Please use this identifier to cite or link to this item: http://hdl.handle.net/11434/1268
Title: Unicortical and bicortical plating in the fixation of comminuted fractures of the clavicle: a biomechanical study.
Epworth Authors: Patel, Minoo
Other Authors: Looft, John
Correa, Lincoln
Rawlings, Mathew
Ackland, David
Keywords: Biomechanics
Biomechanical Testing
Implant
Repair Contruct
Clavicle Fractures
Neurovascular Injury
Torsional Stiffness
Bicortical Locking Screw
Unicortical Locking Screw
Clavicle Plating Techniques
Torsional Strength
Bending Strength
Plate Fixation
Fracture Fixation
Centre for Limb Reconstruction, The Epworth Centre, Richmond, Victoria, Australia.
Department of Orthopaedic Surgery, Epworth Healthcare, Richmond, Victoria, Australia
Issue Date: Nov-2017
Publisher: Wiley
Citation: ANZ J Surg. 2017 Nov;87(11):915-920
Abstract: BACKGROUND: Intraoperative neurovascular complications with clavicle fracture fixation are often due to far cortex penetration by drills and screws, but could be avoided using a unicortical construct. The objective of this study was to compare the bending and torsional strength of a unicortical locking screw plate construct and a hybrid (with central locked and outer non-locked long oblique screws) unicortical plate construct for clavicle fracture fixation with that of a conventional bicortical locking screw construct of plate fixation. METHODS: Twenty-four human clavicle specimens were harvested and fractured in a comminuted mid-shaft butterfly configuration. Clavicles were randomly allocated to three surgical fixation groups: unicortical locking screw, bicortical locking screw and hybrid unicortical screw fixation. Clavicles were tested in torsion and cantilever bending. Construct bending and torsional stiffness were measured, as well as ultimate strength in bending. RESULTS: There were no significant differences in bending stiffness or ultimate bending moment between all three plating techniques. The unicortical locked construct had similar torsional stiffness compared with the bicortical locked construct; however, the hybrid technique was found to have significantly lower torsional stiffness to that of the bicortical locking screw construct (mean difference: 87.5 Nmm/degree, P = 0.028). CONCLUSIONS: Unicortical locked screw plate fixation and hybrid unicortical plating fixation with centrally locked screws and outer long, oblique screws may alleviate far cortex penetration, protecting nearby anatomical structures, and may ease implant removal and conversion to bicortical fixation for revision surgery; however, use of long oblique screws may increase the risk of early loosening under torsion.
URI: http://hdl.handle.net/11434/1268
DOI: 10.1111/ans.14139
PubMed URL: https://www.ncbi.nlm.nih.gov/pubmed/28922701
ISSN: 1445-1433
Journal Title: ANZ Journal of Surgery
Type: Journal Article
Affiliated Organisations: Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
Department of Surgery, Southern Clinical School, Monash University, Melbourne, Victoria, Australia
Type of Clinical Study or Trial: Comparative Study
Appears in Collections:Musculoskeletal

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