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Lee JW, Song MJ, Lee SJ, Song HS, Jung YS, Kim H. Biomechanical comparison between low profile 2.7 mm distal locking hook plate and 3.5 mm distal locking hook plate for acromioclavicular joint injury: A finite element analysis. Injury 2024; 55:111657. [PMID: 39002321 DOI: 10.1016/j.injury.2024.111657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE Although hook plate fixation is popularly used, concerns exist regarding periprosthetic fractures and the necessity to remove the plate to prevent subacromial erosion and subsequent acromion fracture, due to its non-anatomical design. We hypothesized that a low profile 2.7 mm distal locking hook plate would provide comparable stability to a properly used 3.5 mm distal locking hook plate MATERIALS AND METHODS: A 3.5 mm distal locking plate (type 1) and a low profile 2.7 mm plate (type 2) were assessed by finite element analysis. Peak von Mises stress (PVMS) was calculated on the acromion's undersurface, clavicle shaft, and hook, focusing on how these stresses varied with the number and placement of distal locking screws. RESULTS Increased distal screws in both types led to lower PVMS on the acromion's undersurface and the hook, with the lowest acromion PVMS observed in type 2 with three distal screws, and on the hook in type 1 with two distal screws. Increasing the number of distal screws similarly reduced PVMS on the clavicle shaft, with the lowest in type 1 with two distal screws. In both plate types, the most posterior distal locking screw played a crucial role in distributing stress across the acromion and the hook. CONCLUSION The low profile 2.7 mm distal locking hook plate showed comparable biomechanical results to the 3.5 mm distal locking hook plate. Increasing the number of distal locking screws showed less stress concentration on the bone and hook in both models. The most posterior distal locking screw showed an essential role in stress distribution.
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Affiliation(s)
- Jeong-Woo Lee
- Department of Biomedical Engineering, Inje University, Gimhae, Korea
| | - Min-Jun Song
- Department of Biomedical Engineering, Inje University, Gimhae, Korea
| | - Sung-Jae Lee
- Department of Biomedical Engineering, Inje University, Gimhae, Korea
| | - Hyun Seok Song
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn-Sung Jung
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyungsuk Kim
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Saengsirinavin P, Iamsirikulmit C, Piyapittayanun P, Phiphobmongkol V, Jongthanakamol T, Ratanalekha R. Optimizing hook implantation angle of the clavicular hook plate: a cadaveric study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2653-2661. [PMID: 38743102 DOI: 10.1007/s00590-024-03981-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE While Clavicle hook plates have demonstrated favorable results regarding bone and shoulder function, their design can potentially lead to complications due to pressure concentration at the plate's tip. This study aims to investigate the impact of different hook implantation angles on the contact surface area between the hook plate and acromion, with the goal of minimizing mismatch and maximizing contact surface area. METHODS Twenty soft shoulder cadavers were included in the study, and the contact surface area of the hook plate was measured in different positions based on the hook implantation angle. RESULTS The results showed variations in compatibility, width, and length of the contact surface area depending on the hook implantation angle and the medial or lateral row placement. The lateral row generally demonstrated superior compatibility (84.0% vs 46.67%, p-value < 0.001), with a broader contact area (3.55 ± 0.08 mm vs 3.09 ± 0.10 mm, p-value = 0.004) and a longer contact area (7.36 ± 0.19 mm vs 5.10 ± 0.23 mm, p-value < 0.001) at specific angles. A detailed analysis of the lateral position revealed that the zero angle of implantation resulted in the greatest contact surface area, measuring 3.91 ± 0.70 mm in width (p value = 0.083) and 8.85 ± 1.24 mm in length (p value < 0.001). CONCLUSION Placing the hook laterally and at the zero position according to the hook implantation angle can maximize contact surface area, may reduce stress concentration, and minimize complications in hook plate fixation. Further research and consideration of anatomical variations are warranted to refine the placement technique and enhance patient outcomes. LEVEL OF EVIDENCE Level V evidence.
