Comparison of 3 Methods for Maintaining Inter-Fragmentary Compression after Fracture Reduction and Fixation

Brigham Au, John Groundland, T. Kyle Stoops, Brandon G. Santoni, H. Claude Sagi

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: It is recommended that the intra-Articular component of a supracondylar distal femoral fracture be stabilized by a lag screw to create interfragmental compression. Generally, it is thought that lag screw fixation should precede any positional screw or locking screw application. This study compared 3 methods of maintaining interfragmentary compression after fracture reduction with a reduction clamp. Methods: Intra-Articular vertical split fractures were created in synthetic femora. A force transducer was interposed between the medial and lateral condyles and 20 lbs of compression was applied to the fracture with a reduction clamp. 3.5-mm cortical lag screws (group 1), 3.5-mm cortical position screws (group 2), and 5.4-mm distal locking screws through a distal femur locking plate (group 3) were placed across the fracture (n = 4/group). After screw placement, the clamp was removed and the amount of residual interfragmentary compression was recorded. After 2 minutes, a final steady-state force was measured and compared across groups. Results: Locking screws placed through the plate (group 3) maintained 27% of the initial force applied by the clamp (P = 0.043), whereas positional screws (group 2) maintained 90% of the initial force applied by the clamp (P = 0.431). The steady-state compression force measured with lag screws (group 1) increased by 240% (P = 0.030) relative to the initial clamp force. The steady-state force in the lag screw group was significantly greater than groups 1 and 2 (P = 0.012). Conclusions: When reducing intra-Articular fractures and applying interfragmentary compression with reduction clamps, additional lag screws increase the amount of compression across the fracture interface. Compressing a fracture with reduction clamps and relying on locking screws to maintain the compression result in a loss of interfragmentary compression and should be avoided. This study lends biomechanical support that lag screws placed outside of the plate before locking screws for fracture fixation help maintain optimal interfragmentary compression.

Original languageEnglish (US)
Pages (from-to)210-214
Number of pages5
JournalJournal of Orthopaedic Trauma
Volume31
Issue number4
DOIs
StatePublished - Apr 1 2017

Fingerprint

Compression Fractures
Fracture Fixation
Femur
Joints
Intra-Articular Fractures
Femoral Fractures
Transducers
Bone and Bones

Keywords

  • biomechanics
  • interfragmentary compression
  • lag screw
  • locking screw
  • position screw
  • supracondylar distal femur fracture

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Comparison of 3 Methods for Maintaining Inter-Fragmentary Compression after Fracture Reduction and Fixation. / Au, Brigham; Groundland, John; Stoops, T. Kyle; Santoni, Brandon G.; Claude Sagi, H.

In: Journal of Orthopaedic Trauma, Vol. 31, No. 4, 01.04.2017, p. 210-214.

Research output: Contribution to journalArticle

Au, Brigham ; Groundland, John ; Stoops, T. Kyle ; Santoni, Brandon G. ; Claude Sagi, H. / Comparison of 3 Methods for Maintaining Inter-Fragmentary Compression after Fracture Reduction and Fixation. In: Journal of Orthopaedic Trauma. 2017 ; Vol. 31, No. 4. pp. 210-214.
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abstract = "Objectives: It is recommended that the intra-Articular component of a supracondylar distal femoral fracture be stabilized by a lag screw to create interfragmental compression. Generally, it is thought that lag screw fixation should precede any positional screw or locking screw application. This study compared 3 methods of maintaining interfragmentary compression after fracture reduction with a reduction clamp. Methods: Intra-Articular vertical split fractures were created in synthetic femora. A force transducer was interposed between the medial and lateral condyles and 20 lbs of compression was applied to the fracture with a reduction clamp. 3.5-mm cortical lag screws (group 1), 3.5-mm cortical position screws (group 2), and 5.4-mm distal locking screws through a distal femur locking plate (group 3) were placed across the fracture (n = 4/group). After screw placement, the clamp was removed and the amount of residual interfragmentary compression was recorded. After 2 minutes, a final steady-state force was measured and compared across groups. Results: Locking screws placed through the plate (group 3) maintained 27{\%} of the initial force applied by the clamp (P = 0.043), whereas positional screws (group 2) maintained 90{\%} of the initial force applied by the clamp (P = 0.431). The steady-state compression force measured with lag screws (group 1) increased by 240{\%} (P = 0.030) relative to the initial clamp force. The steady-state force in the lag screw group was significantly greater than groups 1 and 2 (P = 0.012). Conclusions: When reducing intra-Articular fractures and applying interfragmentary compression with reduction clamps, additional lag screws increase the amount of compression across the fracture interface. Compressing a fracture with reduction clamps and relying on locking screws to maintain the compression result in a loss of interfragmentary compression and should be avoided. This study lends biomechanical support that lag screws placed outside of the plate before locking screws for fracture fixation help maintain optimal interfragmentary compression.",
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AB - Objectives: It is recommended that the intra-Articular component of a supracondylar distal femoral fracture be stabilized by a lag screw to create interfragmental compression. Generally, it is thought that lag screw fixation should precede any positional screw or locking screw application. This study compared 3 methods of maintaining interfragmentary compression after fracture reduction with a reduction clamp. Methods: Intra-Articular vertical split fractures were created in synthetic femora. A force transducer was interposed between the medial and lateral condyles and 20 lbs of compression was applied to the fracture with a reduction clamp. 3.5-mm cortical lag screws (group 1), 3.5-mm cortical position screws (group 2), and 5.4-mm distal locking screws through a distal femur locking plate (group 3) were placed across the fracture (n = 4/group). After screw placement, the clamp was removed and the amount of residual interfragmentary compression was recorded. After 2 minutes, a final steady-state force was measured and compared across groups. Results: Locking screws placed through the plate (group 3) maintained 27% of the initial force applied by the clamp (P = 0.043), whereas positional screws (group 2) maintained 90% of the initial force applied by the clamp (P = 0.431). The steady-state compression force measured with lag screws (group 1) increased by 240% (P = 0.030) relative to the initial clamp force. The steady-state force in the lag screw group was significantly greater than groups 1 and 2 (P = 0.012). Conclusions: When reducing intra-Articular fractures and applying interfragmentary compression with reduction clamps, additional lag screws increase the amount of compression across the fracture interface. Compressing a fracture with reduction clamps and relying on locking screws to maintain the compression result in a loss of interfragmentary compression and should be avoided. This study lends biomechanical support that lag screws placed outside of the plate before locking screws for fracture fixation help maintain optimal interfragmentary compression.

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