Highlights
- •Few previous studies concerning biomechanical properties of different internal fixation for low transcondylar fractures of the distal humerus.
- •Traditional orthogonal and parallel double-plate configurations, and PPMS construct (posterolateral plate + medial screw) were compared.
- •Axial loading, posterior bending, internal torsion for construct stiffness and failure test under axial loading for construct strength were tested.
- •Combining all results, the overall stiffness and strength of parallel configuration were superior to orthogonal and PPMS configurations.
- •PPMS configuration can provide adequate stability and stiffness comparable double-plate methods under axial loading.
Abstract
Background
We aimed to evaluate the biomechanical stiffness and strength of different internal
fixation configurations and find suitable treatment strategies for low transcondylar
fractures of the distal humerus.
Methods and materials
Thirty 4th generation composite humeri were used to create low transcondylar fracture models
that were fixed by orthogonal and parallel double plates as well as posterolateral
plate and medial screw (PPMS) configurations (n=10 in each group) using an anatomical
locking compression plate-screw system and fully threaded medial cortical screws.
Posterior bending (maximum 50 N), axial loading (maximum 200 N) and internal rotation
(maximum 10 N·m) were tested, in that order, for each specimen. Stiffness under different
biomechanical settings among different configurations were compared. Another 18 sets
of fracture models were created using these three configurations (n=6 in each group)
and the load to failure under axial loading among different configurations was compared.
Results
Under posterior bending, the stiffness of parallel group was higher than orthogonal
group (P<0.001), and orthogonal group was higher than PPMS group (P<0.001). Under
axial loading, the stiffness of parallel group was higher than orthogonal group (P=0.001)
and PPMS group (P<0.001); however, the difference between orthogonal and PPMS group
was not statistically significant (P>0.05). Under internal rotation, the stiffness
of parallel group was higher than orthogonal group (P=0.044), and orthogonal group
was higher than PPMS group (P=0.029). In failure test under axial loading, the load
to failure in the orthogonal group was lower than parallel group (P=0.009) and PPMS
group (P=0.021), but the difference between parallel group and PPMS group was not
statistically significant (P>0.05). All specimens in orthogonal group demonstrated
“distal medial failure”; most specimens had “distal medial and trochlear failure”
in the parallel group; most specimens exhibited “contact failure” in the PPMS group.
Conclusion
For treating low transcondylar fractures, the overall stiffness and strength of the
parallel configuration were superior to those of the orthogonal and PPMS configurations.
Nevertheless, the PPMS configuration can provide adequate stability and stiffness
comparable to double-plate configurations under axial loading. Therefore, the PPMS
construct may have certain clinical value.
Keywords
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Article info
Publication history
Published online: October 26, 2022
Accepted:
October 24,
2022
Identification
Copyright
© 2022 Published by Elsevier Ltd.
