Koronoid kırıklarında önden arkaya başsız vida ile arkadan öne kortikal vida ile fiksasyonların biyomekanik olarak karşılaştırılması

Year 2015, , 307 - 310, 17.07.2015

Onur Hapa , Ahmet Karakasli Cemal Dincer Vadym Zhamilov , Mustafa Guvencer Hasan Havitcioglu

https://doi.org/10.3944/AOTT.2015.14.0183

Abstract

Amaç: Posteriordan anteriora doğru vida ile tespit edilen koronoid kırıkları anteriordan posteriora doğru vida ile tespit edilen koronoid kırıklara göre daha güçlü tespit sağlar. Koronoid kırıklara anterior yaklaşımın redüksiyonu kolaylaştırdığı bilinmektedir. Çalışmanın hipotezi anteriordan posteriora doğru başsız vida (Acutrak®Mini 3.5 mm × 26 mm, Acumed, Oregon, USA) ile tespit edilen koronoid kırıklarının, posteriordan anteriora doğru kortikal vida (2.7-mm AO cortical screw) ile tespiti kadar güçlü olduğunun ispatlamasıdır.

Çalışma planı: Çalışmada 14 tane erişkin kadavradan alınan ve formalin ile işlenmiş ulnalar kullanılmıştır. Koronoid kırıkları (tip 2) oluşturulduktan sonra randomize olarak anteriordan posteriora doğru başsız vida ile tespit edildi (antegrad grup) ve posteriordan anteriora doğru kortikal vida ile tespit edildi (retrograd grup). Yüklenmeler 2 mm’lik deplasman oluşturulana kadar yapıldı. Dayanma yükü (N), fiksasyon sertliği (N/mm–1) ve girinti (kemik) sertliği hesaplandı.

Bulgular: Dayanma yükü retrograd tespit yapılan grupta anlamlı yüksek olarak saptandı (p=0.03), ama fiksasyon sertliği ve girinti sertliği kemik sertliği değerlerinde 2 grup arasında anlamlı bir fark saptanmadı (p>0.05).

Çıkarımlar: Anteriordan posteriora doğru başsız vida ile koronoid kırıkların tespit yöntemi retrograd tepit yönteme göre avantajlı olmadığı görüldü.

 

 

DOI: 10.3944/AOTT.2015.14.0183

Bu özet, makalenin henüz redaksiyonu tamamlanmamış haline aittir ve bilgi verme amaçlıdır. Yayın aşamasında değişiklik gösterebilir.

Keywords

Koronoid kırıkları; tespit; başsız vida.

Biomechanical comparison of headless antegrade screw versus retrograde cortical screw for coronoid fracture fixation

Abstract

Objective: Posterior-to-anterior directed screws are stronger than anterior-to-posterior directed screws for coronoid fracture fixation. Anterior approaches that facilitate direct reduction and fixation of coronoid fractures have been described. The present study was based on the hypothesis that anterior-to-posterior headless screw (Acutrak Mini® 3.5 mm × 26 mm, Acumed, Hillsboro, Oregon, USA) fixation of coronoid fractures would be as strong as posterior-to-anterior 2.7 mm Association for Osteosynthesis (AO) cortical screw fixation.
Methods: This study included 14 ulnas obtained from 14 formalin-preserved adult cadavers. Coronoid type 2 fractures were created and fixed randomly using anterior-to-posterior headless screws (antegrade group) and posterior-to-anterior 2.7 mm AO cortical screws (retrograde group). The experimental constructs were loaded until 2 mm of displacement. Failure load (N), fixation stiffness (Nmm–1), and indentation stiffness were calculated.
Results: Failure load was higher in the retrograde screw group (p=0.03), whereas loading stiffness values of the fixation devices and bones did not differ between the 2 fixation groups (p>0.05).
Conclusion: The present study failed to show that anterior-to-posterior directed headless screw fixation of coronoid fractures could adequately replace posterior-to-anterior placed screw fixation.

