Development and biomechanical study of anatomical locking plate of sternoclavicular joint_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Kun ¹ ,  YANG Yunkang ² , GE Jianhua ² , LI Gen ¹ , WU Tianhao ¹ , BAI Rui ³ , XIANG Feifan ³ , SUN Yuanlin ³

1. Department of Orthopedics, Luzhou People’s Hospital, Luzhou Sichuan, 646000, P.R.China;
2. Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;
3. Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding?author：

YANG Yunkang, Email: droyyk@163.com

Keywords：

Sternoclavicular joint dislocation; internal fixation; anatomical plate; biomechanics

DOI：

10.7507/1002-1892.201705094

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Objective To develop an anatomical locking plate in accordance with the anatomical characteristics of the sternoclavicular joint, which is reliable fixation and easy to operate, so as to provide an ideal internal fixation device for the treatment of sternoclavicular joint dislocation or peripheral fractures. Methods Gross measurement and CT measurement were performed on the 8 adult antiseptic and moist cadaver specimens (16 sides) to measure the parameters of surrounding bone structure of the sternoclavicular joint. The parameters included the thickness of presternum, sternal notch width, anteroposterior diameter of proximal 1/3 of clavicle, upper and lower diameters of proximal 1/3 of clavicle, angle between proximal end of clavicle and presternum in coronal plane, and angle of thoracoclavicular joint at anatomic position forward. According to the anatomical parameters and biomechanical properties of the specimens, the anatomical locking plate was designed and developed. The sternoclavicular ligament and joint capsule of all the specimens were completely cut off to make the sternoclavicular joint dislocation model. The left and right sternoclavicular joint of each specimen were randomly divided into experimental group (anatomic locking plate fixation) and control group (oblique T shape locking plate fixation). The sternoclavicular joint activity and common force mechanism was simulated on the universal mechanical testing machine, and the clavicular distal load test, sternoclavicular joint torsion test, and anti-pulling of steel plate manubrium part test were performed. Results The differences between the anatomical parameters of gross measurement and CT measurement were not significant (P>0.05). In the clavicular distal load test, when the anatomical position perpendicular to the distal clavicle back loading to 20 N, the displacement of loading point in the experimental group was (8.455±0.981) mm, which was significantly less than that in control group [(10.163±1.379) mm] (t=–3.012,P=0.020); the distal clavicle displacement of loading point of experimental group and control group were (5.427±1.154) mm and (6.393±1.040) mm, respectively, showing no significant difference (t=–1.459, P=0.188). In the sternoclavicular joint torsion test, the torque of experimental group was significantly greater than that of control group when the clockwise torsion angle was at 2, 4, 6, 8, and 10 degrees and the counterclockwise torsion angle was at 4, 6, 8, and 10 degrees (P<0.05). The torsional stiffness in the experimental group under clockwise and counterclockwise condition was 0.122 and 0.108 N·m/° respectively, which were significantly higher than those in the control group (0.083 and 0.078 N·m/° respectively) (F=67.824, P=0.000; F=20.992, P=0.002). In the anti-pulling of steel plate manubrium part test, the maximum pullout force of experimental group [(225.24±16.02) N] was significantly higher than that in control group [(174.40±21.90) N] (t=5.785, P=0.001). Conclusion The new type of anatomical locking plate can realize the sternoclavicular joint three-dimensional fixation, and has the advantages of reliable fixation, simple operation, less trauma, superior biomechanical properties, and earlier functional exercise. It may be an ideal internal fixation device in clinical treatment of sternoclavicular joint dislocation or peripheral fractures.

Citation： YANG Kun, YANG Yunkang, GE Jianhua, LI Gen, WU Tianhao, BAI Rui, XIANG Feifan, SUN Yuanlin. Development and biomechanical study of anatomical locking plate of sternoclavicular joint. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(1): 7-13. doi: 10.7507/1002-1892.201705094 Copy

