Biomechanical analysis of a volar variable-angle locking plate: The effect of capturing a distal radial styloid fragment

Spencer J. Stanbury, Art Salo, John Elfar

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose: Variable-angle volar locked constructs for distal radius fractures are a recent treatment addition. This study sought to biomechanically evaluate a variable-angle volar locking plate as compared with a fixed-angle construct. Methods: We created 2 different AO-C3 osteotomies in fourth-generation synthetic composite distal radiuses and labeled them proximal and distal. The distal osteotomy consisted of a smaller radial styloid fragment. We then fixed both sets of specimens with either a fixed-angle or variable-angle volar locking construct. We tested samples in axial compression with regard to cyclical loading and load to failure. Articular stepoff, stiffness, and load to failure data were then analyzed. Results: Neither the proximal nor the distal osteotomy groups showed articular failure after cyclic loading, significant loss of stiffness over cycling, or superior stiffness compared with the other. After load to failure in the proximal osteotomy, 1 of 8 fixed-angle and none of 8 variable-angle constructs had articular failure, whereas in the distal osteotomy, all 8 fixed-angle and none of 8 variable-angle constructs had articular failure. Conclusions: Variable-angle and fixed-angle volar locked fixation of unstable intra-articular distal radius fractures in fourth-generation composite radii provide mechanically sound constructs with high load to failure values and no loss of stiffness over testing. The variable-angle construct exhibited excellent resistance to articular stepoff at load to failure and no loss of stiffness throughout cyclic loading, and did not exhibit significantly less overall stiffness compared with fixed-angle constructs. The variable-angle fixation exhibited a distinct mechanical advantage over fixed-angle fixation in the setting of a smaller radial styloid fragment. Clinical relevance: Variable-angle constructs could be expected to hold up to standard loads in the postoperative period as well as traditional fixed-angle devices. The additional cost associated with variable-angle constructs may be warranted when treating distal radius fractures with radial styloid fragments, owing to the fragment-specific fixation allowed by customized screw placement.

Original languageEnglish (US)
Pages (from-to)2488-2494
Number of pages7
JournalJournal of Hand Surgery
Volume37
Issue number12
DOIs
StatePublished - Dec 1 2012

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Osteotomy
Joints
Radius Fractures
Postoperative Period
Costs and Cost Analysis
Equipment and Supplies
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

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title = "Biomechanical analysis of a volar variable-angle locking plate: The effect of capturing a distal radial styloid fragment",
abstract = "Purpose: Variable-angle volar locked constructs for distal radius fractures are a recent treatment addition. This study sought to biomechanically evaluate a variable-angle volar locking plate as compared with a fixed-angle construct. Methods: We created 2 different AO-C3 osteotomies in fourth-generation synthetic composite distal radiuses and labeled them proximal and distal. The distal osteotomy consisted of a smaller radial styloid fragment. We then fixed both sets of specimens with either a fixed-angle or variable-angle volar locking construct. We tested samples in axial compression with regard to cyclical loading and load to failure. Articular stepoff, stiffness, and load to failure data were then analyzed. Results: Neither the proximal nor the distal osteotomy groups showed articular failure after cyclic loading, significant loss of stiffness over cycling, or superior stiffness compared with the other. After load to failure in the proximal osteotomy, 1 of 8 fixed-angle and none of 8 variable-angle constructs had articular failure, whereas in the distal osteotomy, all 8 fixed-angle and none of 8 variable-angle constructs had articular failure. Conclusions: Variable-angle and fixed-angle volar locked fixation of unstable intra-articular distal radius fractures in fourth-generation composite radii provide mechanically sound constructs with high load to failure values and no loss of stiffness over testing. The variable-angle construct exhibited excellent resistance to articular stepoff at load to failure and no loss of stiffness throughout cyclic loading, and did not exhibit significantly less overall stiffness compared with fixed-angle constructs. The variable-angle fixation exhibited a distinct mechanical advantage over fixed-angle fixation in the setting of a smaller radial styloid fragment. Clinical relevance: Variable-angle constructs could be expected to hold up to standard loads in the postoperative period as well as traditional fixed-angle devices. The additional cost associated with variable-angle constructs may be warranted when treating distal radius fractures with radial styloid fragments, owing to the fragment-specific fixation allowed by customized screw placement.",
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Biomechanical analysis of a volar variable-angle locking plate : The effect of capturing a distal radial styloid fragment. / Stanbury, Spencer J.; Salo, Art; Elfar, John.

