Abstract
Numerous angular stable plates for the distal radius exist, and technically based comparisons of the polyaxial locking interfaces are lacking. The aim of this mechanical study was to investigate three different locking interfaces of angular stable volar plates by cantilever bending: VA-LCP Two-Column Distal Radius Plates 2.4 mm (Synthes® GmbH, Oberdorf, Switzerland), IXOS® P4 (Martin, Tuttlingen, Germany) and VariAX™ (Stryker®, Duisburg, Germany). We assessed the strength of 0°, 5°, 10° and 15° screw locking angles and tested the bending strength from 10° to 5° angles by cyclic loading until breakage. The final setup repeated the above assessments by inclusion of four locking screws. The single screw-plate interfaces of the VA-LCP showed the highest bending moment at an angle of 0° and 5°, the IXOS® P4 at an angle of 10° and 15° and the VariAX™ when changing the insertion angle from 10° into 5°. The strength of polyaxial locking interfaces and mechanism of failure proved to be different among the examined plates.
About the authors
Isabella Mehling received her medical education at the Julius-Maximilians University Würzburg, Germany and her Doctoral thesis in 2003. In 2002–2003 Isabella became a Resident in Orthopedic Surgery at König-Ludwig-Haus Würzburg, Germany under its Chairman Prof. Dr. J. Eulert. From 2004 to April 2005 she was a Resident in Hand Surgery at the Clinic for Handsurgery, Bad Neustadt/Saale, Germany under its Chairman Prof. Dr. U. Lanz, and from May 2005 to the present she has been a Resident in Trauma Surgery at the Center for Musculoskeletal Surgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Germany under its Chairman Prof. Dr. P.M. Rommens. Since October 2010 she has been a medical specialist for orthopaedics and trauma surgery and works mainly in clinical and biomechanical research.
Rebekka Scheifl (M.Sc.) was born in Darmstadt (Germany). Rebekka obtained a diploma in Physics from Rubrecht-Karls-University of Heidelberg in 2004. She worked as a Student Assistant at the Mechanical Laboratory at the University of Applied Science in Wiesbaden (now the University of Applied Science RheinMain) between 2006 and 2008 where she obtained her B.Sc. in 2009 in Applied Physics and her Masters in Engineering Physics in 2012. She was a Medical Physicist in the Radiology Department of the Radiooncology abd Radiation Clinic at the University Center of the Johannes Gutenberg University of Mainz from August 2012 to November 2012. She has also worked at Fields Engineers, CardioSkills GmbH & Co. KG, Frankfurt am Main (2009–2012).
Dorothea Mehler was born in Zabrze (Poland). She studied Physical Engineer at the University of Applied Sciences, Wiesbaden, Germany where she received her Diploma in Engineering. From March 1999 to the present she was worked as a Physical Engineer in trauma surgery at Centre for Musculoskeletal Surgery at the University Hospital Mainz, Germany.
Daniela Klitscher was born in Saarbrucken (Germany). From November 2000 to April 2002 she worked as a Resident in Trauma Surgery at the University Hospital in Homburg, Germany. From July 2002 to September 2010 she worked as a Resident in orthopedic and trauma surgery at the Centre for Musculoskeletal Surgery at the University Hospital Mainz, Germany. From October 2010 to the present she has been working as a Senior doctor in trauma surgery at the Centre for Musculoskeletal Surgery at the University Hospital Mainz, Germany.
Prof. Dr. Hans Hely was born in Gorxheim (Germany). He is Head of the Department of Engineering Physics at the University of Applied Sciences, Hochschule Rhein/Nain, Germany.
Prof. Dr. Pol M. Rommens was born in Roeslare (Belgium), he is Head of the Department of Trauma Surgery at the University Medical Center, Johannes Gutenberg-University of Mainz and is the Director of the Center for Musculoskeletal Surgery at the University Medical Center, Johannes Gutenberg-University of Mainz. He was the President of the Belgian Trauma Society from 1993 to 1997 and the President of the Kuntscher Society from 1997 to 2001. He was President of the European Society of Trauma and Emergency Surgery from 2009 to 2010 and the Secretary-General of the European Society for Trauma and Emergency Surgery from 2011 until 2014. He is also an Honorary Professor at the University of Patras, Greece and is the Editor of the European Journal of Trauma and Emergency Surgery.
