Biomechanical and clinical evaluation of minimal invasive plate osteosynthesis for two-part clavicle shaft fractures
Research output: Contribution to journal › Research article › Contributed › peer-review
Contributors
Abstract
BACKGROUND: Many surgical treatment methods exist for clavicle shaft fractures. A locking compression plate (LCP) fixation with three screws per fracture side is commonly used. For certain fractures a stabilization with 2 screws per side is potentially suitable, offering the advantage of reduced soft tissue approach, while avoiding the disadvantages of minimally-invasive nailing at the same time. This hypothesis was evaluated biomechanically and clinically.
METHODS: Four treatment procedures were investigated biomechanically using composite human clavicle specimens. A load-to-failure test was performed using a three-point cantilever test. In group 1, a simple shaft fracture was simulated and stabilized with 2 screws per fracture side (5-hole LCP). In the second group 3 screws per side (7-hole LCP) were used. In group 3, a non-reduced fracture zone was simulated and treated with 3 screws per side (7-hole LCP). In group 4, an anatomically reduced fracture zone was simulated and treated with 3 screws per side (7-hole LCP). Furthermore 27 patients treated with a short plate and 2 screws per side (similar to group 1) were assessed after a minimum follow-up of 12 months (Constant and DASH Score).
RESULTS: The maximum load-to-failure of group 1 was 367N. We observed the highest load-to-failure in group 2 with 497N and the lowest in group 3 with 90N. In group 4 a maximum load-to-failure of 298N could be evaluated. There was no significant difference in load-to-failure between the treatment of a simple clavicle fracture using 5- or 7-hole LCP (p = 0.121). However, we found a significant difference of load-to-failure between the simple and anatomically reduced fracture using a 7-hole plate (p = 0.014). The mean constant score of the surgically treated patients was 95 and the DASH score 3.0. Fracture consolidation was observed in 96.3%.
CONCLUSIONS: For certain non-fragmented and well interlocking 2-part fractures, a plate osteosynthesis fixed with only 2 screws per fracture side might offer sufficient biomechanical stability, better soft tissue preservation and comparable fusion rates compared to the operative treatment with 3 screws per side. However, the maximum load-to-failure of the 7-hole LCP was higher than of the 5-hole LCP, but this difference was not statistically significant.
TRIAL REGISTRATION: Approval from the ethics committee of the Technical University of Dresden was retrospectively obtained (EK 588122019).
Details
Original language | English |
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Article number | 612 |
Journal | BMC musculoskeletal disorders |
Volume | 24 |
Issue number | 1 |
Publication status | Published - 25 Jul 2023 |
Peer-reviewed | Yes |
External IDs
Scopus | 85165662618 |
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PubMed | 37491249 |
PubMedCentral | PMC10369786 |
ORCID | /0000-0002-3734-665X/work/149798608 |
Keywords
Keywords
- Humans, Clavicle/diagnostic imaging, Retrospective Studies, Fractures, Bone/diagnostic imaging, Fracture Fixation, Internal/adverse effects, Bone Plates, Biomechanical Phenomena