Biomechanical evaluation of a transcondylar screw from the dorsolateral plate support on the stabilization of orthogonal plate configuration in distal humeral fracture
Biomechanical evaluation of a transcondylar screw from the dorsolateral plate support on the stabilization of orthogonal plate configuration in distal humeral fracture
复制标题
背外侧板支撑的跨髁螺钉对肱骨远端骨折正交板构型稳定性的生物力学评估
DOI：
10.1016/j.injury.2018.12.017
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发表时间：
2019
期刊：
影响因子：
2.5
通讯作者：
Kaneko Kazuo
中科院分区：
文献类型：
--
作者：
Hara Akira;Kudo Toshiya;Ichihara Satoshi;Iwase Hideaki;Nagao Masashi;Maruyama Yuichiro;Kaneko Kazuo
肱骨远端关节内双柱骨折需要双钢板固定。在正交接骨板固定中，来自内侧接骨板的螺钉到达桡骨柱，而来自背外侧接骨板的螺钉从后向前延伸，不会产生交错。Synthes LCP-DHP系统具有正交接骨板配置，能够在支持的情况下进行背外侧接骨板固定，因为桡侧和尺侧柱通过远端螺钉的相互交叉连接。我们假设后外侧板的经髁螺钉与内侧板的螺钉相互交叉，使得在远端肱骨AO C型fractions.MethodsA之前的研究报告了使用AO 13-C2.3型关节内骨折模型的正交板固定的生物力学特性，该模型使用人工骨，髁上间隙为1 cm（Kudo等人，伤，2016年）。我们对背外侧接骨板和支撑进行了生物力学研究，并将一枚2.7 mm锁定螺钉沿外侧至内侧方向插入支撑，使远端螺钉相互交错。将0-200 N的轴向载荷分别施加到桡骨和尺骨柱上。我们计算了两个立柱的刚度和髁突骨折块的前向位移。我们比较了生物力学性能的正交钢板与没有interdigitation.ResultsThere没有显着差异，两组之间的桡骨或尺骨轴向压缩。两组尺侧柱的硬度均大于桡侧柱。两组肱骨小头或肱骨托的角位移无显著差异。Capitellum移动更向前比trophila在轴向compressionin both group.DiscussionThe桡骨和尺骨柱连接通过交错的远端螺钉通过添加一个transcondylar螺钉从背外侧板，这并不影响桡骨柱刚度或capitellar轴向压缩下的前向运动。在正交配置，轴向压缩引起更多的前移位的肱骨小头比trophila，这可能会导致继发性碎片或螺钉脱位的背外侧板或不愈合在supracondylar level.ConclusionsThe transcondylar螺钉从背外侧板不影响轴向压缩的桡骨柱或肱骨小头前移位。
IntroductionIntra-articular distal humeral fractures involving both columns require double-plate fixation. In orthogonal plate fixation, screws from the medial plate reach the radial column, while screws from the dorsolateral plate run posterior–anterior, not creating interdigitation. The Synthes LCP-DHP system has an orthogonal plate configuration that enables dorsolateral plating with support, as the radial and ulnar columns are linked via interdigitation of the distal screws. We hypothesized that the transcondylar screw from the posterolateral plate, which interdigitates with screws from the medial plate, enables more rigid stabilization of orthogonal plating in distal humeral AO type C fractures.MethodsA previous study reported the biomechanical properties of orthogonal plate fixation using an AO type 13-C2.3 intra-articular fracture model with a 1-cm supracondylar gap using artificial bones (Kudo et al., Injury, 2016). We performed a biomechanical study of the dorsolateral plate with support, and inserted one 2.7-mm locking screw through the support in the lateral-to-medial direction, creating interdigitation of the distal screws. A 0–200 N axial load was applied separately to the radial and ulnar columns. We calculated the stiffness of both columns, and the anterior displacement of the condylar fragment. We compared the biomechanical properties of orthogonal plating with versus without interdigitation.ResultsThere were no significant differences between the two groups in radial or ulnar axial compression. The ulnar column was stiffer than the radial column in both groups. There were no significant differences between groups in the angular displacements of the capitellum or trochlea. The capitellum moved more anteriorly than the trochlea during axial compression in both groups.DiscussionThe radial and ulnar columns were linked via interdigitation of the distal screws by adding one transcondylar screw from the dorsolateral plate, which did not affect radial column stiffness or capitellar anterior movement under axial compression. In the orthogonal configuration, axial compression induced more anterior displacement of the capitellum than the trochlea, which may induce secondary fragment or screw dislocation on the dorsolateral plate or nonunion at the supracondylar level.ConclusionsThe transcondylar screw from the dorsolateral plate did not affect axial compression of the radial column or capitellar anterior displacement.