Rausch Valentin, Harbrecht Andreas, Kahmann Stephanie L, Fenten Thomas, Jovanovic Nebojsa, Hackl Michael, Müller Lars P, Staat Manfred, Wegmann Kilian
Faculty of Medicine, University of Cologne, Center for Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany.
Faculty of Medicine, University of Cologne, Center for Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany; Department of Anatomy I, Faculty of Medicine, University of Cologne, Cologne, Germany.
J Hand Surg Am. 2020 Oct;45(10):987.e1-987.e8. doi: 10.1016/j.jhsa.2020.04.010. Epub 2020 Jun 1.
The aim of this study was to compare several osteosynthesis techniques (intramedullary headless compression screws, T-plates, and Kirschner wires) for distal epiphyseal fractures of proximal phalanges in a human cadaveric model.
A total of 90 proximal phalanges from 30 specimens (index, ring, and middle fingers) were used for this study. After stripping off all soft tissue, a transverse distal epiphyseal fracture was simulated at the proximal phalanx. The 30 specimens were randomly assigned to 1 fixation technique (30 per technique), either a 3.0-mm intramedullary headless compression screw, locking plate fixation with a 2.0-mm T-plate, or 2 oblique 1.0-mm Kirschner wires. Displacement analysis (bending, distraction, and torsion) was performed using optical tracking of an applied random speckle pattern after osteosynthesis. Biomechanical testing was performed with increasing cyclic loading and with cyclic load to failure using a biaxial torsion-tension testing machine.
Cannulated intramedullary compression screws showed significantly less displacement at the fracture site in torsional testing. Furthermore, screws were significantly more stable in bending testing. Kirschner wires were significantly less stable than plating or screw fixation in any cyclic load to failure test setup.
Intramedullary compression screws are a highly stable alternative in the treatment of transverse distal epiphyseal phalangeal fractures. Kirschner wires seem to be inferior regarding displacement properties and primary stability.
Fracture fixation of phalangeal fractures using plate osteosynthesis may have the advantage of a very rigid reduction, but disadvantages such as stiffness owing to the more invasive surgical approach and soft tissue irritation should be taken into account. Headless compression screws represent a minimally invasive choice for fixation with good biomechanical properties.
本研究旨在在人体尸体模型中比较几种用于近节指骨远端骨骺骨折的接骨术技术（髓内无头加压螺钉、T形钢板和克氏针）。
本研究使用了来自30个标本（示指、环指和中指）的90根近节指骨。剥离所有软组织后，在近节指骨模拟横向远端骨骺骨折。将30个标本随机分配至1种固定技术（每种技术30个），即3.0毫米髓内无头加压螺钉、用2.0毫米T形钢板进行锁定钢板固定或2根1.0毫米斜行克氏针。接骨术后，使用对施加的随机散斑图案进行光学跟踪的方法进行位移分析（弯曲、牵张和扭转）。使用双轴扭转-拉伸试验机，通过增加循环载荷和进行直至破坏的循环载荷来进行生物力学测试。
在扭转测试中，空心髓内加压螺钉在骨折部位的位移明显更小。此外，在弯曲测试中，螺钉明显更稳定。在任何直至破坏的循环载荷测试设置中，克氏针的稳定性明显低于钢板或螺钉固定。
髓内加压螺钉是治疗横向远端骨骺指骨骨折的一种高度稳定的替代方法。克氏针在位移特性和初始稳定性方面似乎较差。
使用钢板接骨术进行指骨骨折固定可能具有非常牢固复位的优点，但应考虑到诸如由于手术入路更具侵入性和软组织刺激导致的僵硬等缺点。无头加压螺钉是一种具有良好生物力学性能的微创固定选择。
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