Comparison of biomechanical stability of plate and screw fixation with tension band wiring and lag screw in ulnar styloid fractures: a cadaver test

Abstract

Background: The management of ulnar styloid is often not appreciated in comparison to its larger counterpart, the radius. There are several surgical treatment recommendations such as fixation with tension band fixation or lag screw compression, and relative techniques, i.e., osteosynthesis with plates and screws. Each technique has their own advantages and disadvantages. Therefore, the researchers require scientific data that compares the three techniques biomechanically. Purpose: To evaluate the biomechanical stability of fixation with tension band wiring, lag screw compression, and plate and screw osteosynthesis. Method: Samples were randomly divided into three groups, i.e., P1 group (tension band wiring), P2 group (lag screw), and P3 group (plate and screw) and each group consisted of nine ulna bones. The fixation of the fracture fragments was completed using tension band wiring, lag screw, and plate and screw fixation. The biomechanical test is used to determine the stability of the three groups of fixation techniques. ANOVA test is used to determine the differences between each group. Result: The statistical calculation with the ANOVA test suggested that the tensile test with 150 N force results in significantly different results between fixation groups in the 10-time tensile test (p = 0.00), 20-time tensile test (p = 0.00), 50-time tensile test (p = 0.001), and 100-time tensile test (p = 0.00). This result indicates that biomechanically fixation with plate and screw is the stablest. Conclusion: Mechanically, plate and screw fixation are stabler than tension band wiring and lag screw compression in ulnar styloid fractures.

References

  • Blom, A., Warwick, D., & Whitehouse, M. (Eds.). (2017). Apley & solomon’s system of orthopaedics and trauma. CRC Press.
  • Chen, A. C. Y., Chiu, C. H., Weng, C. J., Chang, S. S., & Cheng, C. Y. (2018). Early and late fixation of ulnar styloid base fractures yields different outcomes. Journal of orthopaedic surgery and research, 13(1), 193.
  • Gogna, P., Selhi, H. S., Mohindra, M., Singla, R., Thora, A., & Yamin, M. (2014). Ulnar styloid fracture in distal radius fractures managed with volar locking plates: to fix or not?. Journal of hand and microsurgery, 6(2), 53-58.
  • Krämer, S., Meyer, H., O’Loughlin, P. F., Vaske, B., Krettek, C., & Gaulke, R. (2013). The incidence of ulnocarpal complaints after distal radial fracture in relation to the fracture of the ulnar styloid. Journal of Hand Surgery (European Volume), 38(7), 710-717.
  • Logan, A. J., & Lindau, T. R. (2008). The management of distal ulnar fractures in adults: a review of the literature and recommendations for treatment. Strategies in trauma and limb reconstruction, 3(2), 49-56.
  • Marsell, R., & Einhorn, T. A. (2011). The biology of fracture healing. Injury, 42(6), 551-555.
  • Meluzinová, P., Kopp, L., Dráč, P., Edelmann, K., & Obruba, P. (2017). Comparison of Short-Therm Results of Conservative versus Operative Treatment of Distal Ulna Fractures Associated with Distal Radius Fracture Treated by Plate Osteosynthesis. Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca, 84(3), 182-188.
  • Miller, M. D., & Hart, J. A. (2008). Review of orthopaedics. Philadelphia, PA: Saunders.
  • Mullett, H., Brannigan, R., & Fitzpatrick, D. (2004, February). Ulna styloid fracture fixation–a biomechanical study. In Orthopaedic Proceedings (Vol. 86, No. SUPP_II, pp. 121-121). The British Editorial Society of Bone & Joint Surgery.
  • Nunez Jr, F. A., Luo, T. D., & Nunez Sr, F. A. (2017). Treatment of symptomatic non-unions of the base of the ulnar styloid with plate osteosynthesis. Journal of Hand Surgery (European Volume), 42(4), 382-388.
  • Nyary, T., & Scammell, B. E. (2018). Principles of bone and joint injuries and their healing. Surgery (Oxford), 36(1), 7-14.
  • Patel, M., Latkar, C., Patil, S.(2018). Fixation Versus Conservative Treatment for Ulnar Styloid Fracture and Its Functional Outcome. Int J Sci Res.;6(4).
  • Qulub, F., Widiyanti, P., & Ady, J. (2016). Synthesis and Characterization of Composite Poly (1.8 Octanediol-co-Citrate)(POC)/Nano-Hydroxyapatite as Candidate Biodegradable Bone Screw. In Journal of Biomimetics, Biomaterials and Biomedical Engineering (Vol. 27, pp. 36-43). Trans Tech Publications Ltd.
  • Sammer, D. M., Shah, H. M., Shauver, M. J., & Chung, K. C. (2009). The effect of ulnar styloid fractures on patient-rated outcomes after volar locking plating of distal radius fractures. The Journal of hand surgery, 34(9), 1595-1602.
  • Shokanov, A. K., Vereshchak, M. F., Kulbekov, M. K., Manakova, I. A., Zh, H. S., & Smikhan, Y. A. (2018). Mössbauer Research of Surface-Surface Concentric-Zonal Color Effects in Zoloceramic Materials. International Journal of Geography and Geology, 7(3), 45-55.

License

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.