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Affiliation(s)
| | | | | | | | | | - Rosarin Ratanalekha
- Department of Anatomy, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Gao R, Zhang W, Yang Y, Zhang Y, Hu Y, Wu H, Liu M, Fei W, Wang J. Evaluation of the coracoid bone tunnel placement on Dog Bone™ button fixation for acromioclavicular joint dislocation: a cadaver study combined with finite element analysis. BMC Musculoskelet Disord 2023; 24:18. [PMID: 36624428 PMCID: PMC9827623 DOI: 10.1186/s12891-022-06119-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/26/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Dog Bone™ button fixation is frequently used to treat acromioclavicular joint (ACJ) dislocation. However, various studies have reported complications after fixation. OBJECTIVE To investigate the effect of the coracoid bone tunnel location on the treatment of ACJ dislocation through single-tunnel coracoclavicular (CC) ligament fixation with the Dog Bone™ button. METHODS Six cadaveric shoulders were used. Each specimen was subjected to five testing conditions in the following order: (1) normal ACJ (Gn); (2) acromioclavicular and CC ligaments were removed (G0); (3) CC ligament reconstruction was performed using the Dog Bone™ technique, and the coracoid bone tunnel was at the center of the coracoid base (G1); (4) reconstruction was performed at 5 mm distal from the G1 site, along the axis of the coracoid (G2); (5) reconstruction was performed at 10 mm distal from the G1 site, along the axis of the coracoid (G3). The angles of pronation and supination of the clavicle under the same load (30 N) were measured. Next, a finite element (FE) model was created using computed tomography (CT) images of the normal shoulder. Model 1 (M1), model 2 (M2), and model 3 (M3) correspond to G1, G2, and G3, respectively. A force of 70 N was applied as a vertical upward load to the distal clavicle. Subsequently, the von Mises stress, the strain LE along the FiberWire, and the displacement nephogram of the three models were obtained. RESULTS After single-tunnel CC ligament fixation using the Dog Bone™ technique, the clavicle in the G2 group (20.50 (19.50, 21.25) °, 20.00 (18.75, 21.25) °) had the best rotational stability. The peak von Mises stress, the strain LE along the FiberWire, and the maximum displacement were smaller in M2 than in M1 and M3. CONCLUSIONS When the coracoid bone tunnel was located 5 mm anterior to the center of the coracoid base (along the axis of the coracoid), the clavicle showed greater rotational stability.
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Affiliation(s)
- Rangshan Gao
- grid.411971.b0000 0000 9558 1426Dalian Medical University, Dalian, 116044 People’s Republic of China ,grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
| | - Wendong Zhang
- grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
| | - Yuxia Yang
- grid.411971.b0000 0000 9558 1426Dalian Medical University, Dalian, 116044 People’s Republic of China ,grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
| | - Yucheng Zhang
- grid.411971.b0000 0000 9558 1426Dalian Medical University, Dalian, 116044 People’s Republic of China ,grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
| | - Yangyang Hu
- grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
| | - Honghai Wu
- grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
| | - Mingsheng Liu
- grid.411971.b0000 0000 9558 1426Dalian Medical University, Dalian, 116044 People’s Republic of China ,grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
| | - Wenyong Fei
- grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
| | - Jingcheng Wang
- grid.268415.cSports Medicine Department, Northern Jiangsu People’s Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225001 People’s Republic of China
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Wang CC, Lee CH, Chen KH, Pan CC, Tsai MT, Su KC. Biomechanical effects of different numbers and locations of screw-in clavicle hook plates. Front Bioeng Biotechnol 2022; 10:949802. [PMID: 36159681 PMCID: PMC9500396 DOI: 10.3389/fbioe.2022.949802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: We sought to analyze the biomechanical effects which both different numbers and locations of screws have on three different clavicle hook plates, as well as any possible causes of sub-acromial bone erosion and peri-implant clavicular fractures. Methods: This study built thirteen groups of finite element models using three different clavicle hook plates (short plates, long plates, and posterior hook offset plates) in varying numbers and locations of the screws. The von Mises stress distribution of the clavicle and hook plate, as well as the reaction force of the acromion was evaluated. Results: The results show that inserting screws in all available screw holes on the hook plate produces a relatively large reaction force on the acromion, particularly in the axial direction of the bone plate. The fewer the screws implanted into the clavicle hook plate, the larger the area of high-stress distribution there is in the middle of the clavicle, and also, the higher the stress distribution on the clavicle hook plate. Conclusion: This study provides orthopedic physicians with the biomechanical analysis of different numbers and locations of screws in clavicle hook plates to help minimize surgical complications.
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Affiliation(s)
- Cheng-Chi Wang
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Food Science and Technology, HungKuang University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Computer Science and Information Engineering, Providence University, Taichung, Taiwan
| | - Chien-Chou Pan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, HungKuang University, Taichung, Taiwan
| | - Kuo-Chih Su
- Department of Biomedical Engineering, HungKuang University, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Chemical and Materials Engineering, Tunghai University, Taichung, Taiwan
- *Correspondence: Kuo-Chih Su,
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Li Y, Tian Q, Leng K, Guo M. Risk factors for clavicular midshaft fractures after hook plate fixation for the treatment of Neer type II clavicular fractures. J Int Med Res 2021; 49:3000605211035898. [PMID: 34348498 PMCID: PMC8358507 DOI: 10.1177/03000605211035898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Neer type II fractures are common, and hook plate fixation is one of the recommended treatments. Although clavicular midshaft fractures after hook plate fixation are rare, such fractures increase patients' suffering and worsen their functional outcomes. This study was performed to identify the risk factors for this complication. METHODS From 2009 to 2018, 425 patients were admitted with Neer type II clavicular fractures. According to the selection criteria, 352 patients were included in this retrospective observational study. All patients were divided into either the complications group (patients with midshaft fractures) or the control group (patients without midshaft fractures). Data collected included patient demographics and surgical, hook plate, and screw characteristics. The chi-square test was used to conduct between-group comparisons of risk factors. Statistically significant variables were included in a logistic regression model. RESULTS In both the complications group (n = 21) and control group (n = 331), significantly more patients of advanced age and significantly more patients treated with hook plates that were not bent during surgery developed midshaft fractures. CONCLUSION The risk of a clavicular midshaft fracture after hook plate fixation may be significantly increased by advanced age or a lack of hook plate bending.
