Abstract
Purpose
The purpose of this study was to characterise the biomechanical properties of the seven hole superior anterior clavicle LCP (locking compression plate) and to compare these with the properties of commonly applied implants used for the stabilisation of clavicular midshaft fractures such as the locking 7- and ten hole reconstruction plate.
Methods
Twenty-four synthetic clavicles were used. A transverse midshaft fracture was induced. The clavicles were fixed with angle stable clavicle LCPs, seven hole and ten hole reconstruction plates (n = 8 each). Twenty cycles of axial compression and torsion were performed for each sample, which was followed by 1,000 cycles of three point bending and ultimately bending to failure. Axial, torsional and cantilever bending stiffness were calculated from the data recorded.
Results
The clavicle LCP showed the highest overall stiffness compared to the seven and ten hole reconstruction plate. Significantly higher stiffness values were found for axial compression and external rotation. In the load-to-failure tests, the ten hole reconstruction plate especially showed early signs of plastic deformation, which might account for early plate insufficiency so frequently observed clinically.
Conclusion
The results indicate that the clavicle LCP, as compared to the reconstruction plates, leads to superior biomechanical stability in the treatment of midshaft clavicle fractures.
Similar content being viewed by others
References
Robinson CM (1998) Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br 80(3):476–484
Canadian Orthopaedic Trauma Society (2007) Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 89 (1):1–10
Hill JM, McGuire MH, Crosby LA (1997) Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br 79(4):537–539
Pieske O, Dang M, Zaspel J, Beyer B, Loffler T, Piltz S (2008) Midshaft clavicle fractures—classification and therapy. Results of a survey at German trauma departments. Unfallchirurg 111(6):387–394. doi:10.1007/s00113-008-1430-z
Wijdicks FJ, Houwert M, Dijkgraaf M, de Lange D, Oosterhuis K, Clevers G, Verleisdonk EJ (2012) Complications after plate fixation and elastic stable intramedullary nailing of dislocated midshaft clavicle fractures: a retrospective comparison. Int Orthop. doi:10.1007/s00264-012-1615-5
Houwert RM, Wijdicks FJ, Steins Bisschop C, Verleisdonk EJ, Kruyt M (2012) Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review. Int Orthop 36(3):579–585. doi:10.1007/s00264-011-1422-4
Ziegler D, Eden L, Meffert HR (2012) Preliminary, clinical results of a precontoured, angle stable plate in fixation of midshaft clavicle fractures (LCP). 19. Jahreskongress der Deutschen Vereinigung für Schulter-und Ellenbogenchirurgie (DVSE), Berlin, 10–12 May 2012
Robertson C, Celestre P, Mahar A, Schwartz A (2009) Reconstruction plates for stabilization of mid-shaft clavicle fractures: differences between nonlocked and locked plates in two different positions. J Should Elbow Surg 18(2):204–209. doi:10.1016/j.jse.2008.10.002
Partal G, Meyers KN, Sama N, Pagenkopf E, Lewis PB, Goldman A, Wright TM, Helfet DL (2010) Superior versus anteroinferior plating of the clavicle revisited: a mechanical study. J Orthop Trauma 24(7):420–425. doi:10.1097/BOT.0b013e3181c3f6d400005131-201007000-00006
Celestre P, Roberston C, Mahar A, Oka R, Meunier M, Schwartz A (2008) Biomechanical evaluation of clavicle fracture plating techniques: does a locking plate provide improved stability? J Orthop Trauma 22(4):241–247. doi:10.1097/BOT.0b013e31816c7bac
Goswami T, Markert RJ, Anderson CG, Sundaram SS, Crosby LA (2008) Biomechanical evaluation of a pre-contoured clavicle plate. J Should Elbow Surg 17(5):815–818. doi:10.1016/j.jse.2008.02.017
Heiner AD (2008) Structural properties of fourth-generation composite femurs and tibias. J Biomech 41(15):3282–3284. doi:10.1016/j.jbiomech.2008.08.013
Andermahr J, Faymonville C, Rehm KE, Jubel A (2008) Percutaneous plate osteosynthesis for clavicular fractures. Initial description. Unfallchirurg 111(1):43–45. doi:10.1007/s00113-007-1304-9
Iannolo M, Werner FW, Sutton LG, Serell SM, VanValkenburg SM (2010) Forces across the middle of the intact clavicle during shoulder motion. J Should Elbow Surg 19(7):1013–1017. doi:10.1016/j.jse.2010.03.016
Demirhan M, Bilsel K, Atalar AC, Bozdag E, Sunbuloglu E, Kale A (2011) Biomechanical comparison of fixation techniques in midshaft clavicular fractures. J Orthop Trauma 25(5):272–278. doi:10.1097/BOT.0b013e3181ee3db7
Iannotti MR, Crosby LA, Stafford P, Grayson G, Goulet R (2002) Effects of plate location and selection on the stability of midshaft clavicle osteotomies: a biomechanical study. J Should Elbow Surg 11(5):457–462
Acknowledgements
The authors would like to thank Synthes, Germany for donating the plates, screws and financial support.
We thank Gaby Walter from Heraeus, Kulzer for supplying the palacos (PMMA).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Eden, L., Doht, S., Frey, S.P. et al. Biomechanical comparison of the Locking Compression superior anterior clavicle plate with seven and ten hole reconstruction plates in midshaft clavicle fracture stabilisation. International Orthopaedics (SICOT) 36, 2537–2543 (2012). https://doi.org/10.1007/s00264-012-1671-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-012-1671-x