A biomechanical comparison of multidirectional nail and locking plate fixation in unstable olecranon fractures

Background The main theoretic advantage of proximal olecranon fracture intramedullary fixation is decreased soft-tissue irritation and, potentially, less subsequent hardware removal. Despite this possible benefit, questions remain as to whether intramedullary devices are capable of controlling olecr...

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Bibliographic Details
Published in:Journal of shoulder and elbow surgery 2012-10, Vol.21 (10), p.1398-1405
Main Authors: Argintar, Evan, MD, Martin, Benjamin D., MD, Singer, Andrea, MD, Hsieh, Adam H., PhD, Edwards, Scott, MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Biological and medical sciences
Biomechanical Phenomena
Biomechanics. Biorheology
Bone Nails
Bone Plates
Cadaver
comparison
Diseases of the osteoarticular system
Elbow Joint - injuries
Elbow Joint - physiopathology
Elbow Joint - surgery
Female
fracture
Fracture Fixation, Intramedullary - instrumentation
Fractures, Comminuted - physiopathology
Fractures, Comminuted - surgery
Fundamental and applied biological sciences. Psychology
Humans
Injuries of the limb. Injuries of the spine
intramedullary
Male
Medical sciences
Middle Aged
nail
OlecraNail
Olecranon
Olecranon Process - injuries
Olecranon Process - physiopathology
Olecranon Process - surgery
Orthopedics
plate
prominence
Prosthesis Design
Tissues, organs and organisms biophysics
Traumas. Diseases due to physical agents
Ulna Fractures - physiopathology
Ulna Fractures - surgery
unstable
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Summary:Background The main theoretic advantage of proximal olecranon fracture intramedullary fixation is decreased soft-tissue irritation and, potentially, less subsequent hardware removal. Despite this possible benefit, questions remain as to whether intramedullary devices are capable of controlling olecranon fractures to the same extent as locking plates. This study evaluates the ability of a novel multidirectional locking nail to stabilize comminuted fractures and directly compares its biomechanical performance with that of locking olecranon plates. Materials and methods We implanted 8 stainless steel locking plates and stainless steel intramedullary nails to stabilize a simulated comminuted fracture in 16 fresh-frozen cadaveric elbows. Flexion-extension, varus-valgus, gap distance, and rotational 3-dimensional angular displacement analysis was conducted over a 60° motion arc (30° to 90°) to assess fragment motion through physiologic cyclic arcs of motion and failure loading. Displacements in all planes were compared. Results Both implants showed less than 1° of motion in all measured planes and allowed less than 1 mm of gapping through all loads tested until ultimate failure. All failures occurred by sudden, catastrophic means. The mean failure weight for the nail was 14.4 kg compared with 8.7 kg for the plate ( P = .02). The nail survived 1102 cycles, whereas the plate survived 831 cycles ( P = .06). Conclusion In simulated comminuted olecranon fractures, the multidirectional locking intramedullary nails sustained significantly higher maximum loads than the locking plates. The two implants showed no significant differences in fragment control or number of cycles survived. Surgeons can expect the multidirectional locking nails to stabilize comminuted fractures at least as well as locking plates.
ISSN:1058-2746
1532-6500
DOI:10.1016/j.jse.2011.08.068