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Affiliation(s)
- Yihan Li
- Orthopedic Department of Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qingxian Tian
- Orthopedic Department of Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kunpeng Leng
- Orthopedic Department of Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Meng Guo
- Orthopedic Department of Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Biomechanical analysis of a novel clavicular hook plate for the treatment of acromioclavicular joint dislocation: A finite element analysis. Comput Biol Med 2021; 133:104379. [PMID: 33864973 DOI: 10.1016/j.compbiomed.2021.104379] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Clavicular hook plates are frequently used in clinical orthopedics to treat acromioclavicular joint dislocation. However, patients often exhibit acromial osteolysis and peri-implant fracture after hook plate fixation. To solve the above problems, we developed a novel double-hook clavicular plate and used finite element analysis (FEA) to investigate its biomechanical properties. METHODS A finite element (FE) model was constructed and validated. Then, a double-hook clavicular plate, a single-hook clavicular plate, and an anatomical double-hook clavicular plate was implanted into the acromioclavicular joint and fixed with screws in groups 1, 2 and 3, respectively. Finally, a load was applied, and some indicators were recorded and analyzed. RESULTS For both the proximal clavicular rotation angle and the distal clavicular displacement, the range of motion in groups 1 and 3 was more than 90% lower than that in group 2. The maximum von Mises stress of the clavicle in groups 1 and 3 was more than 45% lower than that in group 2. The maximum stress of the acromion in group 2 was significantly higher than that in groups 1 and 3, and that in group 3 was less than that in group 1, for both cortical and cancellous bone. CONCLUSIONS The double-hook clavicular plate could immediately reconstruct the stability of the acromioclavicular joint, effectively reducing the stress of the bone around the clavicle and screws. Additionally, the double-hook clavicular plate could reduce the peak stress of the acromion and produce a more uniform stress distribution.
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Qiao R, Yang J, Zhang K, Song Z. To explore the reasonable selection of clavicular hook plate to reduce the occurrence of subacromial impingement syndrome after operation. J Orthop Surg Res 2021; 16:180. [PMID: 33750451 PMCID: PMC7944884 DOI: 10.1186/s13018-021-02325-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background Acromioclavicular joint dislocation is a shoulder joint injury common in the clinical setting and is generally surgically treated with clavicular hook plate technique with confirmed curative effect. However, symptoms such as shoulder abduction limitation, shoulder discomfort and joint pain postoperatively may occur in some patients. Therefore, this study aimed to explore whether the existing clavicular hook plate can be reasonably selected to reduce the incidence of subacromial impingement syndrome (SIS) and provide a reference for clinical diagnosis and treatment. Materials and methods Patients with SIS admitted from March 2018 to June 2020 were selected as the experimental group and asymptomatic patients postoperatively, as the control group. The hook end depth and acromial height of the hook plate used in patients were recorded, and the difference between them was calculated. Results The difference between the hook plate depth and acromial height was 7.500±1.912 mm and 6.563±1.537 mm in the experimental and control groups, respectively, with statistically significant difference (t=3.021, P=0.006). A difference of >0.6 mm as a grouping index is required to perform a single factor analysis, with statistically significant difference (t=3.908, P=0.048). Conclusions The occurrence of SIS after placing the clavicular hook plate may be related to the difference between its depth and the acromial height. A difference of >6 mm may be a factor affecting the occurrence of SIS. Pre-imaging measurement of the acromial height can provide suggestions for selecting the type of hook plate intraoperatively.
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Affiliation(s)
- Rui Qiao
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, 710054, Shaanxi, China.,Xi'an Medical University, Xi'an, 710054, Shaanxi, China
| | - Jiarui Yang
- Xi'an Medical University, Xi'an, 710054, Shaanxi, China
| | - Kun Zhang
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, 710054, Shaanxi, China
| | - Zhe Song
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, 710054, Shaanxi, China.
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Ni PL, Lin KC, Chen CY, Tarng YW, Chang WN, Renn JH. Peri-implant Fractures Following Hook Plate Fixation for Unstable Distal Clavicle Fractures. Orthopedics 2020; 43:e359-e363. [PMID: 32602920 DOI: 10.3928/01477447-20200619-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 05/20/2019] [Indexed: 02/03/2023]
Abstract
Clavicle hook plate is a common implant for treating distal clavicle fracture. Although high bone union rate and good functional outcome have been reported, so have several complications, such as osteolysis and fracture of the acromion, loss reduction, hook impingement, and rotator cuff tear. Peri-implant fracture over the medial side of the hook plate is a rare complication. Sporadic cases have been reported, and most of them have had no history of trauma. Between June 2015 and August 2018, 7 patients treated for distal clavicle fracture with a 3.5-mm locking compression hook plate with no history of trauma experienced peri-implant fracture of the medial clavicle. This complication occurred at a mean of 29 days. The incidence rate was 9.8%. Peri-implant fracture following hook plate fixation for distal clavicle fracture was not rare. Small hook angle, prolonged retention of the implant, an eccentric medial screw, high plate screw density, and small clavicle diameter may be risk factors for peri-implant fracture. Regarding treatment, 2 patients chose fracture revision with a distal clavicle locking plate and 5 patients chose conservative treatment. All patients achieved bone union at fracture sites. Surgical and conservative management of peri-implant fracture can achieve good functional outcome. [Orthopedics. 2020;43(5);e359-e363.].
