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Tytuł:
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Low-profile double plating of unstable osteoporotic olecranon fractures: a biomechanical comparative study.
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Autorzy:
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Wagner FC; Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany; GERN Gewebeersatz, Regeneration & Neogenese (Tissue Replacement, Regeneration & Neogenesis), Faculty of Medicine, Department of Orthopedics and Trauma Surgery, Medical Center, Albert Ludwig University of Freiburg, Freiburg, Germany. Electronic address: .
Jaeger M; Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
Friebis C; GERN Gewebeersatz, Regeneration & Neogenese (Tissue Replacement, Regeneration & Neogenesis), Faculty of Medicine, Department of Orthopedics and Trauma Surgery, Medical Center, Albert Ludwig University of Freiburg, Freiburg, Germany; Department of Trauma Surgery, Asklepios Klinikum, Hamburg, Germany.
Maier D; Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
Ophoven C; Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
Yilmaz T; Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
Südkamp NP; Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany; GERN Gewebeersatz, Regeneration & Neogenese (Tissue Replacement, Regeneration & Neogenesis), Faculty of Medicine, Department of Orthopedics and Trauma Surgery, Medical Center, Albert Ludwig University of Freiburg, Freiburg, Germany.
Reising K; Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany; Department of Trauma Surgery, Asklepios Klinikum, Hamburg, Germany.
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Źródło:
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Journal of shoulder and elbow surgery [J Shoulder Elbow Surg] 2021 Jul; Vol. 30 (7), pp. 1519-1526. Date of Electronic Publication: 2020 Dec 24.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: St. Louis, MO : Mosby
Original Publication: St. Louis, MO : Mosby Yearbook, Inc., c1992-
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MeSH Terms:
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Olecranon Process*/surgery
Osteoporotic Fractures*
Biomechanical Phenomena ; Bone Plates ; Cadaver ; Fracture Fixation, Internal ; Humans
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Contributed Indexing:
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Keywords: Olecranon fracture fixation; biomechanics; locking plate; low-profile double plate; osteoporosis; posterior plate; proximal ulna; triceps avulsion
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Entry Date(s):
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Date Created: 20201228 Date Completed: 20210728 Latest Revision: 20210728
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Update Code:
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20240105
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DOI:
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10.1016/j.jse.2020.11.008
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PMID:
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33359398
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Background: In the treatment of unstable olecranon fractures, anatomically preshaped locking plates exhibit superior biomechanical results compared with tension band wiring. However, posterior plating (PP) still is accompanied by high rates of plate removal because of soft-tissue irritation and discomfort. Meanwhile, low-profile plates precontoured for collateral double plating (DP) are available and enable muscular soft-tissue coverage combined with angular-stable fixation. The goal of this study was to biomechanically compare PP with collateral DP for osteosynthesis of unstable osteoporotic fractures.
Methods: A comminuted displaced Mayo type IIB fracture was created in 8 osteoporotic pairs of fresh-frozen human cadaveric elbows. Pair-wise angular stable fixation was performed by either collateral DP or PP. Biomechanical testing was conducted as a pulling force to the triceps tendon in 90° of elbow flexion. Cyclical load changes between 10 and 300 N were applied at 4 Hz for 50,000 cycles. Afterward, the maximum load was raised by 0.02 N/cycle until construct failure, which was defined as displacement > 2 mm. Besides failure cycles and failure loads, modes of failure were analyzed.
Results: Following DP, a median endurance of 65,370 cycles (range, 2-83,121 cycles) was recorded, which showed no significant difference compared with PP, with 69,311 cycles (range, 150-81,938 cycles) (P = .263). Failure load showed comparable results as well, with 601 N (range, 300-949 N) after DP and 663 N (range, 300-933 N) after PP (P = .237). All PP constructs and 3 of 8 DP constructs failed by proximal fragment cutout, whereas 5 of 8 DP constructs failed by bony triceps avulsion.
Conclusion: Angular-stable DP showed comparable biomechanical stability to PP in unstable osteoporotic olecranon fractures under high-cycle loading conditions. Failure due to bony triceps avulsion following DP requires further clinical and biomechanical investigation, for example, on suture augmentation or different screw configurations.
(Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
