Biomechanical Comparison of Bicortical, Unicortical, and Unicortical Far-Cortex-Abutting Screw Fixations in Plated Comminuted Midshaft Clavicle Fractures

J. Sawyer Croley, Randal P. Morris, Arsalan Amin, Ronald Lindsey, Zbigniew Gugala

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose The objective of this study was to assess the biomechanical properties of bicortical locking screws, unicortical locking screws, and unicortical far-cortex-abutting locking screw fixation in a cadaver model of comminuted midshaft clavicle fractures stabilized with a locking plate placed on the superior surface of the clavicle. Methods Nine pairs of adult fresh-frozen cadaver clavicles were allocated into 3 groups for either bicortical, unicortical, or unicortical far-cortex-abutting locking plate fixation. After a 1-cm osteotomy to simulate a comminuted fracture and instrumentation with an 8-hole locking plate placed on the superior surface of the clavicle, the specimens were mounted in a custom dual-gimbal fixture in a materials-testing system and tested in axial compression, torsional, and torsional load to failure. Results Axial stiffness and axial osteotomy site stiffness did not demonstrate differences between constructs. In cyclical torsion, both the bicortical and the unicortical far-cortex-abutting constructs were significantly stiffer than the unicortical construct. For torsional failure stiffness, both the bicortical and the unicortical far-cortex-abutting constructs were significantly stiffer than the unicortical construct. There was no difference between bicortical and unicortical far-cortex-abutting for torsional failure stiffness. The bicortical construct exhibited significantly higher peak failure torque compared with the unicortical construct. Conclusions Unicortical far-cortex-abutting locking screw fixation provides comparable mechanical properties under axial and torsional loads to bicortical fixation, without penetrating the far cortex. Clinical relevance Unicortical far-cortex-abutting locking screw fixation obviates far cortex penetration, and thereby protects nearby anatomical structures, may ease symptomatic implant removal, alleviates refracture risk, and eases conversion to bicortical fixation in the case of revision surgery.

Original languageEnglish (US)
Pages (from-to)703-711
Number of pages9
JournalJournal of Hand Surgery
Volume41
Issue number6
DOIs
StatePublished - Jun 1 2016

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Clavicle
Osteotomy
Cadaver
Comminuted Fractures
Materials Testing
Torque
Reoperation

Keywords

  • clavicle fracture
  • Key words Unicortical far-cortex-abutting screw
  • locking-plate biomechanics

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Biomechanical Comparison of Bicortical, Unicortical, and Unicortical Far-Cortex-Abutting Screw Fixations in Plated Comminuted Midshaft Clavicle Fractures. / Croley, J. Sawyer; Morris, Randal P.; Amin, Arsalan; Lindsey, Ronald; Gugala, Zbigniew.

In: Journal of Hand Surgery, Vol. 41, No. 6, 01.06.2016, p. 703-711.

Research output: Contribution to journalArticle

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abstract = "Purpose The objective of this study was to assess the biomechanical properties of bicortical locking screws, unicortical locking screws, and unicortical far-cortex-abutting locking screw fixation in a cadaver model of comminuted midshaft clavicle fractures stabilized with a locking plate placed on the superior surface of the clavicle. Methods Nine pairs of adult fresh-frozen cadaver clavicles were allocated into 3 groups for either bicortical, unicortical, or unicortical far-cortex-abutting locking plate fixation. After a 1-cm osteotomy to simulate a comminuted fracture and instrumentation with an 8-hole locking plate placed on the superior surface of the clavicle, the specimens were mounted in a custom dual-gimbal fixture in a materials-testing system and tested in axial compression, torsional, and torsional load to failure. Results Axial stiffness and axial osteotomy site stiffness did not demonstrate differences between constructs. In cyclical torsion, both the bicortical and the unicortical far-cortex-abutting constructs were significantly stiffer than the unicortical construct. For torsional failure stiffness, both the bicortical and the unicortical far-cortex-abutting constructs were significantly stiffer than the unicortical construct. There was no difference between bicortical and unicortical far-cortex-abutting for torsional failure stiffness. The bicortical construct exhibited significantly higher peak failure torque compared with the unicortical construct. Conclusions Unicortical far-cortex-abutting locking screw fixation provides comparable mechanical properties under axial and torsional loads to bicortical fixation, without penetrating the far cortex. Clinical relevance Unicortical far-cortex-abutting locking screw fixation obviates far cortex penetration, and thereby protects nearby anatomical structures, may ease symptomatic implant removal, alleviates refracture risk, and eases conversion to bicortical fixation in the case of revision surgery.",
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AU - Amin, Arsalan

