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.
- Absolute stability
- Articulated tensioning device
- Clamp compression
- Compression plating
ASJC Scopus subject areas
- Emergency Medicine
- Orthopedics and Sports Medicine