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 language | English (US) |
|---|---|
| Pages (from-to) | 1461-1465 |
| Number of pages | 5 |
| Journal | Injury |
| Volume | 47 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 1 2016 |
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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 journal › Article
}
TY - JOUR
T1 - Optimizing compression
T2 - Comparing eccentric plate holes and external tensioning devices
AU - Lucas, Justin F.
AU - Lee, Mark A
AU - Eastman, Jonathan Garland
PY - 2016/7/1
Y1 - 2016/7/1
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.
KW - Absolute stability
KW - Articulated tensioning device
KW - Clamp compression
KW - Compression plating
UR - http://www.scopus.com/inward/record.url?scp=84969204300&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84969204300&partnerID=8YFLogxK
U2 - 10.1016/j.injury.2016.04.020
DO - 10.1016/j.injury.2016.04.020
M3 - Article
C2 - 27206844
AN - SCOPUS:84969204300
VL - 47
SP - 1461
EP - 1465
JO - Injury
JF - Injury
SN - 0020-1383
IS - 7
ER -