Volar Fixation for Dorsally Angulated Extra-Articular Fractures of the Distal Radius: A Biomechanical Study

S, Koh; Morris, Randal P.; Patterson, Rita M.; Kearney, J Patrick; Buford, William L.; Viegas, Steven F.

doi:10.1016/j.jhsa.2006.02.015

Cited by 80 publications

(67 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The construct was deemed to pass the test if its failure load was greater than 400 N and its stiffness was greater than 80 N/mm. These cutoff values were chosen to be twice the loads applied to the wrist during active digital flexion (an activity promoted immediately postoperatively in clinical care to reduce swelling, pain, and finger stiffness) but less than those achievable by experts using modern plate fixation [5,8,14].…”

Section: Study 2: Mechanical Construct Stability In An Extraarticularmentioning

confidence: 99%

Objective Structured Assessments of Technical Skills (OSATS) Does Not Assess the Quality of the Surgical Result Effectively

Anderson

Long

Thomas

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Performance assessment in skills training is ideally based on objective, reliable, and clinically relevant indicators of success. The Objective Structured Assessment of Technical Skill (OSATS) is a reliable and valid tool that has been increasingly used in orthopaedic skills training. It uses a global rating approach to structure expert evaluation of technical skills with the experts working from a list of operative competencies that are each rated on a 5-point Likert scale anchored by behavioral descriptors. Given the observational nature of its scoring, the OSATS might not effectively assess the quality of surgical results. Questions/purposes (1) Does OSATS scoring in an intraarticular fracture reduction training exercise correlate with the quality of the reduction? (2) Does OSATS scoring in a cadaveric extraarticular fracture fixation exercise correlate with the mechanical integrity of the fixation?Methods Orthopaedic residents at the University of Iowa (six postgraduate year [PGY]-1s) and at the University of Minnesota (seven PGY-1s and eight PGY-2s) undertook a skills training exercise that involved reducing a simulated intraarticular fracture under fluoroscopic guidance. Iowa residents participated three times during 1 month, and Minnesota residents participated twice with 1 month between their two sessions. A fellowship-trained orthopaedic traumatologist rated each performance using a modified OSATS scoring scheme. The quality of the articular reduction obtained was then directly measured. Regression analysis was performed between OSATS scores and two metrics of articular reduction quality: articular surface deviation and estimated contact stress. Another skills training exercise involved fixing a simulated distal radius fracture in a cadaveric specimen. Thirty residents, distributed across four PGY classes (PGY-2 and PGY-3, Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® n = 8 each; PGY-4 and PGY-5, n = 7 each), simultaneously completed the exercise at individual stations. One of three faculty hand surgeons independently scored each performance using a validated OSATS scoring system. The mechanical integrity of each fixation construct was then assessed in a materials testing machine. Regression analysis was performed between OSATS scores and two metrics of fixation integrity: stiffness and failure load. Results In the intraarticular fracture model, OSATS scores did not correlate with articular reduction quality (maximum surface deviations: R = 0.17, p = 0.25; maximum contact stress: R = 0.22, p = 0.13). Similarly in the cadaveric extraarticular fracture model, OSATS scores did not correlate with the integrity of the mechanical fixation (stiffness: R = 0.10, p = 0.60; failure load: R = 0.30, p = 0.10). Conclusions OSATS scoring methods do not effectively assess the quality of the surgical result. Efforts must be made to incorporate assessment metrics that reflect the quality of the surgical result. Clinical Relevance New objectiv...

show abstract

Section: Study 2: Mechanical Construct Stability In An Extraarticularmentioning

confidence: 99%

Objective Structured Assessments of Technical Skills (OSATS) Does Not Assess the Quality of the Surgical Result Effectively

Anderson

Long

Thomas

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…However, two caveats are to be noted. First, in the present work, it was assumed that the bones were not osteoporotic, whereas, in some of the applicable literature studies, information was not given on the bone quality of the cadavers used [26] [27] [28] [32]. Second, the size of the gap of the simulated fracture in the present work is smaller than that in the aforementioned literature studies (4 mm versus 10 -15 mm).…”

Section: Discussionmentioning

confidence: 90%

Finite Element Analysis Study of Prototype of a Novel Intramedullary Injectable Bioresorbable Polymer Fixator versus a Volar Plate for Surgical Treatment of Distal Radius Fractures

