Abe Shingo, Koizumi Kota, Murase Tsuyoshi, Kuriyama Kohji
Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan.
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
BMC Musculoskelet Disord. 2021 Sep 21;22(1):812. doi: 10.1186/s12891-021-04697-5.
The locking plate is a useful treatment for lateral clavicle fractures, however, there are limits to the fragment size that can be fixed. The current study aimed to measure the screw angles of three locking plates for lateral clavicle fractures. In addition, to assess the number of screws that can be inserted in different fragment sizes, to elucidate the size limits for locking plate fixation.
The following three locking plates were analyzed: the distal clavicle plate [Acumed, LLC, Oregon, the USA], the LCP clavicle plate lateral extension [Depuy Synthes, LLC, PA, the USA], and the HAI clavicle plate [HOMS Engineering, Inc., Nagano, Japan]. We measured the angles between the most medial and lateral locking screws in the coronal plane and between the most anterior and posterior locking screws in the sagittal plane. A computer simulation was used to position the plates as laterally as possible in ten normal three-dimensional clavicle models. Lateral fragment sizes of 10, 15, 20, 25, and 30 mm were simulated in the acromioclavicular joint, and the number of screws that could be inserted in the lateral fragment was assessed. Subsequently, the area covered by the locking screws on the inferior surface of the clavicle was measured.
The distal clavicle plate had relatively large screw angles (20° in the coronal plane and 32° in the sagittal plane). The LCP clavicle lateral extension had a large angle (38°) in the sagittal plane. However, the maximum angle of the HAI clavicle plate was 13° in either plane. The distal clavicle plate allowed most screws to be inserted in each size of bone fragment. For all locking plates, all screws could be inserted in 25 mm fragments. The screws of distal clavicle plate covered the largest area on the inferior surface of the clavicle.
Screw angles and the numbers of screws that could be inserted in the lateral fragment differed among products. Other augmented fixation procedures should be considered for fractures with fragment sizes < 25 mm that cannot be fixed with a sufficient number of screws.
锁定钢板是治疗锁骨外侧端骨折的一种有效方法，然而，其可固定的骨折块大小存在一定限制。本研究旨在测量三种用于锁骨外侧端骨折的锁定钢板的螺钉角度。此外，评估不同大小骨折块中可插入的螺钉数量，以阐明锁定钢板固定的大小限制。
分析了以下三种锁定钢板：锁骨远端钢板[美国俄勒冈州Acumed有限责任公司]、锁定加压钢板（LCP）锁骨外侧延伸板[美国宾夕法尼亚州Depuy Synthes有限责任公司]和HAI锁骨钢板[日本长野县HOMS工程公司]。我们测量了冠状面内最内侧和最外侧锁定螺钉之间的角度以及矢状面内最前方和最后方锁定螺钉之间的角度。利用计算机模拟将钢板尽可能向外侧放置在十个正常的三维锁骨模型中。在肩锁关节模拟10、15、20、25和30毫米的外侧骨折块大小，并评估可插入外侧骨折块的螺钉数量。随后，测量锁骨下表面锁定螺钉覆盖的面积。
锁骨远端钢板的螺钉角度相对较大（冠状面为20°，矢状面为32°）。LCP锁骨外侧延伸板在矢状面有较大角度（38°）。然而，HAI锁骨钢板在任一平面的最大角度为13°。锁骨远端钢板在每种大小的骨块中允许插入的螺钉最多。对于所有锁定钢板，所有螺钉均可插入25毫米的骨折块中。锁骨远端钢板的螺钉在锁骨下表面覆盖的面积最大。
不同产品的螺钉角度以及可插入外侧骨折块的螺钉数量存在差异。对于骨折块大小<25毫米且无法用足够数量螺钉固定的骨折，应考虑其他增强固定方法。
