Dual mini-fragment plating for midshaft clavicle fractures: a clinical and biomechanical investigation
| Autor: | Dean G. Lorich, Daniel B. Chan, Jaimo Ahn, Mark L. Prasarn, Geoffrey Wilkin, David S. Wellman, David L. Helfet, Kathleen N. Meyers |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Fixation (surgical) Fracture Fixation Internal Fractures Bone Bone plate medicine Humans Orthopedics and Sports Medicine Plate fixation Retrospective Studies Orthodontics Arm Injuries Miniaturization business.industry Biomechanics General Medicine Equipment Design Middle Aged Clavicle Surgery Biomechanical Phenomena medicine.anatomical_structure Orthopedic surgery Dash score Female Implant business Bone Plates |
| Zdroj: | Archives of orthopaedic and trauma surgery. 135(12) |
| ISSN: | 1434-3916 |
| Popis: | We sought to evaluate clinical and biomechanical outcomes of dual mini-fragment plate fixation for clavicle fractures. We hypothesized that this technique would produce an anatomical reduction with good clinical outcomes, be well tolerated by patients, and demonstrate equivalent biomechanics to single plating. Dual mini-fragment plating was performed for 17 isolated, displaced midshaft clavicle fractures. Functional outcomes and complications were retrospectively reviewed. A sawbones model compared dual plating biomechanics to a (1) superior 3.5-mm locking reconstruction plate, or (2) antero-inferior 3.5-mm locking reconstruction plate. On biomechanical testing, with anterior loading, dual plating was significantly more rigid than single locked anterior-plating (p = 0.02) but less rigid than single locked superior-plating (p = 0.001). With superior loading, dual plating trended toward higher rigidity versus single locked superior-plating (p = 0.07) but was less rigid than single locked anterior-plating (p = 0.03). No statistically significant differences in axial loading (p = 0.27) or torsion (p = 0.23) were detected. Average patient follow-up was 16.1 months (12–38). Anatomic reduction was achieved and maintained through final healing (average 14.7 weeks). No patient underwent hardware removal. Average 1-year DASH score was 4.0 (completed in 88 %). Displaced midshaft clavicle fractures can be effectively managed with dual mini-fragment plating. This technique results in high union rates and excellent clinical outcomes. Compared to single plating, dual plating is biomechanically equivalent in axial loading and torsion, yet offers better multi-planar bending stiffness despite the use of smaller plates. This technique may decrease the need for secondary surgery due to implant prominence and may aid in fracture reduction by buttressing butterfly fragments in two planes. |
| Databáze: | OpenAIRE |
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