1.	Kirby JC, Edwards E, Kamali Moaveni A. Management and functional outcomes following sternoclavicular joint dislocation. Injury, 2015, 46(10): 1906-1913.
2.	Bourghli A, Fabre A. Proximal end clavicle fracture from a parachute jumping injury. Orthop Traumatol Surg Res, 2012, 98(2): 238-241.
3.	Low AK, Duckworth DG, Bokor DJ. Operative outcome of displaced medial-end clavicle fractures in adults. J Shoulder Elbow Surg, 2008, 17(5): 751-754.
4.	Celestre P, Roberston C, Mahar A, et al. Biomechanical evaluation of clavicle fracture plating techniques: does a locking plate provide improved stability? J Orthop Trauma, 2008, 22(4): 241-247.
5.	董加純, 支中正, 顏冰珊, 等. 鋼纜內固定鎖骨近段和胸骨髓腔修復胸鎖關節脫位: 解剖與臨床. 中國組織工程研究, 2014, 18(4): 583-588.
6.	Renfree KJ, Wright TW. Anatomy and biomechanics of the acromioclavicular and sternoclavicular joints. Clin Sports Med, 2003, 22(2): 219-237.
7.	王亦聰. 骨與關節損傷. 4版. 北京: 人民衛生出版社, 2007: 770-772.
8.	Wirth MA, Rockwood CA Jr. Acute and Chronic Traumatic Injuries of the Sternoclavicular Joint. J Am Acad Orthop Surg, 1996, 4(5): 268-278.
9.	Buckerfield CT, Castle ME. Acute traumatic retrosternal dislocation of the clavicle. J Bone Joint Surg (Am), 1984, 66(3): 379-385.
10.	Yeh GL, Williams GR JR. Conservative management of sternoclavicular injuries. Orthop Clin North Am, 2000, 31(2): 189-203.
11.	Robinson CM, Jenkins PJ, Markham PE, et al. Disorders of the sternoclavicular joint. J Bone Joint Surg (Br), 2008, 90(6): 685-696.
12.	Rockwood CA Jr, Groh GI, Wirth MA, et al. Resection arthroplasty of the sternoclavicular joint. J Bone Joint Surg (Am), 1997, 79(3): 387-393.
13.	Van Tongel A, De Wilde L. Sternoclavicular joint injuries: a literature review. Muscles Ligaments Tendons J, 2011, 1(3): 100-105.
14.	戚盈杰, 胡月正, 余華晨, 等. 克氏針加張力帶鋼絲內固定治療胸鎖關節脫位. 中國骨與關節損傷雜志, 2011, 26(9): 824-825.
15.	Groh GI, Wirth MA, Rockwood CA Jr. Treatment of traumatic posterior sternoclavicular dislocations. J Shoulder Elbow Surg, 2011, 20(1): 107-113.
16.	Waters PM, Bae DS, Kadiyala RK. Short-term outcomes after surgical treatment of traumatic posterior sternoclavicular fracture-dislocations in children and adolescents. J Pediatr Orthop, 2003, 23(4): 464-469.
17.	Adamcik S, Ahler M, Gioutsos K, et al. Repair of sternoclavicular joint dislocations with FiberWire (R). Arch Orthop Trauma Surg, 2017, 137(3): 341-345.
18.	劉建斌, 李春龍, 梁曉芬. 胸鎖關節脫位合并同側鎖骨骨折術后克氏針折斷墜入胸腔一例. 中國骨與關節損傷雜志, 2005, 20(8): 570.
19.	Nakayama M, Gika M, Fukuda H, et al. Migration of a Kirschner wire from the clavicle into the intrathoracic trachea. Ann Thorac Surg, 2009, 88(2): 653-654.
20.	Kumar P, Godbole R, Rees GM, et al. Intrathoracic migration of a Kirschner wire. J Royal Society of Med, 2002, 95(4): 198-199.
21.	楊琨, 陽運康. 胸鎖關節脫位治療的研究進展. 中國修復重建外科雜志, 2016, 30(1): 115-118.
22.	Schemitsch LA, Schemitsch EH, Mckee MD. Bipolar clavicle injury: posterior dislocation of the acromioclavicular joint with anterior dislocation of the sternoclavicular joint: a report of two cases. J Shoulder Elbow Surg, 2011, 20(1): e18-22.
23.	Gille J, Schulz A, Wallstabe S, et al. Hook plate for medial clavicle fracture. Indian J Orthop, 2010, 44(2): 221-223.
24.	Shuler FD, Pappas N. Treatment of posterior sternoclavicular dislocation with locking plate osteosynthesis. Orthopedics, 2008, 31(3): 273.
25.	Rockwood CA Jr, Odor JM. Spontaneous atraumatic anterior subluxation of the sternoclavicular joint. J Bone Joint Surg (Am), 1989, 71(9): 1280-1288.
26.	Bontempo NA, Mazzocca AD. Biomechanics and treatment of acromioclavicular and sternoclavicular joint injuries. Br J Sports Med, 2010, 44(5): 361-369.
27.	Abel EW, Sun J. Mechanical evaluation of a new minimum-contact plate for internal fracture fixation. J Orthop Trauma, 1998, 12(6): 382-386.
28.	Wolff J. The classic: on the theory of fracture healing. 1873. Clin Orthop Relat Res, 2010, 468(4): 1052-1055.
29.	Hussey MM, Chen Y, Fajardo RA, et al. Analysis of neurovascular safety between superior and anterior plating techniques of clavicle fractures. J Orthop Trauma, 2013, 27(11): 627-632.