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Wu K, Su X, Roche SJL, Held MFG, Yang H, Dunn RN, Guo JJ. Relationship between the lateral acromion angle and postoperative persistent pain of distal clavicle fracture treated with clavicle hook plate. J Orthop Surg Res 2020; 15:217. [PMID: 32527319 PMCID: PMC7291562 DOI: 10.1186/s13018-020-01737-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/28/2020] [Indexed: 12/01/2022] Open
Abstract
Background The clavicular hook plate is an accepted surgical procedure for distal clavicle fractures. The relationship of the characteristics of the hook plate, acromioclavicular joint and acromion morphology, and clinical outcome has remained poorly understood. We reviewed the clinical records of patients who had distal clavicle fractures with different lateral acromion angles treated using a clavicle hook plate and evaluated their clinical outcomes with respect to shoulder pain and acromial morphology. Methods We retrospectively reviewed 102 patients with distal clavicle fractures treated with hook plates at our institution from 2010 to 2017. They were divided into four groups according to lateral acromion angle on shoulder AP view X-rays. The angle was defined as the incline angle between the superior surface of distal clavicle and the inferior facet of acromion on coronal plane. We reviewed their clinical features, including Neer’s impingement sign, MRI findings, and outcomes using Japanese Orthopaedic Association Scores. The mean follow-up was 25.5 months (range, 24 to 28 months). Results All patients in group D (large lateral acromion angle (α) > 40°, acromion coronal angle (β) < 60°) complained of postoperative symptoms. Compared to those with common lateral acromion angle, the incidence of postoperative impingement in group D was undoubtedly much higher (100%). Japanese Orthopaedic Association (JOA) scores in group D were worse at 3 months post-surgery, 3 months post plate removal, and at the last follow-up despite a slightly earlier removal in this group. Conclusion Lateral acromion angle appears to be an important factor in the development of postoperative pain and worse outcomes (JOA scores) in patients treated with the hook plate. The incidence of subacromial impingement and rotator cuff lesion (RCL) increased with the α angle. Early limited mobility and removal of the implant may improve the prognosis and resolve the postoperative shoulder pain. Study design Retrospective review, level of evidence IV.
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Affiliation(s)
- Kailun Wu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, China.,Department of Orthopedics, Suzhou Dushuhu Public Hospital, The First Affiliated Hospital of Soochow University Dushuhu Branch, Suzhou, China
| | - Xinlin Su
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, China
| | - Stephen J L Roche
- Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Michael F G Held
- Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, China
| | - Robert N Dunn
- Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital and Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Jiong Jiong Guo
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, China.
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Çalışal E, Uğur L. Comparison of two methods for coracoclavicular ligament reconstruction: A finite element analysis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:202-206. [PMID: 32254037 DOI: 10.5152/j.aott.2020.02.288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to compare two different tendon grafting techniques for coracoclavicular ligament reconstruction from the data obtained using finite element analysis. METHODS Three different finite element models of the shoulder girdle were formulated using computerized tomography images: the reference model, coracoid loop technique (CLT), and drilling technique (DT) model. In all these models, forces were applied to the clavicle along three axes (x, y, and z) of the trapezius and sternocleidomastoid muscles. Thereafter, data regarding the loading values of the tendon grafts, loads on the coracoid base, and coracoclavicular vertical distance were measured. RESULTS While the reference model yielded the lowest values for all the loading conditions as well as the shortest coracoclavicular distance, the DT model demonstrated the highest values for all the loading conditions and the largest coracoclavicular distance. CONCLUSION Different tendon grafting techniques may offer different loading values on both bone surface and tendon graft during coracoclavicular ligament reconstruction. The drilling technique may be associated with increased loading on the tendon graft and bone surface, causing further loss of reduction and consequent complications.
