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RESEARCH PRODUCT
Number and Locations of Screw Fixation for Volar Fixed-Angle Plating of Distal Radius Fractures: Biomechanical Study
Dorothea MehlerKlaus J. BurkhartIsabella MehlingPol Maria RommensLars Peter MüllerKatharina DelinskyDipl Ingsubject
Malemusculoskeletal diseasesmedicine.medical_specialtyBone ScrewsBendingFracture Fixation InternalFracture fixationBone platemedicineHumansOrthopedics and Sports MedicineAgedFixation (histology)Aged 80 and overOrthodonticsbusiness.industryBiomechanicsStiffnessRadiusMiddle Agedequipment and suppliesmusculoskeletal systemBiomechanical PhenomenaSurgeryEquipment Failure Analysissurgical procedures operativeOrthopedic surgeryFemaleSurgerymedicine.symptomRadius FracturesbusinessBone Platesdescription
Purpose To compare the biomechanical properties of different numbers and locations of screws in a multidirectional volar fixed-angle plate in a distal radius osteotomy cadaver model. Methods We created an extra-articular fracture in 16 pairs of fresh-frozen human cadaver radiuses. The 32 specimens were randomized into 4 groups. All fractures were fixated with a multidirectional volar fixed-angle plate. We tested 4 different screw-placement options in the distal fragment. The distal fragment was fixed with 4 locking screws in the distal row of the plate in group a, and with 4 locking screws alternately in the distal and proximal rows in group b. In group c, 3 locking screws were used in the proximal row; in group d, 7 locking screws were used, filling all screw holes in the distal and proximal rows of the plate. The proximal fragment was fixed with 3 screws. The specimens were loaded with 80 N under dorsal and volar bending and with 250 N axial loading. Finally, load to failure tests were performed. Results Group d had the highest mean stiffness, 429 N/mm under axial compression, and was statistically significantly stiffer than the other groups. Group b had a mean stiffness of 208 N/mm, followed by group a, with 177 N/mm. Group c showed only a mean stiffness of 83 N/mm under axial compression. There were no statistically significant differences under dorsal and volar bending. Conclusions In this model of distal radial fractures, there was a difference regarding the stiffness and the placement of screws in the distal rows of a volar fixed-angle plate. Inserting screws in all available holes in the distal fragment offered the highest stability. Using only the proximal row with 3 screws created an unstable situation. Based on these findings, we recommend placing at least 4 screws in the distal fragment and assigning at least 2 screws to the distal row of the multidirectional screw-holes.
year | journal | country | edition | language |
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2010-06-01 | The Journal of Hand Surgery |