Universität zu Köln

Wegmann, K., Engel, K., Skouras, E., Hackl, M., Mueller, L. P., Hopf, J. C. and Koslowsky, T. C. (2016). Reconstruction of Monteggia-like proximal ulna fractures using different fixation devices: A biomechanical study. Injury-Int. J. Care Inj., 47 (8). S. 1636 - 1642. OXFORD: ELSEVIER SCI LTD. ISSN 1879-0267

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Abstract

Background: Comminuted proximal ulna fractures are rare and reconstruction of these fractures is discussed controversially. The aim of this study was to test three currently available plate devices in a standardized comminuted four-part fracture model created in proximal ulna sawbones. Material and methods: A standardized four-part fracture of the proximal ulna was created in 80 sawbones. Reconstruction was performed by five experienced test surgeons according to a standardized reconstruction protocol. Each surgeon reconstructed 4 fractures with a 3.5 mm eight-hole reconstruction plate, 4 fractures with seven-hole third-tubular double plates and 4 fractures with a 3.5 mm anatomical seven-hole locked angle proximal ulna plate. 4 more fractures were reconstructed with simple K-wires as a reference construct for further experiments. Outcome measurements were time for reconstruction, quality of reconstruction and stability of the reconstruction. Stability testing was done in 90 degrees and 30 degrees flexion of the elbow. Testing in 30 degrees flexion was done to test the anteroposterior stability regarding the fixed coronoid process. Results: Time for reconstruction was significantly less for K-wire fixation than for the plate devices. Time for reconstruction plating and locked angle plating was significantly lower than for double plating (p < 0.005). Quality of reduction did not differ between the three plate systems (p < 0.05). K-wire fixation showed the best quality of reduction (p < 0.005). In 90 degrees of elbow flexion the anatomic locked angle olecranon plate showed a significantly higher stability compared to the other devices. Furthermore the tubular double plating was significantly more stable than reconstruction plating or K-wire fixation (p < 0.05). In anteroposterior loading at 30 degrees, the stability did not differ between the 4 different fixation techniques (p > 0.05). For all devices the testing in 30 degrees flexion showed a significantly higher rigidity compared to 90 degrees flexion. Conclusion: The locked angle plate system showed the highest stability in 90 degrees of elbow flexion. Each implant was more stable in 30 degrees flexion than in 90 degrees flexion. Testing of the anterior stability of the elbow did not show any differences between the different implants. Because of the superior stability of this device, we conclude that locked angle plating should be preferred for reconstruction of monteggia like complex proximal ulna fractures. (C) 2016 Elsevier Ltd. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Wegmann, K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Engel, K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Skouras, E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hackl, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, L. P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hopf, J. C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Koslowsky, T. C. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-268202
DOI:	10.1016/j.injury.2016.05.010
Journal or Publication Title:	Injury-Int. J. Care Inj.
Volume:	47
Number:	8
Page Range:	S. 1636 - 1642
Date:	2016
Publisher:	ELSEVIER SCI LTD
Place of Publication:	OXFORD
ISSN:	1879-0267
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language COMMINUTED OLECRANON FRACTURES; LOCKING PLATE FIXATION Multiple languages Critical Care Medicine; Emergency Medicine; Orthopedics; Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/26820