Sheldon A McCown, Paul J Weatherby, Randal P Morris, Vinod K Panchbhavi, John C Hagedorn, William M Weiss, Jie Chen
{"title":"使用推拉技术预防先天性腓骨骨折:单皮质后螺钉与双皮质后螺钉的生物力学比较。","authors":"Sheldon A McCown, Paul J Weatherby, Randal P Morris, Vinod K Panchbhavi, John C Hagedorn, William M Weiss, Jie Chen","doi":"10.3928/01477447-20240702-02","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Displaced diaphyseal fractures can be reduced using the push-pull technique, wherein a plate is affixed to the distal fragment of the fracture, a post screw is placed proximal to the plate, and a lamina spreader creates distraction. This study evaluated the load to failure and mechanism of failure of bicortical and unicortical post screws during reduction.</p><p><strong>Materials and methods: </strong>Four matched pairs of cadaver legs were subjected to a 2-cm oblique osteotomy simulating a displaced, oblique diaphyseal fracture. A 6-hole compression plate was affixed to the distal fragment with 2 unicortical locking screws, and a 12-mm unicortical or 20-mm bicortical screw was inserted as a post screw proximal to the plate. A lamina bone spreader was used to exert a distraction force between the plate and the post screw. A mechanical actuator simulated the distraction procedure until failure. Maximum applied load, displacement, and absorbed energy were recorded and compared across unicortical and bicortical groups by paired <i>t</i> tests.</p><p><strong>Results: </strong>At maximum load, we found statistically significant differences in displacement (<i>P</i>=.003) and energy absorbed (<i>P</i>=.022) between the two groups. All unicortical screws failed through screw toggle and bone cut-out. Bicortical screws failed through bending, with no visible damage to the bone at the screw site.</p><p><strong>Conclusion: </strong>When diaphyseal fractures are significantly shortened and require a greater distraction force to achieve reduction, bicortical screws demonstrate a higher mechanical load to failure and increased bone loss from the screw-removal site. A unicortical post screw may be used if minimal distraction is needed. [<i>Orthopedics</i>. 2024;47(5):308-312.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Preventing Iatrogenic Fibula Fractures Using the Push-Pull Technique: A Biomechanical Comparison of Unicortical Versus Bicortical Post Screws.\",\"authors\":\"Sheldon A McCown, Paul J Weatherby, Randal P Morris, Vinod K Panchbhavi, John C Hagedorn, William M Weiss, Jie Chen\",\"doi\":\"10.3928/01477447-20240702-02\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Displaced diaphyseal fractures can be reduced using the push-pull technique, wherein a plate is affixed to the distal fragment of the fracture, a post screw is placed proximal to the plate, and a lamina spreader creates distraction. This study evaluated the load to failure and mechanism of failure of bicortical and unicortical post screws during reduction.</p><p><strong>Materials and methods: </strong>Four matched pairs of cadaver legs were subjected to a 2-cm oblique osteotomy simulating a displaced, oblique diaphyseal fracture. A 6-hole compression plate was affixed to the distal fragment with 2 unicortical locking screws, and a 12-mm unicortical or 20-mm bicortical screw was inserted as a post screw proximal to the plate. A lamina bone spreader was used to exert a distraction force between the plate and the post screw. A mechanical actuator simulated the distraction procedure until failure. Maximum applied load, displacement, and absorbed energy were recorded and compared across unicortical and bicortical groups by paired <i>t</i> tests.</p><p><strong>Results: </strong>At maximum load, we found statistically significant differences in displacement (<i>P</i>=.003) and energy absorbed (<i>P</i>=.022) between the two groups. All unicortical screws failed through screw toggle and bone cut-out. Bicortical screws failed through bending, with no visible damage to the bone at the screw site.</p><p><strong>Conclusion: </strong>When diaphyseal fractures are significantly shortened and require a greater distraction force to achieve reduction, bicortical screws demonstrate a higher mechanical load to failure and increased bone loss from the screw-removal site. A unicortical post screw may be used if minimal distraction is needed. [<i>Orthopedics</i>. 2024;47(5):308-312.].</p>\",\"PeriodicalId\":19631,\"journal\":{\"name\":\"Orthopedics\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Orthopedics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3928/01477447-20240702-02\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/8 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Orthopedics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3928/01477447-20240702-02","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/8 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Preventing Iatrogenic Fibula Fractures Using the Push-Pull Technique: A Biomechanical Comparison of Unicortical Versus Bicortical Post Screws.
Background: Displaced diaphyseal fractures can be reduced using the push-pull technique, wherein a plate is affixed to the distal fragment of the fracture, a post screw is placed proximal to the plate, and a lamina spreader creates distraction. This study evaluated the load to failure and mechanism of failure of bicortical and unicortical post screws during reduction.
Materials and methods: Four matched pairs of cadaver legs were subjected to a 2-cm oblique osteotomy simulating a displaced, oblique diaphyseal fracture. A 6-hole compression plate was affixed to the distal fragment with 2 unicortical locking screws, and a 12-mm unicortical or 20-mm bicortical screw was inserted as a post screw proximal to the plate. A lamina bone spreader was used to exert a distraction force between the plate and the post screw. A mechanical actuator simulated the distraction procedure until failure. Maximum applied load, displacement, and absorbed energy were recorded and compared across unicortical and bicortical groups by paired t tests.
Results: At maximum load, we found statistically significant differences in displacement (P=.003) and energy absorbed (P=.022) between the two groups. All unicortical screws failed through screw toggle and bone cut-out. Bicortical screws failed through bending, with no visible damage to the bone at the screw site.
Conclusion: When diaphyseal fractures are significantly shortened and require a greater distraction force to achieve reduction, bicortical screws demonstrate a higher mechanical load to failure and increased bone loss from the screw-removal site. A unicortical post screw may be used if minimal distraction is needed. [Orthopedics. 2024;47(5):308-312.].
期刊介绍:
For over 40 years, Orthopedics, a bimonthly peer-reviewed journal, has been the preferred choice of orthopedic surgeons for clinically relevant information on all aspects of adult and pediatric orthopedic surgery and treatment. Edited by Robert D''Ambrosia, MD, Chairman of the Department of Orthopedics at the University of Colorado, Denver, and former President of the American Academy of Orthopaedic Surgeons, as well as an Editorial Board of over 100 international orthopedists, Orthopedics is the source to turn to for guidance in your practice.
The journal offers access to current articles, as well as several years of archived content. Highlights also include Blue Ribbon articles published full text in print and online, as well as Tips & Techniques posted with every issue.