Optimizing compression

Comparing eccentric plate holes and external tensioning devices

Research output: Contribution to journalArticle

Abstract

Objective Elimination of interfragmentary motion in fracture fixation using plates to impart compression and promote primary bone healing through absolute stability has been well described as a reliable and successful method to treat simple transverse and short oblique fracture morphologies. Our hypothesis is that dynamic compression plating augmented by external compression techniques would produce and maintain a significantly greater amount of compression than using the plate alone. Methods Simple transverse diayphyseal fractures were simulated in nine 4th generation composite bone models. A load cell was placed within the transverse fracture osteotomy and stabilized and compressed using either eccentric screw placement in a dynamic compression plate alone or augmented with an opposite segment Verbrugge clamp or articulated tensioning device (ATD) compressing using a screw outside of the plate. Dynamic plate compression was evaluated independently and in conjunction with the external compression techniques. Statistical analyses were carried out using a linear mixed effects model and pairwise comparisons between conditions with a significance set at a P-value <0.05. Results Both of the external compression techniques (Verbrugge and ATD) achieved significantly higher compression than the plate compression technique alone with 78% (P < 0.001) and 134% (P < 0.001) more compression respectively. The measured compression across the osteotomy after screw application and removal of external compression decreases by 17% for the Verbrugge device (P = 0.215) and by 22%, after removal of the ATD device (P = 0.038). For both techniques, adding additional screws in eccentric (load) position further increases compression. Conclusion Plate compression is a reliable method for inducing compression across transverse and short oblique fractures. Augmenting plate compression technique with external compression techniques (Verbrugge clamp or ATD) allows for a significantly greater compressive load to be achieved. Compression lost after removal of the external compression device indicates that the maximal compression attainable across a fracture may not be reliably maintained with standard dynamic compression plating techniques.

Original languageEnglish (US)
Pages (from-to)1461-1465
Number of pages5
JournalInjury
Volume47
Issue number7
DOIs
StatePublished - Jul 1 2016

Fingerprint

Equipment and Supplies
Osteotomy
Bone and Bones
Fracture Fixation

Keywords

  • Absolute stability
  • Articulated tensioning device
  • Clamp compression
  • Compression plating

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Optimizing compression : Comparing eccentric plate holes and external tensioning devices. / Lucas, Justin F.; Lee, Mark A; Eastman, Jonathan Garland.

In: Injury, Vol. 47, No. 7, 01.07.2016, p. 1461-1465.

Research output: Contribution to journalArticle

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title = "Optimizing compression: Comparing eccentric plate holes and external tensioning devices",
abstract = "Objective Elimination of interfragmentary motion in fracture fixation using plates to impart compression and promote primary bone healing through absolute stability has been well described as a reliable and successful method to treat simple transverse and short oblique fracture morphologies. Our hypothesis is that dynamic compression plating augmented by external compression techniques would produce and maintain a significantly greater amount of compression than using the plate alone. Methods Simple transverse diayphyseal fractures were simulated in nine 4th generation composite bone models. A load cell was placed within the transverse fracture osteotomy and stabilized and compressed using either eccentric screw placement in a dynamic compression plate alone or augmented with an opposite segment Verbrugge clamp or articulated tensioning device (ATD) compressing using a screw outside of the plate. Dynamic plate compression was evaluated independently and in conjunction with the external compression techniques. Statistical analyses were carried out using a linear mixed effects model and pairwise comparisons between conditions with a significance set at a P-value <0.05. Results Both of the external compression techniques (Verbrugge and ATD) achieved significantly higher compression than the plate compression technique alone with 78{\%} (P < 0.001) and 134{\%} (P < 0.001) more compression respectively. The measured compression across the osteotomy after screw application and removal of external compression decreases by 17{\%} for the Verbrugge device (P = 0.215) and by 22{\%}, after removal of the ATD device (P = 0.038). For both techniques, adding additional screws in eccentric (load) position further increases compression. Conclusion Plate compression is a reliable method for inducing compression across transverse and short oblique fractures. Augmenting plate compression technique with external compression techniques (Verbrugge clamp or ATD) allows for a significantly greater compressive load to be achieved. Compression lost after removal of the external compression device indicates that the maximal compression attainable across a fracture may not be reliably maintained with standard dynamic compression plating techniques.",
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N2 - Objective Elimination of interfragmentary motion in fracture fixation using plates to impart compression and promote primary bone healing through absolute stability has been well described as a reliable and successful method to treat simple transverse and short oblique fracture morphologies. Our hypothesis is that dynamic compression plating augmented by external compression techniques would produce and maintain a significantly greater amount of compression than using the plate alone. Methods Simple transverse diayphyseal fractures were simulated in nine 4th generation composite bone models. A load cell was placed within the transverse fracture osteotomy and stabilized and compressed using either eccentric screw placement in a dynamic compression plate alone or augmented with an opposite segment Verbrugge clamp or articulated tensioning device (ATD) compressing using a screw outside of the plate. Dynamic plate compression was evaluated independently and in conjunction with the external compression techniques. Statistical analyses were carried out using a linear mixed effects model and pairwise comparisons between conditions with a significance set at a P-value <0.05. Results Both of the external compression techniques (Verbrugge and ATD) achieved significantly higher compression than the plate compression technique alone with 78% (P < 0.001) and 134% (P < 0.001) more compression respectively. The measured compression across the osteotomy after screw application and removal of external compression decreases by 17% for the Verbrugge device (P = 0.215) and by 22%, after removal of the ATD device (P = 0.038). For both techniques, adding additional screws in eccentric (load) position further increases compression. Conclusion Plate compression is a reliable method for inducing compression across transverse and short oblique fractures. Augmenting plate compression technique with external compression techniques (Verbrugge clamp or ATD) allows for a significantly greater compressive load to be achieved. Compression lost after removal of the external compression device indicates that the maximal compression attainable across a fracture may not be reliably maintained with standard dynamic compression plating techniques.

AB - Objective Elimination of interfragmentary motion in fracture fixation using plates to impart compression and promote primary bone healing through absolute stability has been well described as a reliable and successful method to treat simple transverse and short oblique fracture morphologies. Our hypothesis is that dynamic compression plating augmented by external compression techniques would produce and maintain a significantly greater amount of compression than using the plate alone. Methods Simple transverse diayphyseal fractures were simulated in nine 4th generation composite bone models. A load cell was placed within the transverse fracture osteotomy and stabilized and compressed using either eccentric screw placement in a dynamic compression plate alone or augmented with an opposite segment Verbrugge clamp or articulated tensioning device (ATD) compressing using a screw outside of the plate. Dynamic plate compression was evaluated independently and in conjunction with the external compression techniques. Statistical analyses were carried out using a linear mixed effects model and pairwise comparisons between conditions with a significance set at a P-value <0.05. Results Both of the external compression techniques (Verbrugge and ATD) achieved significantly higher compression than the plate compression technique alone with 78% (P < 0.001) and 134% (P < 0.001) more compression respectively. The measured compression across the osteotomy after screw application and removal of external compression decreases by 17% for the Verbrugge device (P = 0.215) and by 22%, after removal of the ATD device (P = 0.038). For both techniques, adding additional screws in eccentric (load) position further increases compression. Conclusion Plate compression is a reliable method for inducing compression across transverse and short oblique fractures. Augmenting plate compression technique with external compression techniques (Verbrugge clamp or ATD) allows for a significantly greater compressive load to be achieved. Compression lost after removal of the external compression device indicates that the maximal compression attainable across a fracture may not be reliably maintained with standard dynamic compression plating techniques.

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