Is Bridge Plating of Comminuted Humeral Shaft Fractures Advantageous When Using Compression Plates with Three versus Two Screws per Fragment? A Biomechanical Cadaveric Study.

Autor:	Gomes GS; AO Research Institute Davos, Davos, Switzerland., Zderic I; AO Research Institute Davos, Davos, Switzerland., Ahrend MD; AO Research Institute Davos, Davos, Switzerland.; Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard-Karls University of Tübingen, Tübingen, Germany., Kojima KE; Institute of Orthopedics and Traumatology, University of Sao Paulo, Brazil., Varga P; AO Research Institute Davos, Davos, Switzerland., Belangero WD; Department of Orthopedics and Traumatology, Faculty of Medical Sciences, State University of Campinas, Sao Paulo, Brazil., Richards G; AO Research Institute Davos, Davos, Switzerland., Lambert SM; Department of Trauma and Orthopaedics, University College London Hospital, London, UK., Gueorguiev B; AO Research Institute Davos, Davos, Switzerland.
Jazyk:	angličtina
Zdroj:	BioMed research international [Biomed Res Int] 2021 Mar 06; Vol. 2021, pp. 6649712. Date of Electronic Publication: 2021 Mar 06 (Print Publication: 2021).
DOI:	10.1155/2021/6649712
Abstrakt:	Background: Minimally invasive plate osteosynthesis (MIPO) is one of the generally accepted surgical techniques for the treatment of humeral shaft fractures. However, despite the high bone union rate, a variety of complications are still prevailing. Moreover, the current literature lacks data comparing the anterolateral MIPO approach using dynamic compression plates accommodating different numbers of screws. The aim of this study was to analyze the biomechanical performance of comminuted humeral shaft fractures fixed with dynamic compression plates using either two or three screws per fragment. Methods: Six pairs of fresh-frozen human cadaveric humeri from donors aged 66.8 ± 5.2 years were randomized to two paired study groups for simulation of bridge-plated comminuted shaft fracture type AO/OTA 12-C1/2/3 without interfragmentary bony support, using a dynamic compression plate positioned on the anterolateral surface and fixed with two (group 1) or three (group 2) screws per fragment. All specimens underwent nondestructive quasistatic biomechanical testing under lateral bending, anterior bending, axial bending, and torsion in internal rotation, followed by progressively increasing cyclic torsional loading in internal rotation until failure. Results: Initial stiffness of the plated specimens in lateral bending, anterior bending, axial bending, and torsion was not significantly different between the groups ( P ≥ 0.22). However, cycles to 10°, 15°, and 20° torsional deformation and cycles to construct failure were significantly higher in group 2 compared with group 1 ( P ≤ 0.03). Conclusions: From a biomechanical perspective, no significant superiority is identified in terms of primary stability when using two or three screws per fragment for bridge compression plating of comminuted humeral shaft fractures. However, three-screw configurations provide better secondary stability and maintain it with a higher resistance towards loss of reduction under dynamic loading. Therefore, the use of a third screw may be justified when such better secondary stability is required. Competing Interests: The authors declare that they have no conflicts of interest. (Copyright © 2021 Guilherme Seva Gomes et al.)
Databáze:	MEDLINE
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