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German Congress of Orthopaedics and Traumatology (DKOU 2019)

22. - 25.10.2019, Berlin

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Biomechanical evaluation of three different plating techniques for fixation of displaced midshaft clavicle factures

Meeting Abstract

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  • presenting/speaker Ivan Zderic - AO Research Institute Davos, Davos, Switzerland
  • Parvan Yanev - AO Research Institute Davos, University Multiprofile Hospital "N. I. Pirogov", Davos, Switzerland
  • Yavor Pukalski - AO Research Institute Davos, University Multiprofile Hospital "N. I. Pirogov", Davos, Switzerland
  • Dian Enchev - University Multiprofile Hospital "N. I. Pirogov", Sofia, Bulgaria
  • Mihail Rashkov - University Multiprofile Hospital "N. I. Pirogov", Sofia, Bulgaria
  • R. Geoff Richards - AO Research Institute Davos, Davos, Switzerland
  • Boyko Gueorguiev - AO Research Institute Davos, Davos, Switzerland
  • Asen Baltov - University Multiprofile Hospital "N. I. Pirogov", Sofia, Bulgaria

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019). Berlin, 22.-25.10.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocIN18-1309

doi: 10.3205/19dkou710, urn:nbn:de:0183-19dkou7105

Published: October 22, 2019

© 2019 Zderic et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objectives: Displaced midshaft fractures are the most common surgically treated clavicle fractures. However, they are still associated with high complication rates after plating due to fixation failure in terms of plate breakage, screw breakage or screw loosening. The aim of this biomechanical study was to compare the biomechanical competence of three different plating techniques for fixation of displaced midshaft clavicle fractures.

Methods: Displaced midshaft fractures type 2B according to the Robinson classification were simulated by standardized 5-mm mid-diaphyseal osteotomy gap in 18 artificial clavicles (Sawbones, Limhamn, Sweden). The specimens were assigned to three groups (n=6) for plating with either superiorly placed Dynamic Compression Plate (Group 1), locked Superior Anterior Clavicle Locking Compression Plate (Group 2), or two non-locked Reconstruction Plates placed superiorly and anteriorly (Group 3). Each specimen was mounted horizontally for mechanical testing under craniocaudal cantilever bending, combined with torsion around the shaft axis. The acromial clavicle end was cyclically loaded at 3Hz by means of vertically applied eccentric force between 20N tension and 50N compression along the machine axis over 720000 cycles or until failure occurred. The latter was defined by plate or screw breakage.

Results and conclusion: Initial construct stiffness (N/mm) was 12.53±2.09 in Group 1, 4.19±0.46 in Group 2, and 22.30±4.07 in Group 3. Cycles to failure were 348541±212941 in Group 1, 19536±3586 in Group 2, and 712778±17691 in Group 3. Both outcomes were significantly higher in Group 3 compared to Group 1 and 2 (p<0.019), as well as significantly higher in Group 2 in comparison to Group 1 (p<0.029).

From biomechanical perspective, double plating of unstable midshaft clavicle fractures with reconstruction plates seems to provide the highest stability under dynamic loading, when compared to single compression or locked plating, whereas the latter is associated with considerably inferior performance.