1
|
Behrendt P, Kruse E, Klüter T, Fitschen-Oestern S, Weuster M, Menzdorf L, Finn J, Varoga D, Seekamp A, Müller M, Lippross S. [Fixed angle carbon fiber reinforced polymer composite plate for treatment of distal radius fractures : Pilot study on clinical applications]. Unfallchirurg 2017; 120:139-146. [PMID: 26507986 DOI: 10.1007/s00113-015-0088-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The clinical implementation of a new carbon-fiber-reinforced polyetheretherketon (PEEK) plate for distal radius fractures might offer advantageous properties over the conventional metallic devices. This includes similar elastic modulus to cortical bone, radiolucency, low artifacts on MRI scans and the lack of metal allergies. OBJECTIVE The aim of this study was to evaluate the clinical results at 6-week and 12-month follow-up using either a new fixed angle (monoaxial) PEEK plate system or a fixed angle (polyaxial) titanium plate. METHODES We included 26 patients (mean age 59.3) with displaced fractures of the distal radius (all AO types). Radiological and functional outcomes were measured prospectively at a 6-week and 12 month follow-up. RESULTS We documented no cases of hardware breakage or significant loss of the surgically achieved fracture reduction with the usage oft the new PEEK device. Operating time was 101.0 min using PEEK versus 109.3 min in titanium plates, recorded times were including preparation, draping, and postoperative processing (ns, p 0.156). At the 6-week follow up the PEEK plate showed a trend for better range of motion and functional results (DASH-score, Mayo-wrist score, VAS) with no statistical significance. Results of 12 month follow up with PEEK showed comparable results with corresponding studies examining titanium plate after this period. CONCLUSION First experience with PEEK plate osteosynthesis demonstrate quick clinical implementation with good clinical outcome and the advantage of excellent postoperative radiological assessment. At early follow-up PEEK even showed a trend for improved functional results.
Collapse
Affiliation(s)
- P Behrendt
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland.
| | - E Kruse
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - T Klüter
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - S Fitschen-Oestern
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - M Weuster
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - L Menzdorf
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - J Finn
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - D Varoga
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - A Seekamp
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - M Müller
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - S Lippross
- Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| |
Collapse
|
2
|
Lenz M, Wahl D, Zderic I, Gueorguiev B, Jupiter JB, Perren SM. Head-locking durability of fixed and variable angle locking screws under repetitive loading. J Orthop Res 2016; 34:949-52. [PMID: 26580296 DOI: 10.1002/jor.23108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 11/09/2015] [Indexed: 02/04/2023]
Abstract
Polyaxial locking screws are increasingly applied in fracture fixation. To investigate the durability of the head-locking mechanism, the removal torque of variable angle (VA) and fixed angle (FA) stainless steel and titanium locking screws was investigated without and after a cyclic loading test. Stainless steel (St) and titanium (Ti) 2.4 mm orthogonally inserted FA screws and 2.4 mm VA screws inserted in different inclinations (0°-15°) (n = 6 per group) were locked at 0.8 Nm. Removal torque was determined without (W) and after (A) cyclic loading (sinusoidal load, 5 Hz, constant amplitude of 25 N, up to 10'000 cycles, or failure). Significant differences in-between the groups were detected by Student's t-test (p < 0.05). Except VA Ti in 0deg and FA, all groups exhibited a drop in removal torque below the insertion torque without and after cyclic testing. The removal torque was (St: FA W:0.81 Nm ± 0.04 A:0.72Nm ± 0.04; VA0deg W:0.73 Nm ± 0.04 A:0.65 Nm ± 0.05; VA15deg W:0.51 Nm ± 0.05 A:0.50 Nm ± 0.08; Ti: FA W:0.82 Nm ± 0.03 A:0.70 Nm ± 0.04; VA0deg W:0.80 Nm ± 0.02 A:0.72 Nm ± 0.05; VA15deg W:0.55 Nm ± 0.03 A:0.54 Nm ± 0.06). In all groups, the removal torque after cyclic testing did not drop below 16% of the removal torque without cyclic testing. No head loosening was observed after cyclic testing. Stainless steel and titanium 2.4 mm fixed and variable angle locking screws provide a stable and lasting head-locking mechanism. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:949-952, 2016.
Collapse
Affiliation(s)
- Mark Lenz
- AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos, Switzerland.,Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Germany
| | - Dieter Wahl
- AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos, Switzerland
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos, Switzerland
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos, Switzerland
| | - Jesse B Jupiter
- Department of Orthopaedic Surgery-Hand and Upper Extremity Service, Massachusetts General Hospital, Boston 02114, Massachusetts
| | - Stephan M Perren
- AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos, Switzerland.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
3
|
Lenz M, Wahl D, Gueorguiev B, Jupiter JB, Perren SM. Concept of variable angle locking--evolution and mechanical evaluation of a recent technology. J Orthop Res 2015; 33:988-92. [PMID: 25676391 DOI: 10.1002/jor.22851] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 01/31/2015] [Indexed: 02/04/2023]
Abstract
Applications for fracture-adapted screw positioning offered by variable angle locking screws are increasing. The locking strength of the variable angle locking mechanism at different insertion angles was compared to conventional fixed angle locking screws. Stainless steel (S) and titanium (Ti) variable and fixed angle 2.4 mm locking screws, inserted at different inclinations (0°-15°), and locked at 0.8 Nm were subjected to a load-to-failure test. Ultimate failure moment at the screw-head interface and failure mode of the screws were determined. Significant differences were detected by one-way ANOVA (p < 0.05). Stainless steel and titanium variable angle locking screws inserted at 2°-10° inclination exhibited a failure moment comparable to the 0° position (S 1.67± 0.04 Nm; Ti 1.67 ± 0.14 Nm) and failed predominantly at the screw neck, with the head remaining fixed to the plate. Inserted at 15° inclination, screws revealed a lower failure moment (S 1.33 ± 0.06 Nm, Ti 1.58 ± 0.05Nm), and failed predominantly by breakout of the head thread. Fixed angle locking screws inserted at an inclination >2° did not lock properly in the plate hole, providing insufficient locking strength. Variable angle locking screws offer a stable head-locking mechanism at different inclinations, comparable to the locking strength of orthogonal inserted fixed angle locking screws. Marginal inclinations >15° should be used with care.
Collapse
Affiliation(s)
- Mark Lenz
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland.,Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Germany
| | - Dieter Wahl
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Jesse B Jupiter
- Department of Orthopaedic Surgery-Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, 02114
| | - Stephan Marcel Perren
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|