Biomechanics of distal fixation in distal radius fracture: screws versus smooth pegs. Study in cadaveric models
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Published:
Nov 19, 2015
Keywords:
Distal Radius Fracture, Volar Locking Plate, Locking Screws, Locking Smooth Pegs
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Abstract
ObjectivePerform a biomechanical comparison in cadaveric models between Locking Screws (LS) versus Locking Smooth Pegs (LSP) in extra-articular distal radius fractures stabilized with volar locking plates.MethodsWe reproduced extra-articular dorsal comminuted fractures (AO-A3) in 12 cadaveric radius. We divided them in two groups according the use of LS or LSP in distal fixation. Biomechanical tests were conducted evaluating changes in the rigidity of the systems after performing an axial load. Finally, the systems were led to the failure. Radiological controls were performed in all instances.ResultsWhen the systems fixed with LS were led to the failure, we observed a greater reduction in the height and angle of the osteotomy varying to a greater dorsal inclination of the articular facet. A separation of the plate relative to the bone was observed in those plates fixed LSP. Moreover, the maximum tolerated load in the systems with LS was 1659N and 1905N in those in which we used LSP.ConclusionsWe found a load transfer in two-stage in those models with LSP. A first stage in which the load transfer from the epiphysis to the shaft through the volar plate (bone-plate-bone), bypassing the fracture. In a second stage, the plate is removed from the system due to a back slippage of the LSP from the bone, allowing a transmission directly from the distal to the proximal fragment (bone-bone). This new transfer generated in all cases an incomplete and longitudinal fracture of the volar cortex.
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How to Cite
Muratore, A., Gómez Rodríguez, G. L., Dal Lago, J., Robador, N., Nazur, G., & Clembosky, G. (2015). Biomechanics of distal fixation in distal radius fracture: screws versus smooth pegs. Study in cadaveric models. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 80(4), 292-302. https://doi.org/10.15417/353
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Basic Research
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References
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3. Simic PM, Weiland AJ. Fractures of the distal aspect of the radius: changes in treatment over the past two decades. Instr Course Lect 2003;52:185-95.
4. Jupiter JB. Fractures of the distal end of the radius. J Bone Joint Surg Am 1991;73:461-9.
5. Fernandez DL. Fractures of the distal radius: operative treatment. Instr Course Lect 1993;42:73-88.
6. Jenkins NH, Mintowt-Czyz WJ. Mal union and dysfunction in Colles fracture. J Hand Surg Br 1988;13:291-3.
7. Ring D, Jupiter JB, Brennwald J, Buchler U, Hastings H. Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures. J Hand Surg 1997;22:777-84.
8. Ring D, Jupiter JB. Treatment of osteoporotic distal radius fractures. Osteoporos Int 2005;16:80-4.
9. Jenkins NH. Fractures of the distal end of the radius. J Bone Joint Surg Am 1991;73:461-9.
10. Wright TW, Horodyski M, Smith DW. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed angle tine plate versus external fixation. J Hand Surg Am 2005;30:289-99.
11. Kandemir U, Matiyahu A, Desai R, Puttliz C. Does volar locking plate provide equivalent stability as a dorsal nonlocking plate in a dorsally comminuted distal radius fracture? A biomechanical study. J Orthop Trauma 2008;22:605-10.
12. Nana AD, Joshi A, Litchman DM. Plating of the distal radius. J Am Acad Orthop Surg 2005;13:159-71.
13. Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am 2004;29:96-102.
14. Osada D, Kamei S, Masuzaki K, Takai M, Kameda M, Tamai K. Prospective study of distal fractures treated with a volar locking plate system. J Hand Surg Am 2008;33:691-700.
15. Azzopardi T, Ehrendorfer S, Coulton T, Abela M. Unstable extraarticular fractures of the distal radius: a prospective, randomised study of inmobilisation in a cast versus supplementary percutaneos pinning. J Bone Joint Surg Br 2005;85:837-40.
