Wellman David S, Tucker Scott M, Baxter Josh R, Pardee Nadine C, Lazaro Lionel E, Smith Christopher S, Lorich Dean G, Helfet David L
Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, USA.
Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA.
Arch Orthop Trauma Surg. 2017 Sep;137(9):1173-1179. doi: 10.1007/s00402-017-2735-6. Epub 2017 Jun 20.
Open reduction and internal fixation has long been accepted as optimal treatment for displaced olecranon fractures based on poor results seen with conservative management. With the presence of comminution, tension-band wiring constructs are contraindicated due to tendency to compress through fragments, thereby shortening the articular segment. Therefore, plate fixation is typically employed. Our hypothesis was that in a comminuted fracture model, 2.7 mm reconstruction plating without locking screws will perform equally to 3.5 mm locked plating in terms of fracture displacement and rotation (shear).
A three-part comminuted olecranon fracture pattern was created in nine matched pairs of cadaveric specimen using an oscillating saw in standardized, reproducible fashion. Each matched pair was then randomized to receive either 2.7 mm reconstruction plating or 3.5 mm proximal ulna locked plating. Random allocation software was used to assign the 2.7 mm plate construct to either the right or left side of each pair with the contralateral receiving the 3.5 mm plate construct. Specimens were cyclically loaded simulating passive range of motion exercises commonly performed during rehabilitation. Displacement and rotation in relation to the long axis of the ulna were measured through motion capture. Fragment gapping and rotation was quantified following 100 cycles at 10 N and again following 100 cycles at 500 N.
No significant differences were detected between the 2.7 and 3.5 mm plates in fracture rotation or gapping following loads at 10 N (0.5° and 0.7°; 0.6 and 1.2 mm; respectively; p > 0.05) or 500 N (2.3° and 1.6°; 3.8 and 3.1 mm; respectively; p > 0.05) loading. Fragment rotation and gapping were positively correlated within each plate construct (R > 0.445; p < 0.05).
2.7 mm plating is an alternative to 3.5 mm locked plating with decreased plate prominence without significantly sacrificing displacement and rotational control. This is beneficial in fracture patterns where the traditional dorsal plating does not offer optimal screw trajectory.
基于保守治疗效果不佳，切开复位内固定长期以来一直被认为是治疗移位型尺骨鹰嘴骨折的最佳方法。存在粉碎性骨折时，由于张力带钢丝结构有压缩碎骨块从而缩短关节段的倾向，因此禁忌使用。所以，通常采用钢板固定。我们的假设是，在粉碎性骨折模型中，不带锁定螺钉的2.7毫米重建钢板在骨折移位和旋转（剪切）方面的表现与3.5毫米锁定钢板相同。
使用摆动锯以标准化、可重复的方式在九对匹配的尸体标本上制造三部分粉碎性尺骨鹰嘴骨折模型。然后将每对匹配标本随机分为接受2.7毫米重建钢板或3.5毫米尺骨近端锁定钢板治疗。使用随机分配软件将2.7毫米钢板结构分配到每对标本的右侧或左侧，对侧接受3.5毫米钢板结构。对标本进行循环加载，模拟康复期间通常进行的被动活动范围练习。通过运动捕捉测量相对于尺骨长轴的位移和旋转。在10牛的力作用100个循环后以及在500牛的力作用100个循环后，对碎骨块间隙和旋转进行量化。
在10牛（分别为0.5°和0.7°；0.6和1.2毫米）或500牛（分别为2.3°和1.6°；3.8和3.1毫米）加载后，2.7毫米和3.5毫米钢板在骨折旋转或间隙方面未检测到显著差异（p>0.05）。在每个钢板结构内，碎骨块旋转和间隙呈正相关（R>0.445；p<0.05）。
2.7毫米钢板是3.5毫米锁定钢板的一种替代选择，钢板突出度降低，且在不显著牺牲移位和旋转控制的情况下具有优势。这对于传统背侧钢板无法提供最佳螺钉轨迹的骨折类型有益。
