Pretz Fabian, Zderic Ivan, Beeres Frank J P, Link Björn-Christian, Babst Reto, Lecoultre Yannic, Gueorguiev Boyko, Varga Peter, Pastor Torsten, Wall Bryan J M van de
AO Research Institute Davos, Davos, Switzerland.
Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
Eur J Trauma Emerg Surg. 2025 Apr 29;51(1):183. doi: 10.1007/s00068-025-02854-2.
Low-profile dual plating techniques have gained popularity for diaphyseal clavicula fractures due to their potential to reduce soft tissue irritation. Intramedullary nailing is also an established surgical option for treatment of diaphyseal clavicle fractures. The present study therefore aimed to evaluate whether a 2 × 2.0 mm dual plating system can achieve biomechanical performance comparable to intramedullary nailing while reducing implant-related complications.
Twelve paired human cadaveric clavicles with simulated unstable diaphyseal shaft fractures AO/OTA 15.2 C were stabilized via elastic nailing (Group 1) or dual plating using a superior and an anterior 2.0 mm plate (Group 2). Specimens underwent biomechanical testing with initial quasistatic superior-inferior and anterior-posterior bending, followed by cyclic superior-inferior loading to failure. Interfragmentary movements were monitored by optical motion tracking.
Dual plating demonstrated significantly higher initial construct stiffness in all bending directions and a reduced neutral zone compared to intramedullary nailing (p ≤ 0.016). In addition, fracture displacement amplitudes over all cycles were significantly higher in Group 1 versus Group 2 (p = 0.002). The number of cycles required to reach the test endpoint at a 45 mm displacement did not differ significantly between the groups (p = 0.160), with Group 1 averaging 24,420 cycles (SD ± 3,615) and Group 2 averaging 28,232 cycles (SD ± 5,417).
Low-profile dual plating may offer improved initial stability of midshaft clavicle fractures without compromising their long-term performance, making it a promising alternative to elastic nailing. In selected patients with simpler unstable midshaft clavicle fractures, 2 × 2.0 mm dual plating may offer effective biomechanical stability.
低轮廓双钢板技术因其减少软组织刺激的潜力，在肱骨干骨折治疗中越来越受欢迎。髓内钉固定也是治疗肱骨干骨折的一种成熟手术选择。因此，本研究旨在评估2×2.0毫米双钢板系统能否在减少植入物相关并发症的同时，实现与髓内钉固定相当的生物力学性能。
12对模拟AO/OTA 15.2 C型不稳定肱骨干骨折的人体尸体锁骨，通过弹性髓内钉固定（第1组）或使用一块2.0毫米的上钢板和一块前钢板进行双钢板固定（第2组）。标本先进行初始准静态上下和前后弯曲生物力学测试，然后进行上下循环加载直至失效。通过光学运动跟踪监测骨折块间的运动。
与髓内钉固定相比，双钢板固定在所有弯曲方向上均表现出显著更高的初始结构刚度，且中性区减小（p≤0.016）。此外，第1组在所有循环中的骨折移位幅度明显高于第2组（p = 0.002）。在45毫米移位时达到测试终点所需的循环次数在两组之间无显著差异（p = 0.160），第1组平均为24420次循环（标准差±3615），第2组平均为28232次循环（标准差±5417）。
低轮廓双钢板固定可提高肱骨干中部骨折的初始稳定性，且不影响其长期性能，使其成为弹性髓内钉固定的一个有前景的替代方案。对于选定的较简单的不稳定肱骨干中部骨折患者，2×2.0毫米双钢板固定可能提供有效的生物力学稳定性。
