Sebastian Lappen, Sebastian Siebenlist, Tim Leschinger, Pavel Kadantsev, Stephanie Geyer, Kilian Wegmann, Lars-Peter Müller, Michael Hackl
{"title":"Optimal screw orientation for fixation of coronal shear fractures: a biomechanical comparison.","authors":"Sebastian Lappen, Sebastian Siebenlist, Tim Leschinger, Pavel Kadantsev, Stephanie Geyer, Kilian Wegmann, Lars-Peter Müller, Michael Hackl","doi":"10.1016/j.jse.2024.05.007","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Coronal shear fractures of the capitellum are rare injuries which can be challenging to treat. The aim of this study was to compare the biomechanical properties of different internal screw fixation techniques for Dubberley type IA fractures of the capitellum.</p><p><strong>Methods: </strong>In this biomechanical study, Dubberley type IA fractures of the capitellum were created in 30 human fresh-frozen humeri. The specimens were then divided into 3 groups: fixation was either performed with 3 × 3.0 mm headless cannulated compression screws (HCCSs) in anteroposterior (AP) orientation (AP group), 3 × 3.0 mm HCCSs in posteroanterior (PA) orientation (PA group) or with 2 × 3.0 mm HCCSs in PA orientation and 1 × 3.0 mm HCCS in lateral orientation (LAT) group. Displacement under cyclic loading and ultimate load-to-failure were evaluated in all specimens.</p><p><strong>Results: </strong>There was no significant difference in fragment displacement after 2000 cycles between AP and PA groups (0.8 ± 0.5 mm vs. 0.8 ± 0.6 mm; P = .987) or PA and LAT groups (0.8 ± 0.6 mm vs. 0.8 ± 0.3 mm; P = .966). LAT group showed the highest load-to-failure (548 ± 250 N) without reaching statistically significant difference to AP group (388 ± 173 N; P = .101). There was also no significant difference between AP and PA groups (388 ± 173 N vs. 422 ± 114 N; P = .649).</p><p><strong>Conclusions: </strong>Variations in screw placement had no statistically significant influence on cyclic displacement or load-to-failure in Dubberley Type IA fractures. However, fracture fixation in 2 planes-both the coronal and the sagittal plane-by adding a screw in a lateral to medial direction may be beneficial to increase primary stability.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":"543-549"},"PeriodicalIF":2.9000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Shoulder and Elbow Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jse.2024.05.007","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/26 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Coronal shear fractures of the capitellum are rare injuries which can be challenging to treat. The aim of this study was to compare the biomechanical properties of different internal screw fixation techniques for Dubberley type IA fractures of the capitellum.
Methods: In this biomechanical study, Dubberley type IA fractures of the capitellum were created in 30 human fresh-frozen humeri. The specimens were then divided into 3 groups: fixation was either performed with 3 × 3.0 mm headless cannulated compression screws (HCCSs) in anteroposterior (AP) orientation (AP group), 3 × 3.0 mm HCCSs in posteroanterior (PA) orientation (PA group) or with 2 × 3.0 mm HCCSs in PA orientation and 1 × 3.0 mm HCCS in lateral orientation (LAT) group. Displacement under cyclic loading and ultimate load-to-failure were evaluated in all specimens.
Results: There was no significant difference in fragment displacement after 2000 cycles between AP and PA groups (0.8 ± 0.5 mm vs. 0.8 ± 0.6 mm; P = .987) or PA and LAT groups (0.8 ± 0.6 mm vs. 0.8 ± 0.3 mm; P = .966). LAT group showed the highest load-to-failure (548 ± 250 N) without reaching statistically significant difference to AP group (388 ± 173 N; P = .101). There was also no significant difference between AP and PA groups (388 ± 173 N vs. 422 ± 114 N; P = .649).
Conclusions: Variations in screw placement had no statistically significant influence on cyclic displacement or load-to-failure in Dubberley Type IA fractures. However, fracture fixation in 2 planes-both the coronal and the sagittal plane-by adding a screw in a lateral to medial direction may be beneficial to increase primary stability.
目的：帽状腱膜冠状剪切骨折是一种罕见的损伤，治疗难度很大。本研究旨在比较不同内螺丝固定技术治疗帽状腱膜 Dubberley IA 型骨折的生物力学特性：在这项生物力学研究中，我们在 30 个人体新鲜冷冻肱骨上创建了岬部 Dubberley IA 型骨折。然后将标本分为三组：使用 3 x 3.0 mm 无头套管加压螺钉（HCCS）在前胸（AP）方向进行固定（AP 组），使用 3 x 3.0 mm HCCS 在后前方（PA）方向进行固定（PA 组），或者使用 2 x 3.0 mm HCCS 在 PA 方向进行固定，使用 1 x 3.0 mm HCCS 在侧方进行固定（LAT 组）。对所有试样进行了循环加载下的位移和极限破坏荷载评估：AP组和PA组（0.8 ± 0.5 mm vs. 0.8 ± 0.6 mm; p = 0.987）或PA组和LAT组（0.8 ± 0.6 mm vs. 0.8 ± 0.3 mm; p = 0.966）在2000次循环后的碎片位移无明显差异。LAT 组显示出最高的失效载荷（548 ± 250 N），与 AP 组（388 ± 173 N；p = 0.101）相比无显著统计学差异。AP 组和 PA 组之间也无明显差异（388 ± 173 N vs. 422 ± 114 N；p = 0.649）：结论：螺钉位置的变化对 Dubberley IA 型骨折的循环位移或加载到破坏的影响没有统计学意义。然而，在两个平面（冠状面和矢状面）上进行骨折固定，在外侧到内侧的方向上增加一颗螺钉，可能有利于增加原发性稳定性。
期刊介绍：
The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
