Biomechanical comparison of screw osteosyntheses and anatomical plating for coronoid shear fractures of the ulna
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TRAUMA SURGERY
Biomechanical comparison of screw osteosyntheses and anatomical plating for coronoid shear fractures of the ulna Valentin Rausch1 · Birger Jettkant1,2 · Sebastian Lotzien1 · Thomas Rosteius1 · Eileen Mempel1 · Thomas A. Schildhauer1 · Dominik Seybold1 · Jan Geßmann1 · Matthias Königshausen1 Received: 22 March 2020 / Accepted: 30 September 2020 © The Author(s) 2020
Abstract Introduction Among the few techniques described for the treatment of coronoid fractures, osteosynthesis techniques include screw osteosynthesis from anterior to posterior (AP) or from posterior to anterior (PA) and plate osteosynthesis. The aim of this study was to test the biomechanical stability of screw osteosynthesis and plate osteosynthesis using anatomical plates in coronoid process fractures. Materials and methods On a total of 25 biomechanical synthetical ulnae, a coronoid shear fracture including 70% of the coronoid height was simulated. Osteosynthesis was then performed using two 2.7 mm screws from anterior, posterior and with use of three different anatomical plates of the coronoid process. For the biomechanical testing, axial load was applied to the fragment with 1000 cycles from 5 to 250 N, load to failure and load at 100 µm displacement. Displacements were measured using a point-based three-dimensional motion analysis system. Results Osteosynthesis using the PA-screw showed significant more displacement during cyclic loading compared with all other osteosyntheses (0.99 mm), whereas AP-screw showed the smallest displacement (0.10 mm) during cyclic loading. The PA-screw technique showed a significant lower load to failure compared to all other osteosynthesis with the highest load in AP-screw osteosynthesis. The load for 100 µm displacement was the smallest in PA-screw with a significant difference to the AP-screw and one plate osteosynthesis. Conclusion Osteosynthesis of large coronoid shear fractures with two small-fragment screws from anterior allows stable fixation that is not inferior to anterior plate osteosynthesis and might be an alternative in specific fracture types. Posterior screw fixation was found as the weakest fixation method. Level of evidence Basic science study Keywords Elbow · Biomechanics · Coronoid fracture · Elbow instability
Introduction Injuries to the coronoid process can destabilize the elbow as it resists axial loading with varus and valgus stress [1]. Historically, these injuries were classified according the size of the fragment on lateral radiographs alone [2]. The newer * Valentin Rausch [email protected] 1
Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle‑de‑la‑Camp‑Platz 1, 44789 Bochum, Germany
Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
2
classification system by O’Driscoll et al. is driven by a better understanding of the injury mechanism and account for the orientation and morphology of the fracture fragment leading t
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