A biomechanical comparison of midshaft clavicle plate fixation between two screws and three screws on each side of the fractures

Naufal Ranadi Firas, Erwin Ramawan

Abstract

ABSTRACT

 

The operative management of mid-clavicle fractures with plate and screw fixation is often performed, with either two or three screws on each side of the fracture. This research aimed to compare biomechanical stability on plate and screw fixation of the middle clavicle fracture with two screws and three screws on each fracture side. There were 12 samples of the fractured cadaveric clavicle in the middle and divided into two treatment groups. The first treatment group was given plate fixation and two screws on each side of the fracture, the second treatment group with plate fixation and three screws. Each group was given a repetitive load tensile force of 200 N, and the fracture shift was measured every ten times, 20 times, and 50 times. The statistical analysis showed a significant difference between plate fixation with two screws and three screws on the tensile force's repetition 20 times and 50 times. The lowest average displacement value after repetition of tensile forces is found in fixation with three screws. Biomechanically, the plate fixation system with three screws on each fracture side was more stable than the two screws in the middle clavicle fracture fixation.

Keywords:            biomechanics, clavicle fracture, plate, screw

Correspondence:       nau.orthobaya@gmail.com

Keywords

biomechanics, clavicle fracture, plate, screw

Full Text:

PDF

References

Altamimi, S. A., & McKee, M. D. (2008). Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures: Surgical technique. JBJS, 90(Supplement_2_Part_1), 1–8.

Bilmont, A., Palierne, S., Verset, M., Swider, P., & Autefage, A. (2015). Biomechanical comparison of two locking plate constructs under cyclic torsional loading in a fracture gap model. Veterinary and Comparative Orthopaedics and Traumatology, 28(5), 323–330.

Duan, X., Zhong, G., Cen, S., Huang, F., & Xiang, Z. (2011). Plating versus intramedullary pin or conservative treatment for midshaft fracture of clavicle: a meta-analysis of randomized controlled trials. Journal of Shoulder and Elbow Surgery, 20(6), 1008–1015.

Grawe, B., Le, T., Williamson, S., Archdeacon, A., & Zardiackas, L. (2012). Fracture fixation with two locking screws versus three non-locking screws: A biomechanical comparison in a normal and an osteoporotic bone model. Bone & Joint Research, 1(6), 118–124.

Hak, D. J., Althausen, P., & Hazelwood, S. J. (2010). Locked plate fixation of osteoporotic humeral shaft fractures: are two locking screws per segment enough? Journal of Orthopaedic Trauma, 24(4), 207–211.

Hill, J. M., McGuire, M. H., & Crosby, L. A. (1997). Closed treatment of displaced middle-third fractures of the clavicle gives poor results. The Journal of Bone and Joint Surgery. British Volume, 79(4), 537–538.

Jeray, K. J. (2007). Acute midshaft clavicular fracture. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 15(4), 239–248.

Kleweno, C. P., Jawa, A., Wells, J. H., O’Brien, T. G., Higgins, L. D., Harris, M. B., & Warner, J. J. P. (2011). Midshaft clavicular fractures: comparison of intramedullary pin and plate fixation. Journal of Shoulder and Elbow Surgery, 20(7), 1114–1117.

Larsen, C. G., Sleasman, B., & Chudik, S. C. (2017). A Biomechanical and Clinical Comparison of Midshaft Clavicle Plate Fixation: Are 2 Screws as Good as 3 on Each Side of the Fracture? Orthopaedic Journal of Sports Medicine, 5(9), 2325967117725293.

Laursen, M. B., & Døssing, K. V. (1999). Clavicular nonunions treated with compression plate fixation and cancellous bone grafting: the functional outcome. Journal of Shoulder and Elbow Surgery, 8(5), 410–413.

Liu, G., Tong, S., Ou, S., Zhou, L., Fei, J., Nan, G., & Gu, J. (2013). Operative versus non-operative treatment for clavicle fracture: a meta-analysis. International Orthopaedics, 37(8), 1495–1500.

Narsaria, N., Singh, A. K., Arun, G. R., & Seth, R. R. S. (2014). Surgical fixation of displaced midshaft clavicle fractures: elastic intramedullary nailing versus precontoured plating. Journal of Orthopaedics and Traumatology, 15(3), 165–171.

Postacchini, F., Gumina, S., De Santis, P., & Albo, F. (2002). Epidemiology of clavicle fractures. Journal of Shoulder and Elbow Surgery, 11(5), 452–456.

Robinson, C M, Goudie, E. B., Murray, I. R., Jenkins, P. J., Ahktar, M. A., Read, E. O., Foster, C. J., Clark, K., Brooksbank, A. J., & Arthur, A. (2013). Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. JBJS, 95(17), 1576–1584.

Robinson, C Michael. (1998). Fractures of the clavicle in the adult: epidemiology and classification. The Journal of Bone and Joint Surgery. British Volume, 80(3), 476–484.

Smekal, V., Oberladstaetter, J., Struve, P., & Krappinger, D. (2009). Shaft fractures of the clavicle: current concepts. Archives of Orthopaedic and Trauma Surgery, 129(6), 807–815.

Society, C. O. T. (2007). Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. The Journal of Bone and Joint Surgery. American Volume, 89(1), 1–10.

Thyagarajan, D. S., Day, M., Dent, C., Williams, R., & Evans, R. (2009). Treatment of mid-shaft clavicle fractures: a comparative study. International Journal of Shoulder Surgery, 3(2), 23.

Ye, Y., Hao, J., Mauffrey, C., Hammerberg, E. M., Stahel, P. F., & Hak, D. J. (2015). Optimizing stability in femoral neck fracture fixation. Orthopedics, 38(10), 625–630.

Zlowodzki, M., Zelle, B. A., Cole, P. A., Jeray, K., & McKee, M. D. (2005). Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. Journal of Orthopaedic Trauma, 19(7), 504–507.


DOI: http://dx.doi.org/10.30651/jqm.v6i1.7626