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Affiliation(s)
- Emre Çalışal
- Department of Orthopedics and Traumatology, Amasya University, School of Medicine, Amasya, Turkey
| | - Levent Uğur
- Department of Mechanical Engineering, Amasya University, School of Technology, Amasya, Turkey
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Civan O, Atmaca H, Uğur L. Biomechanical comparison of double versus triple button reconstruction techniques in patients with acromioclavicular joint dislocation. Int J Med Robot 2019; 16:e2057. [DOI: 10.1002/rcs.2057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/10/2019] [Accepted: 11/06/2019] [Indexed: 01/18/2023]
Affiliation(s)
- Osman Civan
- Elmalı State Hospital, Department of Orthopaedics and Traumatology Antalya Turkey
| | - Halil Atmaca
- ArtroKlinik, Department of Orthopaedics and Traumatology Kocaeli Turkey
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Kim E, Lee S, Jeong HJ, Park JH, Park SJ, Lee J, Kim W, Park HJ, Lee SY, Murase T, Sugamoto K, Ikemoto S. Three-dimensional scapular dyskinesis in hook-plated acromioclavicular dislocation including hook motion. J Shoulder Elbow Surg 2018; 27:1117-1124. [PMID: 29449083 DOI: 10.1016/j.jse.2017.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/08/2017] [Accepted: 12/12/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study is to analyze the 3-dimensional scapular dyskinesis and the kinematics of a hook plate relative to the acromion after hook-plated acromioclavicular dislocation in vivo. Reported complications of acromioclavicular reduction using a hook plate include subacromial erosion and impingement. However, there are few reports of the 3-dimensional kinematics of the hook and scapula after the aforementioned surgical procedure. METHODS We studied 15 cases of acromioclavicular dislocation treated with a hook plate and 15 contralateral normal shoulders using computed tomography in the neutral and full forward flexion positions. Three-dimensional motion of the scapula relative to the thorax during arm elevation was analyzed using a computer simulation program. We also measured the distance from the tip of the hook plate to the greater tuberosity, as well as the angular motion of the plate tip in the subacromial space. RESULTS Decreased posterior tilting (22° ± 10° vs 31° ± 8°) in the sagittal plane and increased external rotation (19° ± 9° vs 7° ± 5°) in the axial plane were evident in the affected shoulders. The mean values of translation of the hook plate and angular motion against the acromion were 4.0 ± 1.6 mm and 15° ± 8°, respectively. The minimum value of the distance from the hook plate to the humeral head tuberosity was 6.9 mm during arm elevation. CONCLUSIONS Acromioclavicular reduction using a hook plate may cause scapular dyskinesis. Translational and angular motion of the hook plate against the acromion could lead to subacromial erosion. However, the hook does not seem to impinge directly on the humeral head.
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Affiliation(s)
- Eugene Kim
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seunghee Lee
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hwa-Jae Jeong
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jai Hyung Park
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se-Jin Park
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jaewook Lee
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woosub Kim
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So Yeon Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuomi Sugamoto
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Sumika Ikemoto
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Kocadal O, Yüksel K, Güven M. Evaluation of the clavicular tunnel placement on coracoclavicular ligament reconstruction for acromioclavicular dislocations: a finite element analysis. INTERNATIONAL ORTHOPAEDICS 2018; 42:1891-1896. [DOI: 10.1007/s00264-018-3789-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 01/18/2018] [Indexed: 10/18/2022]
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14
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Zhang L, Zhou X, Qi J, Zeng Y, Zhang S, Liu G, Ping R, Li Y, Fu S. Modified closed-loop double-endobutton technique for repair of rockwood type III acromioclavicular dislocation. Exp Ther Med 2017; 15:940-948. [PMID: 29399102 PMCID: PMC5772745 DOI: 10.3892/etm.2017.5487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/02/2017] [Indexed: 12/15/2022] Open
Abstract
Acromioclavicular dislocation (ACD) is a common injury. According to the Rockwood classification, ACD is classified into six types (type I–VI); however, for type III injuries, it remains controversial whether or not operative treatment should be applied. Numerous studies have advocated early surgical treatment to ensure early rehabilitation activities. Thus, the present study aimed to investigate a modified closed-loop double-endobutton technique (MCDT), that may be used to repair Rockwood type III ACD. In the current study, 61 patients with Rockwood type III ACD were enrolled during a period of 5 years at the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. Patients were divided into three groups according to the surgical method used, the MCDT group (n=20), the common closed-loop double-endobutton technique (CCDT) group (n=21), and the clavicular hook plate fixation (CHPF) group (n=20). Preoperative and intraoperative information were recorded. Furthermore, the functional scores of injured shoulder were evaluated prior to surgery and following surgery with a 1-year follow-up. Among the three groups, postoperative functional scores were significantly more improved compared with those prior to surgery (P<0.05), and no significant difference was observed regarding the coracoclavicular interval with the 1-year follow-up (P>0.05). Postoperative functional scores in the MCDT and CCDT groups were significantly more improved compared those in the CHPF group (P<0.05). In addition, the duration of surgery in the MCDT group was significantly shorter compared with that in the CCDT group (P<0.05). Furthermore, compared with the CHPF group, the incision length was significantly shorter with reduced hemorrhage in the MCDT group (P<0.05). In conclusion, the results of the current study suggest that MCDT is more simple, convenient and efficient compared with CCDT, and is worth popularizing.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China.,Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xin Zhou
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Ji Qi
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Yan Zeng
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Shaoqun Zhang
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Gang Liu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Ruiyue Ping
- Department of Dermatology, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510403, P.R. China
| | - Yikai Li
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Shijie Fu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
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15
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Shen PC, Zhu Y, Zhang H, Zhu LF, Weng FB, Jiang FG, Xu N, Ju W, Li XL. Three-dimensional morphological analysis of acromioclavicular joint in patients with and without subacromial erosion after hook plate fixation. J Int Med Res 2017; 46:511-521. [PMID: 28856939 PMCID: PMC6011301 DOI: 10.1177/0300060517725973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the role of acromioclavicular joint morphology in the presence of subacromial erosion after hook plate fixation. Methods We retrospectively analyzed the clinical data of 36 patients (17 men, 19 women; mean age, 48.7 years; range, 21–76 years) treated with hook plate fixation for distal clavicular fractures (n = 20) or acromioclavicular joint dislocation (n = 16) from August 2011 to March 2013. The patients were divided into two groups: the subacromial erosion group (18 patients) and the normal group (18 patients). Differences in multiple anatomical parameters between the two groups were measured and compared. Results The distal clavicle–acromion angle was significantly larger in the subacromial erosion group (mean, 51.37° ± 5.59°) than in the normal group (mean, 44.20° ± 3.83°), as was the distal clavicle–coronal angle (mean, 25.44° ± 2.51° vs. 21.67° ± 4.06°, respectively). The thickness of the acromion was significantly different between men and women (9.72 ± 1.13 vs. 8.16 ± 1.89 mm, respectively). Conclusion The results of this study indicate that the distal clavicle–acromion angle and distal clavicle–coronal angle are closely correlated with the occurrence of subacromial erosion after hook plate fixation.
