Please use this identifier to cite or link to this item: http://hdl.handle.net/11434/683
Title: A hybrid approach to mid-shaft clavicle fixation.
Epworth Authors: Knox, David
Patel, Minoo
Other Authors: Rawlings, Mathew
Ackland, David
Keywords: Strength
Surgery
Vascular Injuries
Clavicle
Fracture Fixation
Orthopaedic Fixation Devices
Hybrid Unicortical Construct
Bone Screws
Locking Screws
Centre for Limb Reconstruction, The Epworth Centre, Richmond, Victoria, Australia.
Department of Orthopaedic Surgery, Epworth Healthcare, Richmond, Victoria, Australia
​Musculoskeletal Clinical Institute, Epworth HealthCare, Richmond, Victoria, Australia.
Issue Date: Apr-2016
Publisher: Elsevier
Citation: Injury. 2016 Apr;47(4):893-8.
Abstract: BACKGROUND: The purpose of this study was to demonstrate the strength characteristics of a hybrid uni-cortical construct for clavicle fixation. The technique reported aims to combine benefits of uni-cortical fixation with stability comparable to traditional bi-cortical fixation. The approach utilises long, oblique uni-cortical screws at the distal ends of the plate acting as surrogate bi-cortical screws. Locked uni-cortical screws positioned centrally provide bending and torsion strength to the construct. This alternative hybrid uni-cortical technique does not require far cortex screw or drill penetration required in bi-cortical fixation techniques, thus avoiding potentially catastrophic vascular and or neurologic injury. The purpose of this study was to compare the mechanical behaviour of the hybrid uni-cortical construct to standard bi-cortical fixations under both torsion and bending loads. METHOD: Thirty osteotomized human cadaveric clavicles were randomly allocated to three surgical fixation techniques: bi-cortical locked screw fixation, bi-cortical non-locked screw fixation and hybrid uni-cortical screw fixation. Each clavicle construct was tested non-destructively under torsional loading, and then under cantilever bending to failure. Construct bending and torsional stiffness, as well as ultimate failure strength, were measured. RESULTS: There were no significant differences between uni-cortical or bi-cortical fixation constructs in either bending stiffness or ultimate bending moment (p>0.05); however, there was a trend towards greater bending stiffness in the hybrid construct. The uni-cortical hybrid fixation technique displayed a significantly lower mean torsional stiffness value when compared with the bi-cortical locked screw fixation (mean difference: 134.4Nmm/degrees, 95% confidence interval [32.3, 236.4], p=0.007). CONCLUSION: A hybrid uni-cortical approach to clavicle plate fixation that may improve screw purchase and reduce risk of intra-operative vascular damage demonstrates comparable bending strength to current bi-cortical approaches.
URI: http://hdl.handle.net/11434/683
DOI: 10.1016/j.injury.2016.01.042
PubMed URL: http://www.ncbi.nlm.nih.gov/pubmed/26944179
ISSN: 0020-1383
Journal Title: Injury
Type: Journal Article
Affiliated Organisations: Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia.
Department of Surgery, Southern Clinical School, Monash University, Clayton, Victoria, Australia.
Type of Clinical Study or Trial: Comparative Study
Appears in Collections:Musculoskeletal

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