Zysk¹,

Lewis²

2017

WJET

View full text Add to dashboard Cite

Complications and shortcomings of volar plating, which is very widely used for surgical treatment of distal radius fractures, are well known. Thus, there is scope for alternative innovative surgical methods. In the present work, we used the finite element analysis method to compare the biomechanical performance of a model of a construct comprising a simulated distal radius fracture considered fixated using a notional intramedullary injectable bioresorbable polymer-bioresorbable balloon osteosynthesis system ("fixator") versus using a commercially-available volar locking plate (VP). The biomechanical parameters determined were longitudinal stiffness and factor of safety under each of the applied loads. For the fixator model, 1) each of the biomechanical parameters was markedly influenced by fracture gap fill ratio (FGFR) (defined as the proportion of the volume of the fracture gap that is considered occupied by the expanded polymer-filled balloon) but not by modulus of elasticity assigned to the polymer; 2) with FGFR = 100%, stiffness was comparable to that of the Ti-6Al-4V alloy VP construct model; and 3) stiffness was within the range of literature values for stiffness of constructs comprising simulated fractures in fresh cadaveric distal radii fixated using metal volar locking plate. These results suggest that the fixator may be an alternative modality to metal volar plating and, as such, deserves further evaluation.

show abstract

“…The tapered-shaped end of the T-plate shaft facilitates insertion and sliding under soft tissue, whereas an indentation allows adjustment in the distal radius, features that resemble other plate models (Ruchelsman et al 2010). The advent of the locking systems has given rise to the development of new bone-plate designs for treating a distal radius fracture in human patients; these include implants with combi holes that allow insertion of locking or standard screws at the same hole, plates containing only locking screw holes, and those with separated locking and non-locking screw holes (Osada et al 2003, Koh et al 2006, Willis et al 2006. The plate used in the present study has a shaft with three locked screw holes used to stabilize the construct and one dynamic compression hole that enables interfragmentary compression.…”

Section: Discussionmentioning

confidence: 99%

“…The biomechanical studies of plating systems in the treatment of distal radial fractures in human medicine have employed a wedge osteotomy model and/or segmental bone gap model (Osada et al 2004, Koh et al 2006, Willis et al 2006. In veterinary medicine, transverse osteotomy was performed to evaluate three methods of plate fixation in distal fracture of the radius (Wallace et al 1992), and 2 mm gap to analyze stacked plating techniques to stabilize distal radial fractures (Rose et al 2009).…”

Section: Discussionmentioning

confidence: 99%

Development and mechanical properties of a locking T-plate

Mesquita

Rahal

Neto³

et al. 2017

Pesq. Vet. Bras.

View full text Add to dashboard Cite

RESUMO.-[Desenvolvimento e as propriedades mecânicas de uma placa bloqueada em formato de T.] O objetivo deste estudo foi desenvolver uma placa bloqueada em formato de T e avaliar as propriedades mecânicas em um modelo sintético. Uma placa-T em liga de titânio 2,7mm foi desenhada com uma haste contendo três orifícios para parafusos bloqueados e um orifício para realização de compressão dinâmica. 40 blocos de poliuretano em formato de T e 20 placas-T foram utilizados para os ensaios mecâni-cos. Seis montagens osso-placa foram testados até a falha, sendo três em força de compressão axial e três em flexão engastada. 14 montagens osso-placa foram testadas até a falha em fatiga, sendo 7 em força de compressão axial e 7 em flexão engastada. No teste estático, os valores mais altos foram observados em todas as variáveis no teste de compressão axial quando comparado à flexão engastada. Já nos testes de fadiga na força de compressão axial, todas as montagens osso-placa resistiram à 1000000 de ciclos. No teste de fadiga em flexão engastada, quatro montagens osso-placa falharam antes de alcançarem 1000000 de ciclos. Em conclusão, a placa-T estudada apresenta propriedades mecânicas que oferecem uma melhor resistência em estabilizar as fraturas na atuação das forças de compressão axial que nas forças de flexão.TERMOS DE IDEXAÇÃO: Osso-placa, implante, fratura, estudo mecânico.

show abstract

Volar Fixation for Dorsally Angulated Extra-Articular Fractures of the Distal Radius: A Biomechanical Study

Cited by 80 publications

References 14 publications

Objective Structured Assessments of Technical Skills (OSATS) Does Not Assess the Quality of the Surgical Result Effectively

Objective Structured Assessments of Technical Skills (OSATS) Does Not Assess the Quality of the Surgical Result Effectively

Finite Element Analysis Study of Prototype of a Novel Intramedullary Injectable Bioresorbable Polymer Fixator versus a Volar Plate for Surgical Treatment of Distal Radius Fractures

Development and mechanical properties of a locking T-plate

Contact Info

Product

Resources

About