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Affiliation(s)
- Peng-Cheng Shen
- 1 Orthopedic Institute of the First People's Hospital of Wujiang, Suzhou, Jiangsu, China
| | - Yu Zhu
- 2 Department of Orthopaedic Surgery, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu, China
| | - Hui Zhang
- 3 Orthopedic Institute of Yangpu District Central Hospital Affiliated to Tongji University, Shanghai, China
| | - Li-Fan Zhu
- 1 Orthopedic Institute of the First People's Hospital of Wujiang, Suzhou, Jiangsu, China
| | - Feng-Biao Weng
- 1 Orthopedic Institute of the First People's Hospital of Wujiang, Suzhou, Jiangsu, China
| | - Fu-Gui Jiang
- 1 Orthopedic Institute of the First People's Hospital of Wujiang, Suzhou, Jiangsu, China
| | - Neng Xu
- 1 Orthopedic Institute of the First People's Hospital of Wujiang, Suzhou, Jiangsu, China
| | - Wen Ju
- 1 Orthopedic Institute of the First People's Hospital of Wujiang, Suzhou, Jiangsu, China
| | - Xiao-Lin Li
- 4 Department of Orthopedic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, Shanghai, China
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16
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Xu D, Luo P, Chen J, Ji L, Yin L, Wang W, Zhu J. Outcomes of surgery for acromioclavicular joint dislocation using different angled hook plates: a prospective study. INTERNATIONAL ORTHOPAEDICS 2017; 41:2605-2611. [DOI: 10.1007/s00264-017-3611-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/09/2017] [Indexed: 12/01/2022]
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17
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TZENG CHUNGYUH, HUANG KUICHUO, WU YUNCHE, CHANG CHULING, LEE KUANRONG, SU KUOCHIH. BIOMECHANICAL EFFECT OF DIFFERENT LAG SCREW LENGTHS WITH DIFFERENT BARREL LENGTHS IN DYNAMIC HIP SCREW SYSTEM: A FINITE ELEMENT ANALYSIS STUDY. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417500087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The dynamic hip screw (DHS) system is commonly used to treat intertrochanteric fracture of the hip joint. Breakage of the lag screw was noted in clinical practice and the length of lag screw as well as the length of the side plate in the DHS system appeared to play a role in the risk of breakage. Thus, the aim of this study was to investigate the biomechanical effect of different lag screw lengths and barrel plate lengths in the DHS implant system by finite element analysis (FEA). Four FEA simulation models were created according to different lengths of lag screw (79[Formula: see text]mm and 63[Formula: see text]mm) and different lengths of barrel side plate (43[Formula: see text]mm and 37[Formula: see text]mm). The von Mises stress was used as the observation indicator. The results showed that the maximum tensile stress on the long lag screw was slightly greater than that of the shorter lag screw. Use of a shorter barrel side plate may also cause high stress between the lag screw and the barrel side plate. This finding provides biomechanical reference data that may be of value to orthopedic surgeons with respect to choice of implant size and length in the treatment of intertrochanteric fracture with a DHS system to prevent complications such as implant failure caused by broken lag screws.
