Skip to main content

Advertisement

Log in

Unicortical PEEK inset locking fixation for metacarpal fractures: a biomechanical study

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

There are numerous constructs employed in the treatment of metacarpal fractures with varying degrees of success. While plate fixation commonly involves dorsal application of a bicortical non-locking plate, there has been recent exploration of other fixation options including unicortical locked plating. The purpose of this study was to evaluate the biomechanical integrity of a polyetheretherketone (PEEK) inset locking plate and, in doing so, compare it to standard plate fixation (utilizing a clinically proven bicortical non-locking titanium plate) in a simulated porcine metacarpal fracture model.

Methods

Reproducible mid-shaft fractures were created in porcine second metacarpals. The fractured specimens were reduced and plated with either a bicortical non-locking plate or a unicortical locking plate with a PEEK locking design. Constructs were then loaded to failure in the same fashion as performed to create the fracture. Peak load was measured as the apex on the load-to-failure deflection curve. Stiffness was calculated as the linear slope on the load-to-failure deflection curve. Data were analyzed via Student’s t test.

Results

Unicortical locking constructs failed at 344 ± 119 N, while bicortical non-locking constructs were found to fail at 277 ± 101 N (p = 0.19). The unicortical locking constructs demonstrated a stiffness of 80 ± 36 N/mm compared with the bicortical non-locking constructs (69 ± 36 N/mm) although again the difference was not found to be statistically different (p = 0.49).

Conclusion

Based on this study, a locked plating construct using a polymer mechanism provides an interesting new locking fixation method for small bone fractures and with our limited number of specimens tested, provided at least a similar strength and rigidity profile in comparison with bicortical fixation in the treatment of metacarpal fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Fusetti C, Meyer H, Borish N, Stern R, Santa DD, Papaloizos M (2002) Complications of plate fixation in metacarpals. J Trauma 52(3):535–539

    Article  PubMed  Google Scholar 

  2. Perren SM (2002) Evolution of the internal fixation of long bone fractures. The scientific basis of biologic internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 84(8):1093–1110

    Article  PubMed  Google Scholar 

  3. Gautier E, Perren SM, Cordey J (2000) Effect of plate position relative to bending direction on the rigidity of a plate osteosynthesis. A theoretical analysis. Injury 31(suppl 3):C14–C20

    Article  PubMed  Google Scholar 

  4. Egol KA, Kubiak EN, Fulkerson E, Kummer FJ (2004) Biomechanics of locked plates and screws. J Orthop Trauma 18:488–493

    Article  PubMed  Google Scholar 

  5. Strauch RJ, Rosenwasser MP, Lunt JG (1998) Metacarpal shaft fractures: the effect of shortening on the extensor tendon mechanism. J Hand Surg Am 23(3):519–523

    Article  CAS  PubMed  Google Scholar 

  6. Ruchelsman DE, Mudgal CS, Jupiter JB (2010) The role of locking technology in the hand. Hand Clin 26(3):307–319

    Article  PubMed  Google Scholar 

  7. Kurtz SM, Devine JN (2007) PEEK biomaterials in trauma, orthopaedic, and spinal implants. Biomaterials 28(32):4845–4869

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Horn J, Linke B, Hontzsch D, Gueorquiev B, Schweiger K (2009) Angle stable interlocking screws improve construct stability of intramedullary nailing of distal tibia fractures: a biomechanical study. Injury 40(7):767–771

    Article  CAS  PubMed  Google Scholar 

  9. Ochman S, Doht S, Paletta J, Langer M, Raschke MJ, Meffert RH (2010) Comparison between locking and non-locking plates for fixation of metacarpal fractures in an animal model. Hand Surg Am 35(4):597–603

    Article  Google Scholar 

  10. Page SM, Stern PJ (1998) Complications and range of motion following plate fixation of metacarpal and phalangeal fractures. J Hand Surg Am 23(5):827–832

    Article  CAS  PubMed  Google Scholar 

  11. Doht S, Jansen H, Meffert R, Frey S (2012) Higher stability with locking plates in hand surgery? Biomechanical investigation of the TriLock system in a fracture model. Int Orthop 36(8):1641–1646

    Article  PubMed Central  PubMed  Google Scholar 

  12. Gajendran VK, Szabo RM, Myo GK, Curtiss SB (2009) Biomechanical comparison of double-row locking plates versus single- and double-row non-locking plates in a comminuted metacarpal fracture model. J Hand Surg Am 34(10):1851–1858

    Article  PubMed  Google Scholar 

  13. Hoffmeier KL, Hoffman GO, Muckley T (2009) The strength of polyaxial locking interfaces of distal radius plates. Clin Biomech (Bristol, Avon) 24(8):637–641

    Article  Google Scholar 

  14. Cordey J, Borgeaud M, Perren SM (2000) Force transfer between the plate and the bone: relative importance of the bending stiffness of the screws friction between the plate and bone. Injury 31(suppl 3):C21–C28

    Article  PubMed  Google Scholar 

  15. Hallab NJ, McAllister K, Brady M, Jarman-Smith M (2011) Macrophage reactivity to different polymers demonstrates particle size-and material-specific reactivity: PEEK-OPTIMA® particles versus UHMWPE particles in the submicron, micron, and 10 micron size ranges. J Biomed Mater Res B Appl Biomater. E. pub Nov 21

  16. Rhee PC, Kakar S, Shin AY (2012) Four corner arthrodesis with a locking, dorsal circular polyether-ether ketone (PEEK-Optima) Plate. Tech Hand Up Extrem Surg 16(4):236–241

    Article  PubMed  Google Scholar 

  17. Kraisarin J, Dennison DG, Berglund LJ, An KN, Shin AY (2011) Biomechanical comparison of three fixation techniques used for four corner arthrodesis. J Hand Surg Eur 36(7):560–567

    Article  CAS  Google Scholar 

  18. Ochman S, Vordemvenne T, Paletta J, Raschke MJ, Meffert RH, Doht S (2011) Experimental fracture model versus osteotomy model in metacarpal bone plate fixation. Sci World J 11:1692–1698

    Article  CAS  Google Scholar 

Download references

Acknowledgments

Hardware for this study was provided by TriMed, Inc., Santa Clarita, CA. Dr. Isaacs has received consultant fees and travel expenses from TriMed, Inc. Partial financial support was received from the Richmond Eye and Ear Healthcare Alliance Research and Education Fund.

Conflict of interest

Dr. Mudrick reports non-financial support from TriMed, during the conduct of the study. Dr. Isaacs reports personal fees from TriMed, during the conduct of the study; personal fees from TriMed, outside the submitted work. Dr. Wayne has nothing to disclose. Mr. Owen has nothing to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jonathan E. Isaacs.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mudrick, C.A., Owen, J.R., Wayne, J.S. et al. Unicortical PEEK inset locking fixation for metacarpal fractures: a biomechanical study. Eur J Orthop Surg Traumatol 24, 1415–1420 (2014). https://doi.org/10.1007/s00590-013-1322-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-013-1322-y

Keywords

Navigation