Purpose
Comminuted olecranon fractures are commonly fixed with posterior locking plates (PLPs).
Though biomechanically validated, this method comes with risks of symptomatic implant
prominence and wound breakdown. Dual locking plates (DLPs) placed on the medial and
lateral surfaces of the olecranon theoretically avoid these risks and allow for fixation
of proximal fracture fragments in multiple planes. A biomechanical comparison of DLP
and PLP fixation would help to validate the use of DLPs in comminuted olecranon fractures.
Methods
Seven matched pairs of cadaveric upper extremities were evaluated with quantitative
computed tomography scans to evaluate bone mineral density (BMD). Osteotomies simulating
comminuted olecranon fractures (Mayo Type IIB) were created and the specimens were
fixed either with variable angle PLPs or variable angle DLPs. The specimens were then
cyclically loaded and loaded to failure. The ultimate strength, fracture displacement,
and mechanism of failure were recorded and compared across groups. The correlation
between BMD and ultimate strength was analyzed.
Results
The mean total BMD was 0.79 g/cm2 (SD, 0.14 g/cm2). No specimen failed during cyclic testing. Five of 7 PLP specimens and 5 of 7 DLP
specimens failed by fracture through the proximal screws though in different planes
(sagittal vs axial splits, respectively). The mean ultimate strengths of the PLP (1077
N [SD, 462 N]) and DLP (1241 N [SD, 506 N]) groups were similar. There was a linear
relationship between ultimate strength and BMD (R2 = 0.33).
Conclusion
Dual locking plates display biomechanical properties that suggest that they can be
used in the fixation of comminuted olecranon fractures. Catastrophic failure of the
fixation constructs occurs around stress risers at the proximal screws rather than
due to displacement at the fracture itself.
Clinical relevance
Dual locking plate constructs can be considered for use in the fixation of comminuted
olecranon fractures.
Key words
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Article info
Publication history
Published online: January 12, 2022
Accepted:
July 29,
2021
Received:
July 2,
2020
Footnotes
Research support has been provided by Medartis and Zimmer Biomet in the form of surgical implants and instrumentation.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
