Biomechanical evaluation of clavicle fracture plating techniques: does a locking plate provide improved stability?
OBJECTIVE
To evaluate the biomechanical properties of both plate location (superior versus anterior-inferior) and plate type Small Fragment Contourable Dual Compression Plate (CDCP) versus 3.5 mm Universal Locking System Contourable Dual Compression Plate (Locked CDCP) in a synthetic midshaft transverse clavicle fracture model.


METHODS
Twenty-four pre-osteomized synthetic clavicles were repaired with either CDCP or locked CDCP technology 3.5 mm plates in either the superior or anterior-inferior position to form 4 groups of 6 clavicles. These were subsequently tested to evaluate torsional and axial construct stiffness, as well as bending load to failure, bending failure stiffness, and method of failure.


RESULTS
In axial compression, locked CDCP constructs were significantly more stiff than CDCP constructs (p < 0.001), but no statistically significant effect of plate location was observed. Torsional tests demonstrated a significant 2-way interaction favoring locked CDCP plates in the superior position and standard CDCP plates in the anterior-inferior position (p < 0.001). Bending failure testing revealed that the superior plate location had higher load to failure and bending failure stiffness than the anterior-inferior location (p < 0.0001). In addition, the superior locked CDCP plates demonstrated significantly greater bending failure stiffness than superior CDCP plates (p < 0.0001).


CONCLUSIONS
Biomechanically, repairing a midshaft clavicle fracture with a superior plate was more favorable compared to anterior-inferior plating in terms of both load to failure and bending failure stiffness. Furthermore, superior locked CDCP plates show improved bending failure stiffness over superior CDCP plates.
Celestre
Paul
P
Department of Orthopaedic Surgery, University of California - San Diego, San Diego, California, USA.
Roberston
Claire
C
Mahar
Andrew
A
Oka
Richard
R
Meunier
Matthew
M
Schwartz
Alexandra
A
D001696:Biomechanical Phenomena; D001858:Bone Nails; D002968:Clavicle / Q000293:injuries*; D020099:Coated Materials, Biocompatible; D004868:Equipment Failure; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D050723:Fractures, Bone / Q000534:rehabilitation / Q000601:surgery; D006801:Humans; D019637:Orthopedic Procedures / Q000295:instrumentation* / Q000379:methods
D020099:Coated Materials, Biocompatible