BIOCHEMICAL FINITE ELEMENT ANALYSIS OF THE LOCKED KIRSCHNER WIRE SYSTEM VERSUS VOLAR PLATE FIXATION OF DISTAL RADIUS FRACTURE
Background: Volar locking plate (VP) and Kirschner wire (K-wire) fixations of distal end radius fractures are the most frequently used techniques that produce similar long term clinical results. However, inadequate fixation strength of the K-wire may cause pin loosening or migration. Although these complications can be prevented by immobilization, joint stiffness and a prolonged recovery period can occur.
Objective: Herein, a technique that provided more stability, allowing immediate motion after fixation by linking the K-wires into a single system (locked K-wire system) was proposed.
Methods: We evaluated biomechanical responses of the locked K-wire system and a VP in extraarticular distal radius fracture models AO/OTAa type 23A2 and 23A3 using three-dimensional finite element analysis. All models were tested under axial, bending, and torsional loads.
Results: From the simulation results, the total displacement was greater in the dorsal wedge fracture than that from the simple fracture under all loads for both fixation systems. The locked K-wire system and the VP could withstand immediate physiologic load with maximum displacements of 1.15 mm and 1.39 mm, respectively.
Conclusion: Considering the immediate physiologic load resistance and the ability to preserve its position during the bone-healing period, the locked K-wire system might be used as an alternative to fix distal radius fractures.
Sander AL, Leiblein M, Sommer K, Marzi I, Schneidmüller D, Frank J. Epidemiology and treatment of distal radius fractures: Current concept based on fracture severity and not on age. Eur J Trauma Emerg Surg 2020; 46: 585–90.
Chung KC and Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am 2001; 26: 908–15.
Koo OT, Tan DM and Chong AK. Distal radius fractures: An epidemiological review. Orthop Surg 2013; 5: 209–13.
Chaudhry H, Kleinlugtenbelt YV, Mundi R, Ristevski B, Goslings JC, Bhandari M. Are volar locking plates superior to percutaneous K-wires for distal radius fractures? A metaanalysis. Clin Orthop Relat Res 2015; 473: 3017–27.
Costa ML, Achten J, Parsons NR, Rangan A, Griffin D, Tubeuf S, et al. DRAFFT Study Group Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius: Randomised controlled trial. BMJ 2014; 349: g4807.
Youlden DJ, Sundaraj K, Smithers C. Volar locking plating versus percutaneous Kirschner wires for distal radius fractures in an adult population: A meta-analysis. ANZ J Surg 2019; 89: 821–826.
Downing ND, Karantana A. A revolution in the management of fractures of the distal radius? J Bone Joint Surg Br 2008; 90: 1271–75.
Zysk A, Lewis G. Finite element analysis study of prototype of a novel intramedullary injectable bioresorbable polymer fixator versus a volar plate for surgical treatment of distal radius fractures. World J Eng Technol 2017; 5: 648–67.
Satake H, Hanaka N, Honma R, Watanabe T, Inoue S, Kanauchi Y, et al. Complications of distal radius fractures treated by volar locking plate fixation. Orthopedics 2016; 39: e893–e896.
Stahl S, Schwartz O. Complications of K-wire fixation of fractures and dislocations in the hand and wrist. Arch Orthop Trauma Surg 2001; 121: 527–30.
Tubiana R. Early mobilization of fractures of the metacarpals and phalanges. Ann Chir Main 1983; 2: 293–97.
Lin CL, Lin YH, Chen AC. Buttressing angle of the double-plating fixation of a distal radius fracture: A finite element study. Med Biol Eng Comput 2006; 44: 665–73.
Cheng HY, Lin CL, Lin YH, Chao-Yu Chen A. Biomechanical evaluation of the modified double-plating fixation for the distal radius fracture. Clin Biomech 2007; 22: 510–17.
Trease C, McIff T, Toby EB. Locking versus nonlocking T-plates for dorsal and volar fixation of dorsally comminuted distal radius fractures: a biomechanical study. J Hand Surg Am 2005; 30: 756–63.
Brown CJ, Wang CJ, Yettramand AL, Procter P. Intramedullary nails with two lag screws. Clin Biomech 2004; 19: 519–25.
Aro HT, Chao EYS. Bone-healing patterns affected by loading, fracture fragment stability, fracture type, and fracture site compression. Clin Orthop Relat Res 1993; 293: 8–17.
Marshall, T, Momaya, A, Eberhardt, A, Chaudhari N, Hunt III, TR. Biomechanical comparison of volar fixed-angle locking plates for AO C3 distal radius fractures: titanium plates versus stainless steel with compression. J Hand Surg 2015; 40: 2032–2038.
Rogge RD, Adams BD, Goel VK. An analysis of bone stresses and fixation stability using a finite element model of simulated distal radius fractures. J Hand Surg 2002; 27: 86–92.
Lin Y, Sun MT, Chen AC, et al. Biomechanical analysis of volar and dorsal double locking plates for fixation in comminuted extra-articular distal radius fractures: A 3D finite element study. J Med Biol Eng 2012; 32: 349–56.
Osada D, Fujita S, Tamai K, Iwamoto A, Tomizawa K, Saotome K. Biomechanics in uniaxial compression of three distal radius volar plates. J Hand Surg Am 2004; 29: 446–51.
Shyamalan G, Theokli C, Pearse Y, Tennent D. Volar locking plates versus Kirschner wires for distal radial fractures - A cost analysis study. Injury 2009; 40: 1279–81.
Putnam MD, Meyer NJ, Nelson EW, Gesensway D, Lewis JL. Distal radial metaphyseal forces in an extrinsic grip model: Implications for postfracture rehabilitation. J Hand Surg 2000; 25: 469–75.
Jupiter JB. Complex articular fractures of the distal radius: Classification and management. J Am Acad Orthop Surg 1997; 5: 119–29.
Chao EY, Kasman RA, An KN. Rigidity and stress analysis of external fracture fixation devices - A theoretical approach. J Biomech 1982; 15: 971–83.
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