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01.12.2016 | Research article | Ausgabe 1/2016 Open Access

BMC Musculoskeletal Disorders 1/2016

Using self-drilling screws in volar plate osteosynthesis for distal radius fractures: a feasibility study

Zeitschrift:
BMC Musculoskeletal Disorders > Ausgabe 1/2016
Autoren:
Alexaner Synek, Lars Borgmann, Hannes Traxler, Wolfgang Huf, Ekkehard Euler, Yan Chevalier, Sebastian F. Baumbach
Wichtige Hinweise

Competing interests

All named authors hereby declare that they have no conflicts of interest to disclose.
Medartis Inc. provided the osteosynthetic material. None of the authors is linked to Medartis (no conflict of interest) nor has Medartis Inc. been involved in the planning and execution of the study. The study was funded by a research grant of the Medical University of Munich (LMU, FöFoLe #828). The authors declare that they have no competing interests.

Authors’ contributions

AS and YC helped design the study, conducted the biomechanical testing and helped with the interpretation of the data. LB and WH conducted data preparation, statistical analysis and figure preparation. HT, helped prepare the radii, conducted the morphometric measurements and helped with the analysis and interpretation of the data. EE helped with the general setup, study design, sample preparation and interpretation of the data. SFB had the study idea, conducted specimen preparation and data interpretation. All authors contributed significantly to the drafting of either part of the draft, conducted proof-reading for the whole manuscript and approved it for publication.

Abstract

Background

Symptomatic extensor tendon irritation is a frequent complication in volar plate osteosynthesis of distal radius fractures. It is typically caused by dorsal screw protrusion and overdrilling of the dorsal cortex. The use of self-drilling locking screws (SDLS) could overcome both causes. The practical applicability of SDLS depends on two prerequisites: (1) the feasibility of preoperative distal screw length determination, and (2) sufficient primary biomechanical stability of SDLS compared to standard locking screws (SLS).

Methods

We first assessed the feasibility of preoperative screw length determination (1): Distal radius width, depth and distal screw lengths were measured in 38 human radii. Correlations between distal radius width and depth were assessed, a cluster analysis (Ward’s method and squared Euclidean distance) for distal radius width conducted, and intra-cluster screw lengths analyzed (ANOVA). The biomechanical performance of SDLS (2) was assessed by comparison to SLS in a distal radius fracture model (AO-23 A3). 75 % distal screw length was chosen for both groups to simulate a worst-case scenario. Uniaxial compression tests were conducted to measure stiffness, elastic limit, maximum force and residual tilt. Statistics comprised of independent sample t-tests and a Bonferroni correction (p < 0.0125).

Results

(1) Distal radius width and depth showed a high correlation (R 2  = 0.79; p < 0.001). Three distal radius width clusters could be identified: small <34 mm; medium 34–36.9 mm; large >36.9 mm. ANOVA and Tukey post-hoc analysis revealed significantly different volar-dorsal depths (p < 0.05) for nearly all screws. (2) To assess biomechanical stability nine specimens were tested each; no significant differences were found between the SDLS and SLS groups.

Conclusions

This feasibility study demonstrates that (1) distal radius width can be used as a predictor for distal screw length and (2) that SDLS provides mechanical stability equivalent to SLS. These results highlight the feasibility of applying SDLS screws in volar plate osteosynthesis at least in extraarticular fractures.
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