16. Martineau PA, Waitayawinyu T, Malone KJ, Hanel DP, Trumble TE. Volar plating of AO C3 distal radius fractures: biomechanical evaluation of locking screw and locking smooth peg configurations. J Hand Surg Am 2008;33:827-34.
17. Boretto JG, Pacher N, Giunta D, Gallucci GL, Alfie V, De Carli P. Comparative clinical study of locking screws versus smooth locking pegs in volar plating of distal radius fractures. J Hand Surg Eur 2014;39:775-60.
18. Weninger P, DallAra E, Leixnering M, Pezzei C, Hertz H, Drobetz H, et al. Volar fixed-angle plating of extraarticular distal radius fractures. A biomechanical analysis comparing threaded screw and smooth pegs. J Orthop Trauma 2010;69:46-55.
19. Leib ES, Lewiecki EM, Binkley N, Hamdy RC. Official Positions of the International Society for Clinical Densitometry. J Clin Densitom 2004;7:1-5.
20. Drobetz H, Bryant A, Pokorny T, Spitaler R, Leixnering M, Jupiter J. Volar fixed angle plating of distal radius extension fractures: Influence of plate position on secondary loss of reduction–a biomechanic study in cadaveric model. J Hand Surg Am 2006;31:615-22.
21. Wolfe SW, Lorenze MD, Austin G, Swigart CR, Panjabi MM. Load displacement behavior in a distal fracture model. The effect of simulated healing on motion. J Bone Joint Surg Am 1999;81:53-9.
22. Putnam MD, Meyer NJ, Nelson EW, Gesensway D, Lewis JL. Distal radial metaphyseal forces in an extrinsic grip model: implications for postfracture rehabilitation. J Hand Surg Am 2000;25:469-75.
23. Koh S, Morris RP, Patterson RM, Kearney JP, Buford WL, Viegas SF. Volar fixation for dorsally angulated extraarticular fractures of the distal radius: a biomechanical study. J Hand Surg Am 2006;31:771-9.
24. Rockwood C, Green D. Fracturas del adulto, Madrid: Ed Marbán; 2003.
25. Willis AA, Kutsumi K, Zobbitz ME, Cooney WP. Internal fixation of dorsally displaced fractures of the distal part of the radius. A biomechanical analysis of volar plate stability. J Bone Joint Surg Am 2006;88:2411-7.
26. Angulen J, Kyle RF, Marsh JL, Virkus WW, Waters WC, Warren M, et al. Locking plates for extremity fractures. J Am Acad Orthop Surg 2009;17:465-72.
27. Mehling I, Klitscher D, Mehling AP, Nowak TE, Sternstein W, Rommens PM, et al. Volar fixed-angle plating of distal radius fractures: screws versus pegs-a biomechanical study in a cadaveric model. J Orthop Trauma 2012;26:395-401.
2. O´Neil TW, Cooper C, Finn JD, Lunt M, Purdie D, Reid DM, Rowe R, Woolf AD, Wallace WA; UK Colle´s Fracture Study Group. Incidence of distal forearm fracture in British men and women. Osteoporos Int 2001;12:555-8.
3. Simic PM, Weiland AJ. Fractures of the distal aspect of the radius: changes in treatment over the past two decades. Instr Course Lect 2003;52:185-95.
4. Jupiter JB. Fractures of the distal end of the radius. J Bone Joint Surg Am 1991;73:461-9.
5. Fernandez DL. Fractures of the distal radius: operative treatment. Instr Course Lect 1993;42:73-88.
6. Jenkins NH, Mintowt-Czyz WJ. Mal union and dysfunction in Colles fracture. J Hand Surg Br 1988;13:291-3.
7. Ring D, Jupiter JB, Brennwald J, Buchler U, Hastings H. Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures. J Hand Surg 1997;22:777-84.
