Hopf Johannes Christof, Nowak Tobias Eckhard, Mehler Dorothea, Arand Charlotte, Gruszka Dominik, Westphal Ruben, Rommens Pol Maria
Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany.
Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany.
BMC Musculoskelet Disord. 2020 Sep 17;21(1):616. doi: 10.1186/s12891-020-03637-z.
Comminuted proximal ulna fractures are severe injuries with a high degree of instability. These injuries require surgical treatment, usually angular stable plating or double plating is performed. Nailing of proximal ulna fracture is described but not performed regularly. The aim of this study was to compare a newly developed, locked proximal ulna nail with an angular stable plate in an unstable fracture of the proximal ulna. We hypothesize, that locked nailing of the proximal ulna will provide non-inferior stability compared to locked plating.
A defect fracture distal to the coronoid was simulated in 20 sawbones. After nailing or plate osteosynthesis the constructs were tested in a servo-pneumatic testing machine under physiological joint motion (0°-90°) and cyclic loading (30 N - 300 N). Intercyclic osteotomy gap motion and plastic deformation of the constructs were analyzed using micromotion video-analysis.
The locked nail showed lower osteotomy gap motion (0.50 ± 0.15 mm) compared to the angular stable plate (1.57 ± 0.37 mm, p < 0.001). At the anterior cortex the plastic deformation of the constructs was significantly lower for the locked nail (0.09 ± 0.17 mm vs. 0.39 ± 0.27 mm, p = 0.003). No statistically significant differences were observed at the posterior cortex for both parameters.
Nail osteosynthesis in comminuted proximal ulna fractures shows lower osteotomy gap motion and lower amount of plastic deformation compared to locking plate osteosynthesis under laboratory conditions.
尺骨近端粉碎性骨折是严重损伤，具有高度不稳定性。这些损伤需要手术治疗，通常采用角稳定钢板或双钢板固定。尺骨近端骨折的髓内钉固定虽有描述，但未常规开展。本研究的目的是在尺骨近端不稳定骨折中，将一种新开发的锁定式尺骨近端髓内钉与角稳定钢板进行比较。我们假设，尺骨近端锁定髓内钉固定与锁定钢板固定相比，稳定性不劣于后者。
在20具尸体骨上模拟冠突远端的缺损骨折。髓内钉固定或钢板接骨术后，在伺服气动试验机上对构建物进行生理关节活动（0°-90°）和循环加载（30N - 300N）测试。使用微动视频分析技术分析构建物的环间截骨间隙运动和塑性变形。
与角稳定钢板（1.57±0.37mm，p<0.001）相比，锁定髓内钉的截骨间隙运动更低（0.50±0.15mm）。在前方皮质，锁定髓内钉构建物的塑性变形显著更低（0.09±0.17mm对0.39±0.27mm，p = 0.003）。在后方皮质，两个参数均未观察到统计学显著差异。
在实验室条件下，与锁定钢板接骨术相比，尺骨近端粉碎性骨折的髓内钉接骨术截骨间隙运动更低，塑性变形量更小。