We would like to thank Dr. rer. physiol. Antje Jahn from the Institute of Medical Biometry, Epidemiology and Informatics (IMBEI), Mainz, Germany for performing statistical analysis. This work is part of the laboratory project of Rebekka Scheifl.
Conflict of interest statement:
There was no financial support. The implants, which were used from Synthes and Martin, were provided by the companies. However, this involvement had no influence on study design, interpretation of data or writing of the manuscript. The authors declare that they do not have any personal relationship with this company.
References
[1] Hoffmeier KL, Hofmann GO, Mückley T. The strength of polyaxial locking interfaces of distal radius plates. Clin Biomechan 2009; 24: 637–641.10.1016/j.clinbiomech.2009.06.004Search in Google Scholar
[2] Hove LM, Nilsen PT, Furnes O, Oulie HE, Solheim E, Mölster AO. Open reduction and internal fixation of displaced intraarticular fractures of the distal radius. 31 patients followed for 3–7 years. Acta Orthop Scand 1997; 68: 59–63.10.3109/17453679709003977Search in Google Scholar
[3] Kambouroglou GK, Axelrod TS. Complications of the AO/ASIF titanium distal radius plate system (pi plate) in internal fixation of the distal radius: a brief report. J Hand Surg Am 1998; 23: 737–741.10.1016/S0363-5023(98)80063-4Search in Google Scholar
[4] Kandemir U, Matityahu A, Desai R, Puttlitz C. Does a volar locking plate provide equivalent stability as a dorsal nonlocking plate in a dorsally comminuted distal radius fractures? A biomechanical study. J Orthop Trauma 2008; 22: 605–610.10.1097/BOT.0b013e318186006fSearch in Google Scholar
[5] Leung F, Zhu L, Ho H, Lu WW, Chow SP. Palmar plate fixation of AO type C2 fracture of distal radius using a locking compression plate – a biomechanical study in a cadaveric model. J Hand Surg Br 2003; 28: 263–266.10.1016/S0266-7681(03)00011-1Search in Google Scholar
[6] Liporace FA, Kubiak EN, Jeong GK, Iesaka K, Egol KA, Koval KJ. A biomechanical comparison of two volar locked plates in a dorsally unstable distal radius fracture model. J Trauma 2006; 61: 668–672.10.1097/01.ta.0000234727.51894.7dSearch in Google Scholar PubMed
[7] Mehling I, Meier M, Schlör U, Krimmer H. Multidirectional palmar fixed-angle plate fixation for unstable distal radius fracture. Handchir Mikrochir Plast Chir 2007; 39: 29–33.10.1055/s-2007-964933Search in Google Scholar PubMed
[8] Muller LP, Klitscher D, Rudig L, Mehler D, Rommens PM, Prommersberger KJ. Locking plates for corrective osteotomy of malunited dorsally tilted distal radial fractures: a biomechanical study. J Hand Surg Br 2006; 31: 556–561.10.1016/J.JHSB.2006.06.002Search in Google Scholar
[9] Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am 2002; 27: 205–215.10.1053/jhsu.2002.32081Search in Google Scholar PubMed
[10] Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractures in the elderly patient. J Hand Surg Am 2004; 29: 96–102.10.1016/j.jhsa.2003.09.015Search in Google Scholar PubMed
[11] Osada D, Kamei S, Masuzaki K, Takai M, Kameda M, Tamai K. Prospective study of distal radius fractures treated with a volar locking plate system. J Hand Surg Am 2008; 33: 691–700.10.1016/j.jhsa.2008.01.024Search in Google Scholar PubMed
[12] Rausch S, Klos K, Stephan H, et al. Evaluation of a polyaxial angle-stable volar plate in a distal radius C-fracture model – a biomechanical study. Injury 2011; 42: 1248–1252.10.1016/j.injury.2010.12.005Search in Google Scholar PubMed
[13] Trapp OM, Gregor M, von Oldenburg G. Biomechanical performance of screw locking mechanisms in distal radius plates. Stryker osteosynthesis, white paper. Duisberg: Stryker 2008.Search in Google Scholar
[14] Uzdil T, Winker KH. Distale Radiusfrakturen. Orthopäd Unfallchirurg 2007; 2: 1–20.10.1055/s-2007-966177Search in Google Scholar
[15] Walz M, Kolbow B, Auerbach F. Do fixed-angle T-plates offer advantages for distal radius fractures in elderly patients? Unfallchirurg 2004; 107: 664–670 (in German).Search in Google Scholar
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