AU - Lindsey, Ronald

AU - Gugala, Zbigniew

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N2 - Purpose The objective of this study was to assess the biomechanical properties of bicortical locking screws, unicortical locking screws, and unicortical far-cortex-abutting locking screw fixation in a cadaver model of comminuted midshaft clavicle fractures stabilized with a locking plate placed on the superior surface of the clavicle. Methods Nine pairs of adult fresh-frozen cadaver clavicles were allocated into 3 groups for either bicortical, unicortical, or unicortical far-cortex-abutting locking plate fixation. After a 1-cm osteotomy to simulate a comminuted fracture and instrumentation with an 8-hole locking plate placed on the superior surface of the clavicle, the specimens were mounted in a custom dual-gimbal fixture in a materials-testing system and tested in axial compression, torsional, and torsional load to failure. Results Axial stiffness and axial osteotomy site stiffness did not demonstrate differences between constructs. In cyclical torsion, both the bicortical and the unicortical far-cortex-abutting constructs were significantly stiffer than the unicortical construct. For torsional failure stiffness, both the bicortical and the unicortical far-cortex-abutting constructs were significantly stiffer than the unicortical construct. There was no difference between bicortical and unicortical far-cortex-abutting for torsional failure stiffness. The bicortical construct exhibited significantly higher peak failure torque compared with the unicortical construct. Conclusions Unicortical far-cortex-abutting locking screw fixation provides comparable mechanical properties under axial and torsional loads to bicortical fixation, without penetrating the far cortex. Clinical relevance Unicortical far-cortex-abutting locking screw fixation obviates far cortex penetration, and thereby protects nearby anatomical structures, may ease symptomatic implant removal, alleviates refracture risk, and eases conversion to bicortical fixation in the case of revision surgery.

AB - Purpose The objective of this study was to assess the biomechanical properties of bicortical locking screws, unicortical locking screws, and unicortical far-cortex-abutting locking screw fixation in a cadaver model of comminuted midshaft clavicle fractures stabilized with a locking plate placed on the superior surface of the clavicle. Methods Nine pairs of adult fresh-frozen cadaver clavicles were allocated into 3 groups for either bicortical, unicortical, or unicortical far-cortex-abutting locking plate fixation. After a 1-cm osteotomy to simulate a comminuted fracture and instrumentation with an 8-hole locking plate placed on the superior surface of the clavicle, the specimens were mounted in a custom dual-gimbal fixture in a materials-testing system and tested in axial compression, torsional, and torsional load to failure. Results Axial stiffness and axial osteotomy site stiffness did not demonstrate differences between constructs. In cyclical torsion, both the bicortical and the unicortical far-cortex-abutting constructs were significantly stiffer than the unicortical construct. For torsional failure stiffness, both the bicortical and the unicortical far-cortex-abutting constructs were significantly stiffer than the unicortical construct. There was no difference between bicortical and unicortical far-cortex-abutting for torsional failure stiffness. The bicortical construct exhibited significantly higher peak failure torque compared with the unicortical construct. Conclusions Unicortical far-cortex-abutting locking screw fixation provides comparable mechanical properties under axial and torsional loads to bicortical fixation, without penetrating the far cortex. Clinical relevance Unicortical far-cortex-abutting locking screw fixation obviates far cortex penetration, and thereby protects nearby anatomical structures, may ease symptomatic implant removal, alleviates refracture risk, and eases conversion to bicortical fixation in the case of revision surgery.

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