8. Ring D, Jupiter JB. Treatment of osteoporotic distal radius fractures. Osteoporos Int 2005;16:80-4.
9. Jenkins NH. Fractures of the distal end of the radius. J Bone Joint Surg Am 1991;73:461-9.
10. Wright TW, Horodyski M, Smith DW. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed angle tine plate versus external fixation. J Hand Surg Am 2005;30:289-99.
11. Kandemir U, Matiyahu A, Desai R, Puttliz C. Does volar locking plate provide equivalent stability as a dorsal nonlocking plate in a dorsally comminuted distal radius fracture? A biomechanical study. J Orthop Trauma 2008;22:605-10.
12. Nana AD, Joshi A, Litchman DM. Plating of the distal radius. J Am Acad Orthop Surg 2005;13:159-71.
13. Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am 2004;29:96-102.
14. Osada D, Kamei S, Masuzaki K, Takai M, Kameda M, Tamai K. Prospective study of distal fractures treated with a volar locking plate system. J Hand Surg Am 2008;33:691-700.
15. Azzopardi T, Ehrendorfer S, Coulton T, Abela M. Unstable extraarticular fractures of the distal radius: a prospective, randomised study of inmobilisation in a cast versus supplementary percutaneos pinning. J Bone Joint Surg Br 2005;85:837-40.
16. Martineau PA, Waitayawinyu T, Malone KJ, Hanel DP, Trumble TE. Volar plating of AO C3 distal radius fractures: biomechanical evaluation of locking screw and locking smooth peg configurations. J Hand Surg Am 2008;33:827-34.
17. Boretto JG, Pacher N, Giunta D, Gallucci GL, Alfie V, De Carli P. Comparative clinical study of locking screws versus smooth locking pegs in volar plating of distal radius fractures. J Hand Surg Eur 2014;39:775-60.
18. Weninger P, DallAra E, Leixnering M, Pezzei C, Hertz H, Drobetz H, et al. Volar fixed-angle plating of extraarticular distal radius fractures. A biomechanical analysis comparing threaded screw and smooth pegs. J Orthop Trauma 2010;69:46-55.
19. Leib ES, Lewiecki EM, Binkley N, Hamdy RC. Official Positions of the International Society for Clinical Densitometry. J Clin Densitom 2004;7:1-5.
20. Drobetz H, Bryant A, Pokorny T, Spitaler R, Leixnering M, Jupiter J. Volar fixed angle plating of distal radius extension fractures: Influence of plate position on secondary loss of reduction–a biomechanic study in cadaveric model. J Hand Surg Am 2006;31:615-22.
21. Wolfe SW, Lorenze MD, Austin G, Swigart CR, Panjabi MM. Load displacement behavior in a distal fracture model. The effect of simulated healing on motion. J Bone Joint Surg Am 1999;81:53-9.
22. Putnam MD, Meyer NJ, Nelson EW, Gesensway D, Lewis JL. Distal radial metaphyseal forces in an extrinsic grip model: implications for postfracture rehabilitation. J Hand Surg Am 2000;25:469-75.
23. Koh S, Morris RP, Patterson RM, Kearney JP, Buford WL, Viegas SF. Volar fixation for dorsally angulated extraarticular fractures of the distal radius: a biomechanical study. J Hand Surg Am 2006;31:771-9.
24. Rockwood C, Green D. Fracturas del adulto, Madrid: Ed Marbán; 2003.
25. Willis AA, Kutsumi K, Zobbitz ME, Cooney WP. Internal fixation of dorsally displaced fractures of the distal part of the radius. A biomechanical analysis of volar plate stability. J Bone Joint Surg Am 2006;88:2411-7.
26. Angulen J, Kyle RF, Marsh JL, Virkus WW, Waters WC, Warren M, et al. Locking plates for extremity fractures. J Am Acad Orthop Surg 2009;17:465-72.
27. Mehling I, Klitscher D, Mehling AP, Nowak TE, Sternstein W, Rommens PM, et al. Volar fixed-angle plating of distal radius fractures: screws versus pegs-a biomechanical study in a cadaveric model. J Orthop Trauma 2012;26:395-401.