist higher loads. This is further supported by the observation that the plate failed by bending at its midpoint, where the osteotomy was placed.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Evaluation of Four Internal Fixation Constructs for Scaphoid Fractures

Beutel

Melamed

Hinds

et al. 2016

Hand (New York, N,Y.)

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The Comparative Stability of Screw Versus Plate Versus Screw and Plate Coronoid Fixation

Cited by 22 publications

References 45 publications

Use of Fine-threaded K-wires in the Treatment of Coronoid Fractures in Complex Elbow Instability

Use of Fine-threaded K-wires in the Treatment of Coronoid Fractures in Complex Elbow Instability

Biomechanical comparison of screw osteosyntheses and anatomical plating for coronoid shear fractures of the ulna

Mechanical Evaluation of Four Internal Fixation Constructs for Scaphoid Fractures

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