Biomechanical comparison of three internal fixation configurations for low transcondylar fractures of the distal humerus |
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| Institution: | 1. Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing 100035, China;2. State Key Laboratory of Nonlinear Mechanics (LNM), Institute of Mechanics, Chinese Academy of Sciences, Beijing, China;1. Orthopedic Surgery and Traumatology, Servicio de Cirugía Ortopédica y Traumatología, Hospital Miguel Servet, Paseo Isabel la Católica, 1-3, Zaragoza 50.009, Spain;2. Institute for Health Research Aragón, Zaragoza, Spain;3. Universidad de Zaragoza, Spain;1. Orthopaedic Surgeon, University of Toronto, St. Michael''s Hospital, Toronto, Ontario, Canada;2. The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Suite J129, Ottawa, Ontario, Canada;3. University of Calgary, 0490 McCaig Tower, Foothills Hospital, 3134 Hospital Drive NW Calgary, Alberta T2N 5A1, Canada;1. Department of Orthopedics, Third People''s Hospital of Hubei Province, Wuhan 430000, China;2. Department of Orthopedic Trauma, Wuhan Fourth Hospital, Wuhan 430000, China;1. Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS, 39216;1. University of Rochester Medical Center, Department of Orthopaedics, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA;2. University of California, Davis, Department of Orthopaedic Surgery, Sacramento, CA, USA |
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| Abstract: | BackgroundWe aimed to evaluate the biomechanical stiffness and strength of different internal fixation configurations and find suitable treatment strategies for low transcondylar fractures of the distal humerus.Methods and materialsThirty 4th generation composite humeri were used to create low transcondylar fracture models that were fixed by orthogonal and parallel double plates as well as posterolateral plate and medial screw (PPMS) configurations (n=10 in each group) using an anatomical locking compression plate-screw system and fully threaded medial cortical screws. Posterior bending (maximum 50 N), axial loading (maximum 200 N) and internal rotation (maximum 10 N·m) were tested, in that order, for each specimen. Stiffness under different biomechanical settings among different configurations were compared. Another 18 sets of fracture models were created using these three configurations (n=6 in each group) and the load to failure under axial loading among different configurations was compared.ResultsUnder posterior bending, the stiffness of parallel group was higher than orthogonal group (P<0.001), and orthogonal group was higher than PPMS group (P<0.001). Under axial loading, the stiffness of parallel group was higher than orthogonal group (P=0.001) and PPMS group (P<0.001); however, the difference between orthogonal and PPMS group was not statistically significant (P>0.05). Under internal rotation, the stiffness of parallel group was higher than orthogonal group (P=0.044), and orthogonal group was higher than PPMS group (P=0.029). In failure test under axial loading, the load to failure in the orthogonal group was lower than parallel group (P=0.009) and PPMS group (P=0.021), but the difference between parallel group and PPMS group was not statistically significant (P>0.05). All specimens in orthogonal group demonstrated “distal medial failure”; most specimens had “distal medial and trochlear failure” in the parallel group; most specimens exhibited “contact failure” in the PPMS group.ConclusionFor treating low transcondylar fractures, the overall stiffness and strength of the parallel configuration were superior to those of the orthogonal and PPMS configurations. Nevertheless, the PPMS configuration can provide adequate stability and stiffness comparable to double-plate configurations under axial loading. Therefore, the PPMS construct may have certain clinical value. |
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