Onur HAPA, Ahmet KARAKASLİ, Cemal DİNCER, Vadym ZHAMİLOV, Mustafa GUVENCER, Hasan HAVİTCİOGLU

Koronoid kırıklarında önden arkaya başsız vida ile arkadan öne kortikal vida ile fiksasyonların biyomekanik olarak karşılaştırılması

Amaç: Posteriordan anteriora doğru vida ile tespit edilen koronoid kırıkları anteriordan posteriora doğru vida ile tespit edilen koronoid kırıklara göre daha güçlü tespit sağlar. Koronoid kırıklara anterior yaklaşımın redüksiyonu kolaylaştırdığı bilinmektedir. Çalışmanın hipotezi anteriordan posteriora doğru başsız vida (Acutrak®Mini 3.5 mm × 26 mm, Acumed, Oregon, USA) ile tespit edilen koronoid kırıklarının, posteriordan anteriora doğru kortikal vida (2.7-mm AO cortical screw) ile tespiti kadar güçlü olduğunun ispatlamasıdır.Çalışma planı: Çalışmada 14 tane erişkin kadavradan alınan ve formalin ile işlenmiş ulnalar kullanılmıştır. Koronoid kırıkları (tip 2) oluşturulduktan sonra randomize olarak anteriordan posteriora doğru başsız vida ile tespit edildi (antegrad grup) ve posteriordan anteriora doğru kortikal vida ile tespit edildi (retrograd grup). Yüklenmeler 2 mm’lik deplasman oluşturulana kadar yapıldı. Dayanma yükü (N), fiksasyon sertliği (N/mm–1) ve girinti (kemik) sertliği hesaplandı.Bulgular: Dayanma yükü retrograd tespit yapılan grupta anlamlı yüksek olarak saptandı (p=0.03), ama fiksasyon sertliği ve girinti sertliği kemik sertliği değerlerinde 2 grup arasında anlamlı bir fark saptanmadı (p>0.05).Çıkarımlar: Anteriordan posteriora doğru başsız vida ile koronoid kırıkların tespit yöntemi retrograd tepit yönteme göre avantajlı olmadığı görüldü. DOI: 10.3944/AOTT.2015.14.0183Bu özet, makalenin henüz redaksiyonu tamamlanmamış haline aittir ve bilgi verme amaçlıdır. Yayın aşamasında değişiklik gösterebilir.

Anahtar Kelimeler:

Koronoid kırıkları; tespit; başsız vida.

Biomechanical comparison of headless antegrade screw versus retrograde cortical screw for coronoid fracture fixation

Objective: Posterior-to-anterior directed screws are stronger than anterior-to-posterior directed screws for coronoid fracture fixation. Anterior approaches that facilitate direct reduction and fixation of coronoid fractures have been described. The present study was based on the hypothesis that anterior-to-posterior headless screw (Acutrak Mini® 3.5 mm × 26 mm, Acumed, Hillsboro, Oregon, USA) fixation of coronoid fractures would be as strong as posterior-to-anterior 2.7 mm Association for Osteosynthesis (AO) cortical screw fixation.Methods: This study included 14 ulnas obtained from 14 formalin-preserved adult cadavers. Coronoid type 2 fractures were created and fixed randomly using anterior-to-posterior headless screws (antegrade group) and posterior-to-anterior 2.7 mm AO cortical screws (retrograde group). The experimental constructs were loaded until 2 mm of displacement. Failure load (N), fixation stiffness (Nmm–1), and indentation stiffness were calculated.Results: Failure load was higher in the retrograde screw group (p=0.03), whereas loading stiffness values of the fixation devices and bones did not differ between the 2 fixation groups (p>0.05).Conclusion: The present study failed to show that anterior-to-posterior directed headless screw fixation of coronoid fractures could adequately replace posterior-to-anterior placed screw fixation.

Keywords:

Coronoid fracture, fixation headless screw,

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