In: Journal of Hand Surgery, Vol. 37, No. 12, 01.12.2012, p. 2488-2494.

Research output: Contribution to journalArticle

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N2 - Purpose: Variable-angle volar locked constructs for distal radius fractures are a recent treatment addition. This study sought to biomechanically evaluate a variable-angle volar locking plate as compared with a fixed-angle construct. Methods: We created 2 different AO-C3 osteotomies in fourth-generation synthetic composite distal radiuses and labeled them proximal and distal. The distal osteotomy consisted of a smaller radial styloid fragment. We then fixed both sets of specimens with either a fixed-angle or variable-angle volar locking construct. We tested samples in axial compression with regard to cyclical loading and load to failure. Articular stepoff, stiffness, and load to failure data were then analyzed. Results: Neither the proximal nor the distal osteotomy groups showed articular failure after cyclic loading, significant loss of stiffness over cycling, or superior stiffness compared with the other. After load to failure in the proximal osteotomy, 1 of 8 fixed-angle and none of 8 variable-angle constructs had articular failure, whereas in the distal osteotomy, all 8 fixed-angle and none of 8 variable-angle constructs had articular failure. Conclusions: Variable-angle and fixed-angle volar locked fixation of unstable intra-articular distal radius fractures in fourth-generation composite radii provide mechanically sound constructs with high load to failure values and no loss of stiffness over testing. The variable-angle construct exhibited excellent resistance to articular stepoff at load to failure and no loss of stiffness throughout cyclic loading, and did not exhibit significantly less overall stiffness compared with fixed-angle constructs. The variable-angle fixation exhibited a distinct mechanical advantage over fixed-angle fixation in the setting of a smaller radial styloid fragment. Clinical relevance: Variable-angle constructs could be expected to hold up to standard loads in the postoperative period as well as traditional fixed-angle devices. The additional cost associated with variable-angle constructs may be warranted when treating distal radius fractures with radial styloid fragments, owing to the fragment-specific fixation allowed by customized screw placement.

AB - Purpose: Variable-angle volar locked constructs for distal radius fractures are a recent treatment addition. This study sought to biomechanically evaluate a variable-angle volar locking plate as compared with a fixed-angle construct. Methods: We created 2 different AO-C3 osteotomies in fourth-generation synthetic composite distal radiuses and labeled them proximal and distal. The distal osteotomy consisted of a smaller radial styloid fragment. We then fixed both sets of specimens with either a fixed-angle or variable-angle volar locking construct. We tested samples in axial compression with regard to cyclical loading and load to failure. Articular stepoff, stiffness, and load to failure data were then analyzed. Results: Neither the proximal nor the distal osteotomy groups showed articular failure after cyclic loading, significant loss of stiffness over cycling, or superior stiffness compared with the other. After load to failure in the proximal osteotomy, 1 of 8 fixed-angle and none of 8 variable-angle constructs had articular failure, whereas in the distal osteotomy, all 8 fixed-angle and none of 8 variable-angle constructs had articular failure. Conclusions: Variable-angle and fixed-angle volar locked fixation of unstable intra-articular distal radius fractures in fourth-generation composite radii provide mechanically sound constructs with high load to failure values and no loss of stiffness over testing. The variable-angle construct exhibited excellent resistance to articular stepoff at load to failure and no loss of stiffness throughout cyclic loading, and did not exhibit significantly less overall stiffness compared with fixed-angle constructs. The variable-angle fixation exhibited a distinct mechanical advantage over fixed-angle fixation in the setting of a smaller radial styloid fragment. Clinical relevance: Variable-angle constructs could be expected to hold up to standard loads in the postoperative period as well as traditional fixed-angle devices. The additional cost associated with variable-angle constructs may be warranted when treating distal radius fractures with radial styloid fragments, owing to the fragment-specific fixation allowed by customized screw placement.

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