Keywords

Coronoid fracture, fixation, headless screw

References

• Clarke SE, Lee SY, Raphael JR. Coronoid fixation using suture anchors. Hand (N Y) 2009;4:156–60.
• McKay PL, Katarincic JA. Fractures of the proximal ulna olecranon and coronoid fractures. Hand Clin 2002;18:43– 53.
• O’Driscoll SW, Jupiter JB, Cohen MS, Ring D, McKee MD. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect 2003;52:113–34.
• O’Driscoll S. Coronoid fractures. In: Norris TR, eds. Orthopedic Knowledge Update: Shoulder and Elbow 2. Rosemont, IL: American Academy of Orthpaedic Sur- geons 2002;379–84.
• Cohen MS. Fractures of the coronoid process. Hand Clin 2004;20:443–53.
• Doornberg JN, van Duijn J, Ring D. Coronoid frac- ture height in terrible-triad injuries. J Hand Surg Am 2006;31:794–7.
• Moon JG, Zobitz ME, An KN, O’Driscoll SW. Optimal screw orientation for fixation of coronoid fractures. J Or- thop Trauma 2009;23:277–80.
• Kang LQ, Ding ZQ, Sha M, Hong JY, Chen W. A mini- mally invasive anterior approach to reduction and screw fixation of coronoid fractures. J Hand Surg Eur Vol 2010;35:224–7.
• Zhang C, Zhong B, Luo CF. Treatment strategy of terrible triad of the elbow: experience in Shanghai 6th People’s Hospital. Injury 2014;45:942–8.
• Han SH, Yoon HK, Rhee SY, Lee JK. Anterior approach for fixation of isolated type III coronoid process fracture. Eur J Orthop Surg Traumatol 2013;23:395–405.
• Hartzler RU, Llusa-Perez M, Steinmann SP, Morrey BF, Sanchez-Sotelo J. Transverse coronoid fracture: when does it have to be fixed? Clin Orthop Relat Res 2014;472:2068– 74.
• Morrey BF. Complex instability of the elbow. Instr Course Lect 1998;47:157–64.
• Ring D. Fractures of the coronoid process of the ulna. J Hand Surg Am 2006;31:1679–89.
• McKee MD, Pugh DM, Wild LM, Schemitsch EH, King GJ. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Surgical tech- nique. J Bone Joint Surg Am 2005;87 Suppl 1(Pt 1):22– 32.
• Garofalo R, Bollmann C, Kombot C, Moretti B, Borens O, Mouhsine E. Minimal invasive surgery for coronoid frac- ture: technical note. Knee Surg Sports Traumatol Arthrosc 2005;13:608–11.
• Reichel LM, Milam GS, Reitman CA. Anterior approach for operative fixation of coronoid fractures in complex elbow instability. Tech Hand Up Extrem Surg 2012;16:98–104.
• Elkowitz SJ, Kubiak EN, Polatsch D, Cooper J, Kum- mer FJ, Koval KJ. Comparison of two headless screw de- signs for fixation of capitellum fractures. Bull Hosp Jt Dis 2003;61:123–6.
• Hausman MR, Klug RA, Qureshi S, Goldstein R, Par- sons BO. Arthroscopically assisted coronoid fracture fixation: a preliminary report. Clin Orthop Relat Res 2008;466:3147–52.
• Sanders R, Haidukewych GJ, Milne T, Dennis J, Latta LL. Minimal versus maximal plate fixation techniques of the ulna: the biomechanical effect of number of screws and plate length. J Orthop Trauma 2002;16:166–71.
• Ouellette EA, Dennis JJ, Latta LL, Milne EL, Makowski AL. The role of soft tissues in plate fixation of proximal phalanx fractures. Clin Orthop Relat Res 2004;418:213–8.
• Osada D, Fujita S, Tamai K, Iwamoto A, Tomizawa K, Sao- tome K. Biomechanics in uniaxial compression of three dis- tal radius volar plates. J Hand Surg Am 2004;29:446–51.
• Burkhart KJ, Mueller LP, Krezdorn D, Appelmann P, Prommersberger KJ, Sternstein W, et al. Stability of radial head and neck fractures: a biomechanical study of six fixa- tion constructs with consideration of three locking plates. J Hand Surg Am 2007;32:1569–75.