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Affiliation(s)
- CHUNG-YUH TZENG
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Nursing, Hung Kuang University, Taichung, Taiwan
- Institute of Molecular Medicine, College of Life Science, National Tsing Hua University, HsinChu, Taiwan
| | - KUI-CHUO HUANG
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - YUN-CHE WU
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - CHU-LING CHANG
- Department of Nursing, Hung Kuang University, Taichung, Taiwan
| | - KUAN-RONG LEE
- Institute of Molecular Medicine, College of Life Science, National Tsing Hua University, HsinChu, Taiwan
| | - KUO-CHIH SU
- Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sector, Taichung City 40705, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Biomedical Engineering, Hung Kuang University, Taichung, Taiwan
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18
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KE MINGJEN, HUANG KUICHOU, LEE CHENGHUNG, CHU HENGYI, WU YUNGTSAN, CHANG SHINTSU, CHIANG SHANGLIN, SU KUOCHIH. INFLUENCE OF THREE DIFFERENT CURVATURES FLEX-FOOT PROSTHESIS WHILE SINGLE-LEG STANDING OR RUNNING: A FINITE ELEMENT ANALYSIS STUDY. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417500555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Flex foot device was one of the most common prosthesis for the athletes with the transtibial amputation on the recent market. Thus, the results of investigation with biomechanics on the flex foot would be a considerable impact on the performance of disabled athletes wearing the flex foots. This study was designed to investigate the biomechanical condition of the flex foot prosthesis with different curvatures while standing and running by finite element analysis. This study demonstrated finite element models of flex foot established with three different curvatures 20[Formula: see text] (small bending), 35[Formula: see text] (medium bending) and 50[Formula: see text] (big bending). Besides, it simulates and investigates the condition of flex foot while a person is wearing it with single-leg standing or running. The evaluation indices were selected as von Mises stress and displacements at top of socket surface. The results show that the big-bending flex foot generated the higher stress and the larger deformed displacement. Without exceeding the material tolerance of the flex foot, the larger displacement of big-bending flex foot could generate more energy, which possessed larger resilient potential energy and enabled the athletes to have better performance after using the flex foot. As a result, due to its beneficial property of energy storage and return, the large-bending flex foot user could have better effect. In the future, more innovative designs of the flex foot prosthesis can be laid out with the reference of the result in this study.
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Affiliation(s)
- MING-JEN KE
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - KUI-CHOU HUANG
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Occupational Therapy, Asia University, Taichung, Taiwan
- Department of Orthopedics, Asia University Hospital, Taichung, Taiwan
| | - CHENG-HUNG LEE
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Biotechnology, Hung Kuang University, Taichung, Taiwan
| | - HENG-YI CHU
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - YUNG-TSAN WU
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - SHIN-TSU CHANG
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
| | - SHANG-LIN CHIANG
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - KUO-CHIH SU
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Biomedical Engineering, Hung Kuang University, Taichung, Taiwan
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19
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Hung LK, Su KC, Lu WH, Lee CH. Biomechanical analysis of clavicle hook plate implantation with different hook angles in the acromioclavicular joint. INTERNATIONAL ORTHOPAEDICS 2017; 41:1663-1669. [PMID: 28097386 DOI: 10.1007/s00264-016-3384-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE A clavicle hook plate is a simple and effective method for treating acromioclavicular dislocation and distal clavicle fractures. However, subacromial osteolysis and peri-implant fractures are complicated for surgeons to manage. This study uses finite element analysis (FEA) to investigate the post-implantation biomechanics of clavicle hook plates with different hook angles. METHODS This FEA study constructed a model with a clavicle, acromion, clavicle hook plate, and screws to simulate the implantation of clavicle hook plates at different hook angles (90°, 95°, 100°, 105°, and 110°) for treating acromioclavicular joint dislocations. This study investigated the biomechanics of the acromion, clavicle, hook plate, and screws. RESULTS A smaller hook angle increases the stress on the middle third of the clavicle. A larger hook angle increases the force exerted by the clavicle hook plate on the acromion. The screw at the most medial position on the plate generated the highest stress. The highest stress on the implanted clavicle hook plate was on the turning corner of the hook. CONCLUSIONS A clavicle hook plate with different hook angles may induce different biomechanical behaviors in the clavicle and acromion. Orthopedic surgeons must select a suitable clavicle hook plate based on the anatomical structure of each patient.
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Affiliation(s)
- Li-Kun Hung
- Department of Orthopedics, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705, Taiwan.,Department of Orthopedics, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Kuo-Chih Su
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Biomedical Engineering, Hung Kuang University, Taichung, Taiwan
| | - Wen-Hsien Lu
- Department of Orthopedics, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705, Taiwan.,Department of Orthopedics, Feng-Yuan Hospital, Taichung, Taiwan.,Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705, Taiwan. .,Department of Biotechnology, Hung Kuang University, Taichung, Taiwan.
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20
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Şükür E, Öztürkmen Y, Akman YE, Güngör M. Clinical and radiological results on the fixation of Neer type 2 distal clavicle fractures with a hook plate. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2016; 50:489-493. [PMID: 27742156 PMCID: PMC6197475 DOI: 10.1016/j.aott.2016.08.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/24/2015] [Accepted: 01/16/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to analyze the clinical and functional results of hook plate fixation in Neer type 2 distal clavicle fractures. Methods We retrospectively analyzed 16 patients (11 males, 5 females) who were diagnosed with Neer type 2 distal clavicle fractures and treated with hook plate fixation between 2013 and 2014. Mean age was 38 (range: 27–61), and mean follow-up time was 14.3 (range: 12–18) months. Complications seen on radiographs were implant failure and subacromial osteolysis. The clinical results were evaluated with modified UCLA (University of California Los Angeles) scoring system. Results Bone union was achieved in all patients at the end of the first 4 months. Mean modified UCLA score was 32.75 (range 31–35). In 12 patients (68%), the implants had to be removed due to complications. After removal, the complaints regressed and shoulders' range of motion increased. Conclusion Clinical and radiological results on the fixation of Neer type 2 distal clavicle fractures with a hook plate are good in terms of fracture union and function. The major disadvantage of the method was the requirement of early implant removal due to the hardware related complications and good results can be achieved only after plate removal. Optimizing the length of hook plate may lower the rate of complications. Level of evidence Level IV, Therapeutic study.