1. Kirby JC, Edwards E, Kamali Moaveni A. Management and functional outcomes following sternoclavicular joint dislocation. Injury, 2015, 46(10): 1906-1913.
2. Bourghli A, Fabre A. Proximal end clavicle fracture from a parachute jumping injury. Orthop Traumatol Surg Res, 2012, 98(2): 238-241.
3. Low AK, Duckworth DG, Bokor DJ. Operative outcome of displaced medial-end clavicle fractures in adults. J Shoulder Elbow Surg, 2008, 17(5): 751-754.
4. Celestre P, Roberston C, Mahar A, et al. Biomechanical evaluation of clavicle fracture plating techniques: does a locking plate provide improved stability? J Orthop Trauma, 2008, 22(4): 241-247.
5. 董加純, 支中正, 顏冰珊, 等. 鋼纜內固定鎖骨近段和胸骨髓腔修復胸鎖關節脫位: 解剖與臨床. 中國組織工程研究, 2014, 18(4): 583-588.
6. Renfree KJ, Wright TW. Anatomy and biomechanics of the acromioclavicular and sternoclavicular joints. Clin Sports Med, 2003, 22(2): 219-237.
7. 王亦聰. 骨與關節損傷. 4版. 北京: 人民衛生出版社, 2007: 770-772.
8. Wirth MA, Rockwood CA Jr. Acute and Chronic Traumatic Injuries of the Sternoclavicular Joint. J Am Acad Orthop Surg, 1996, 4(5): 268-278.
9. Buckerfield CT, Castle ME. Acute traumatic retrosternal dislocation of the clavicle. J Bone Joint Surg (Am), 1984, 66(3): 379-385.
10. Yeh GL, Williams GR JR. Conservative management of sternoclavicular injuries. Orthop Clin North Am, 2000, 31(2): 189-203.
11. Robinson CM, Jenkins PJ, Markham PE, et al. Disorders of the sternoclavicular joint. J Bone Joint Surg (Br), 2008, 90(6): 685-696.
12. Rockwood CA Jr, Groh GI, Wirth MA, et al. Resection arthroplasty of the sternoclavicular joint. J Bone Joint Surg (Am), 1997, 79(3): 387-393.
13. Van Tongel A, De Wilde L. Sternoclavicular joint injuries: a literature review. Muscles Ligaments Tendons J, 2011, 1(3): 100-105.
14. 戚盈杰, 胡月正, 余華晨, 等. 克氏針加張力帶鋼絲內固定治療胸鎖關節脫位. 中國骨與關節損傷雜志, 2011, 26(9): 824-825.
15. Groh GI, Wirth MA, Rockwood CA Jr. Treatment of traumatic posterior sternoclavicular dislocations. J Shoulder Elbow Surg, 2011, 20(1): 107-113.
16. Waters PM, Bae DS, Kadiyala RK. Short-term outcomes after surgical treatment of traumatic posterior sternoclavicular fracture-dislocations in children and adolescents. J Pediatr Orthop, 2003, 23(4): 464-469.
17. Adamcik S, Ahler M, Gioutsos K, et al. Repair of sternoclavicular joint dislocations with FiberWire (R). Arch Orthop Trauma Surg, 2017, 137(3): 341-345.
18. 劉建斌, 李春龍, 梁曉芬. 胸鎖關節脫位合并同側鎖骨骨折術后克氏針折斷墜入胸腔一例. 中國骨與關節損傷雜志, 2005, 20(8): 570.
19. Nakayama M, Gika M, Fukuda H, et al. Migration of a Kirschner wire from the clavicle into the intrathoracic trachea. Ann Thorac Surg, 2009, 88(2): 653-654.
20. Kumar P, Godbole R, Rees GM, et al. Intrathoracic migration of a Kirschner wire. J Royal Society of Med, 2002, 95(4): 198-199.
21. 楊琨, 陽運康. 胸鎖關節脫位治療的研究進展. 中國修復重建外科雜志, 2016, 30(1): 115-118.
22. Schemitsch LA, Schemitsch EH, Mckee MD. Bipolar clavicle injury: posterior dislocation of the acromioclavicular joint with anterior dislocation of the sternoclavicular joint: a report of two cases. J Shoulder Elbow Surg, 2011, 20(1): e18-22.
23. Gille J, Schulz A, Wallstabe S, et al. Hook plate for medial clavicle fracture. Indian J Orthop, 2010, 44(2): 221-223.
24. Shuler FD, Pappas N. Treatment of posterior sternoclavicular dislocation with locking plate osteosynthesis. Orthopedics, 2008, 31(3): 273.
25. Rockwood CA Jr, Odor JM. Spontaneous atraumatic anterior subluxation of the sternoclavicular joint. J Bone Joint Surg (Am), 1989, 71(9): 1280-1288.
26. Bontempo NA, Mazzocca AD. Biomechanics and treatment of acromioclavicular and sternoclavicular joint injuries. Br J Sports Med, 2010, 44(5): 361-369.
27. Abel EW, Sun J. Mechanical evaluation of a new minimum-contact plate for internal fracture fixation. J Orthop Trauma, 1998, 12(6): 382-386.
28. Wolff J. The classic: on the theory of fracture healing. 1873. Clin Orthop Relat Res, 2010, 468(4): 1052-1055.
29. Hussey MM, Chen Y, Fajardo RA, et al. Analysis of neurovascular safety between superior and anterior plating techniques of clavicle fractures. J Orthop Trauma, 2013, 27(11): 627-632.

Chinese Journal of Reparative and Reconstructive Surgery

Development and biomechanical study of anatomical locking plate of sternoclavicular joint

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