Suter Cyrill, von Rohr Martina, Majewski Martin, Dürselen Lutz, Warnecke Daniela, Schild Natalie, Nowakowski Andrej Maria
University of Basel, Medical Faculty, Klingelbergstrasse 61, 4056 Basel, Switzerland.
University of Basel, Medical Faculty, Klingelbergstrasse 61, 4056 Basel, Switzerland.
Clin Biomech (Bristol). 2019 Jul;67:78-84. doi: 10.1016/j.clinbiomech.2019.05.001. Epub 2019 May 2.
Neer Type IIb lateral clavicle fractures typically lead to dislocation of the medial fragment. Therefore, most surgeons recommend surgical treatment for such a fracture pattern. The use of a locking compression plate with a lateral extension has produced satisfactory results in various studies over recent years. Double-plate fixation is a common technique in the treatment of complex distal radius fractures. The authors use this technique as a routine procedure in the treatment of Neer type IIb fractures. In this biomechanical testing study, the mechanical properties of the two techniques were compared.
On 20 clavicles from fresh frozen cadavers a Neer Type IIb fracture-like osteotomy was performed. A cyclic loading test followed by a load-to-failure test was carried out. Parameters for statistical evaluation were the stiffness at cycles 1, 100 and 17,500 as well as the ultimate tensile load and the deformation at the point of failure.
All specimens withstood the cyclic loading test without any noticeable damage. At cycles 100 and 17,500, the double-plate technique was less stiff. Failure loads were not significantly different from each other, but deformation at the point of failure was significantly greater for the double-plate technique.
Both techniques provided sufficient fixation to the fracture site to endure the cyclic loading test, which is supposed to simulate an incident-free week postoperatively. In summary, the double-plate technique offers biomechanically a feasible alternative to the single-plate technique in lateral clavicle fractures of Neer Type IIb.
Neer IIb型锁骨外侧端骨折通常会导致内侧骨折块移位。因此，大多数外科医生建议对这种骨折类型进行手术治疗。近年来，使用带有外侧延伸的锁定加压钢板在各项研究中均取得了满意的效果。双钢板固定是治疗复杂桡骨远端骨折的常用技术。作者将此技术作为治疗Neer IIb型骨折的常规方法。在这项生物力学测试研究中，对这两种技术的力学性能进行了比较。
在20具新鲜冷冻尸体的锁骨上进行类似Neer IIb型骨折的截骨术。进行循环加载试验，随后进行破坏载荷试验。统计评估参数为第1、100和17500次循环时的刚度以及极限拉伸载荷和破坏点处的变形。
所有标本均经受住了循环加载试验，无明显损伤。在第100和17500次循环时，双钢板技术的刚度较低。破坏载荷彼此无显著差异，但双钢板技术在破坏点处的变形显著更大。
两种技术均为骨折部位提供了足够的固定，以承受循环加载试验，该试验旨在模拟术后一周无意外情况。总之，在Neer IIb型锁骨外侧端骨折中，双钢板技术在生物力学上为单钢板技术提供了一种可行的替代方案。