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Affiliation(s)
- Erhan Şükür
- İstanbul Education and Research Hospital, İstanbul, Turkey
| | | | | | - Mustafa Güngör
- İstanbul Education and Research Hospital, İstanbul, Turkey
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21
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Xiong C, Lu Y, Wang Q, Chen G, Hu H, Lu Z. Anatomical principles for minimally invasive reconstruction of the acromioclavicular joint with anchors. INTERNATIONAL ORTHOPAEDICS 2016; 40:2317-2324. [PMID: 27590201 DOI: 10.1007/s00264-016-3283-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 08/23/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study was to evaluate the outcome of a minimally invasive surgical technique for the treatment of patients with acromioclavicular joint dislocation. METHODS Sixteen patients with complete acromioclavicular joint dislocation were enrolled in this study. All patients were asked to follow the less active rehabilitation protocol post-operatively. Computed tomography with 3-D reconstruction of the injured shoulder was performed on each patient post operatively for the assessment of the accuracy of the suture anchor placement in the coracoid process and the reduction of the acromioclavicular joint. Radiographs of Zanca view and axillary view of both shoulders were taken for evaluating the maintenance of the acromioclavicular joint reduction at each follow-up visit. The Constant shoulder score was used for function assessment at the final follow-up. RESULTS Twenty seven of the 32 anchors implanted in the coracoid process met the criteria of good position. One patient developed complete loss of reduction and another had partial loss of reduction in the anteroposterior plane. For the other 14 patients, the mean Constant score was 90 (range, 82-95). For the patients with partial and complete loss of reduction, the Constant score were 92 and 76 respectively. All of them got nearly normal range of motion of the shoulders and restored to pre-operative life and works. CONCLUSION With this minimally invasive approach and limited exposure of the coracoid, a surgeon can place the suture anchors at the anatomical insertions of the coracoclavicular ligament and allow the dislocated joint reduced and maintained well. LEVEL OF EVIDENCE Level IV, Case series; therapeutic study.
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Affiliation(s)
- Chuanzhi Xiong
- The Orthopedic Department, Northern Jiangsu People's Hospital, Yangzhou University, NO. 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China.
| | - Yaojia Lu
- The Orthopedic Department, Northern Jiangsu People's Hospital, Yangzhou University, NO. 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
| | - Qiang Wang
- The Orthopedic Department, Northern Jiangsu People's Hospital, Yangzhou University, NO. 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
| | - Gang Chen
- The Orthopedic Department, Northern Jiangsu People's Hospital, Yangzhou University, NO. 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
| | - Hansheng Hu
- The Orthopedic Department, Northern Jiangsu People's Hospital, Yangzhou University, NO. 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
| | - Zhihua Lu
- The Orthopedic Department, Northern Jiangsu People's Hospital, Yangzhou University, NO. 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
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22
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Lee CH, Shih CM, Huang KC, Chen KH, Hung LK, Su KC. Biomechanical Analysis of Implanted Clavicle Hook Plates With Different Implant Depths and Materials in the Acromioclavicular Joint: A Finite Element Analysis Study. Artif Organs 2016; 40:1062-1070. [PMID: 26814438 DOI: 10.1111/aor.12679] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Clinical implantation of clavicle hook plates is often used as a treatment for acromioclavicular joint dislocation. However, it is not uncommon to find patients that have developed acromion osteolysis or had peri-implant fracture after hook plate fixation. With the aim of preventing complications or fixation failure caused by implantation of inappropriate clavicle hook plates, the present study investigated the biomechanics of clavicle hook plates made of different materials and with different hook depths in treating acromioclavicular joint dislocation, using finite element analysis (FEA). This study established four parts using computer models: the clavicle, acromion, clavicle hook plate, and screws, and these established models were used for FEA. Moreover, implantations of clavicle hook plates made of different materials (stainless steel and titanium alloy) and with different depths (12, 15, and 18 mm) in patients with acromioclavicular joint dislocation were simulated in the biomechanical analysis. The results indicate that deeper implantation of the clavicle hook plate reduces stress on the clavicle, and also reduces the force applied to the acromion by the clavicle hook plate. Even though a clavicle hook plate made of titanium alloy (a material with a lower Young's modulus) reduces the force applied to the acromion by the clavicle hook plate, slightly higher stress on the clavicle may occur. The results obtained in this study provide a better reference for orthopedic surgeons in choosing different clavicle hook plates for surgery.
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Affiliation(s)
- Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Biotechnology, Hung Kuang University, Taichung, Taiwan
| | - Cheng-Min Shih
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Kui-Chou Huang
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan.,Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Li-Kun Hung
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Orthopaedics, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Kuo-Chih Su
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan.,Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan
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