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Biomechanischer Vergleich sechs verschiedener Fixationstechniken zur Versorgung von Halsfrakturen der Metakarpale

Biomechanical comparison of six different fixation techniques for treatment of metacarpal neck fractures

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Zusammenfassung

Zielsetzung

Ziel dieser Studie war es, die Primärstabilität etablierter Fixierungstechniken zur Versorgung von Halsfrakturen der Metakarpale auszuwerten und mit der Primärstabilität eines innovativen Osteosyntheseverfahrens zu vergleichen: IlluminOss™, das fotodynamische System zur Knochenstabilisierung.

Material und Methode

Durch Osteotomie mit einer Bandsäge wurden Halsfrakturen der Metakarpale (MK) an 24 aus frisch gefrorenen menschlichen Kadavern entnommenen MK II–V herbeigeführt. Die Präparate wurden einer von insgesamt 6 Gruppen randomisiert zugeteilt: Versorgung mit (1) K‑Draht-Osteosynthese, (2) dorsaler Plattenosteosynthese, (3) externer Fixierung, (4) gekreuzter K‑Draht-Spickung, (5) IlluminOss™ und (6) verriegeltem IlluminOss™. In jeder Gruppe wurden jeweils 16 Präparate entweder mono- oder polyzyklischen Belastungsprotokollen unterzogen.

Ergebnisse

Während der monozyklischen Belastung versagte keines der Präparate vor der maximalen Verformung von 3 mm. Bei der intramedullären K‑Draht-Osteosynthese waren die mittleren Lasten signifikant niedriger als die anderer Techniken. Mittlere Lasten, die eine Verformung von 2 mm bei externer Fixierung verursachten, waren signifikant niedriger als jene mit dorsaler Plattenosteosynthese. Die mittlere lineare Steifigkeit der K‑Draht-Osteosynthese war signifikant niedriger als bei den anderen Fixierungstechniken, und jene der externen Fixierung war signifikant niedriger als bei dorsalen Platten. Im Hinblick auf die lineare Steifigkeit zwischen den Gruppen mit dorsaler Platte, Fragment-Fixation-System (FFS), IlluminOss™ bzw. verriegeltem IlluminOss™ zeigte sich kein signifikanter Unterschied.

Während der polyzyklischen Testung fiel der Widerstandsverlust bei der dorsalen Plattenosteosynthese signifikant geringer aus als bei der K‑Draht- bzw. IlluminOss™-Fixierung. Beim Widerstandsverlust zeigten sich zwischen dorsaler Plattenosteosynthese, externer Fixierung, FFS und verriegelter IlluminOss™-Fixierung keine signifikanten Unterschiede.

Schlussfolgerung

Schlussfolgernd kann festgestellt werden, dass IlluminOss™ als intramedulläres Stabilisationssystem zur Versorgung von Halsfrakturen der MK eingesetzt werden kann. In Kombination mit Verriegelungsschrauben sind die biomechanischen Eigenschaften von IlluminOss™ mit denen anderer Fixierungstechniken vergleichbar.

Abstract

Purpose

The purpose of this study was to evaluate the primary stability of commonly used fixation techniques for metacarpal neck fractures and to compare it with that of an innovative osteosynthesis device: IlluminOss™, the photodynamic bone stabilization system™.

Material and methods

Metacarpal neck fractures were created on the second to fifth metacarpal bones of 24 freshly frozen human cadavers using a band saw. Specimens were randomly assigned to one of six groups and treated with (1) K-wire fixation, (2) dorsal plating, (3) external fixation, (4) cross-threaded K‑wire fixation, (5) IlluminOss™ and (6) locked IlluminOss™. In each group 16 specimens each underwent either monocyclic or polycyclic loading protocols.

Results

During monocyclic loading none of the specimens failed prior to a maximum deformation of 3 mm. With intramedullary K‑wire fixation the mean loads were significantly lower than those of the other techniques. Mean loads causing 2 mm deformation with external fixation were significantly lower than those with dorsal plate osteosynthesis. The mean linear stiffness of the K‑wire osteosynthesis was significantly lower than for the other fixation techniques and all methods of external fixation were significantly lower than dorsal plates. There were no significant differences with respect to the linear stiffness between the groups with dorsal plates, fragment fixation system (FFS), IlluminOss™ and locked IlluminOss™. During polycyclic testing the loss of resistance in dorsal plate osteosynthesis was significantly lower than with K‑wire and IlluminOss™ fixation. No significant differences in loss of resistance could be shown between dorsal plate osteosynthesis, external fixation, FFS and locked IlluminOss™.

Conclusion

In summary, IlluminOss™ can be used as an intramedullary stabilization system for treatment of metacarpal neck fractures. In combination with locking screws the biomechanical characteristics of IlluminOss™ are comparable to the other fixation techniques.

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Authors and Affiliations

  1. Klinik für Unfall- und Wiederherstellungschirurgie, Handchirurgie und Orthopädie, St. Vinzenz-Hospital, Köln, Deutschland

    S. Gick & D. Pennig

  2. Klinik für Orthopädie und Unfallchirurgie, Medizinische Fakultät, Universitätsklinikum Köln, Köln, Deutschland

    J. Oppermann

  3. Fachklinik für Orthopädie, STENUM Ortho GmbH, Ganderkesee, Deutschland

    I. Owerst

  4. Klinik für Orthopädie, St. Josefs-Hospital Wiesbaden, Wiesbaden, Deutschland

    J. Dargel

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  4. D. Pennig
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Correspondence to S. Gick.

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Interessenkonflikt

S. Gick, J. Oppermann, I. Owerst, D. Pennig und J. Dargel, ihre nächsten Familienangehörigen sowie jede Forschungsstiftung, mit der sie verbunden sind, haben keine finanziellen Zahlungen oder andere Vorteile von einem gewerblichen Unternehmen erhalten, die mit dem Gegenstand dieses Artikels zusammenhängen.

Alle beschriebenen Untersuchungen am Menschen oder an menschlichem Gewebe wurden mit Zustimmung der zuständigen Ethikkommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Die Untersuchungen erfolgten unter Einhaltung der Vorgaben der Zentralen Ethikkommission der Bundesärztekammer.

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Gick, S., Oppermann, J., Owerst, I. et al. Biomechanischer Vergleich sechs verschiedener Fixationstechniken zur Versorgung von Halsfrakturen der Metakarpale. Unfallchirurg 122, 587–595 (2019). https://doi.org/10.1007/s00113-019-0671-3

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