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  1. Shanmugam R, Jian CYCCS, Haseeb A, Aik S
    J Orthop Surg (Hong Kong), 2018 10 3;26(3):2309499018802511.
    PMID: 30270746 DOI: 10.1177/2309499018802511
    PURPOSE: Metacarpal bone fractures constitute 10% of all fractures. Unstable metacarpal fractures require surgical intervention, which poses danger to flexor tendon either due to bicortical drilling or construct of the implant. Unicortical locking plate fixation may be the solution to preventing flexor tendon injury. Studies have compared locking and compression plates. However, in these studies, the biomechanical properties were tested using the static loading method. This study looks into cyclical loading that is more representative of in vivo conditions, particularly for early rehabilitation. We compared the biomechanical strength of the unicortical locking plate and bicortical compression plate system in a transverse metacarpal fracture, tested with cyclical loading and torsion.

    METHOD: Twenty pieces of fourth-generation, biomechanical testing grade, left third metacarpal composite bones were used. Resin was used to create the holding block at both ends of the bone. An oscillating saw with 0.8 mm thick saw blade was used to osteotomize the metacarpal sawbones to create a midshaft transverse metacarpal fracture model. Ten pieces were fixed with a 2.0 mm titanium locking plate via unicortical screw purchase and 10 were fixed with a 2.0 mm, four holes, titanium dynamic compression plate, bicortical purchase of screws. They were subjected to cyclic load to failure testing three-point bending and torsion.

    RESULTS: There were no significant difference in stiffness and cyclic three-point bending to failure between the unicortical locking plate group and the bicortical compression plate group. The bicortical compression plate group is stiffer and has a higher cyclic bending load to failure as compared to the unicortical locking plate group.

    CONCLUSION: Unicortical locking plate fixation of metacarpal fracture can be reliably applied clinically to produce a strong and stable construct that allows early mobilization of the joints. This will not only reduce the complication rate of metacarpal plating, but also improve the functional outcome of the hand.

    Matched MeSH terms: Metacarpal Bones/surgery
  2. Bajuri MN, Abdul Kadir MR, Murali MR, Kamarul T
    Med Biol Eng Comput, 2013 Feb;51(1-2):175-86.
    PMID: 23124814 DOI: 10.1007/s11517-012-0982-9
    The total replacement of wrists affected by rheumatoid arthritis (RA) has had mixed outcomes in terms of failure rates. This study was therefore conducted to analyse the biomechanics of wrist arthroplasty using recently reported implants that have shown encouraging results with the aim of providing some insights for the future development of wrist implants. A model of a healthy wrist was developed using computed tomography images from a healthy volunteer. An RA model was simulated based on all ten general characteristics of the disease. The ReMotion ™ total wrist system was then modelled to simulate total wrist arthroplasty (TWA). Finite element analysis was performed with loads simulating the static hand grip action. The results show that the RA model produced distorted patterns of stress distribution with tenfold higher contact pressure than the healthy model. For the TWA model, contact pressure was found to be approximately fivefold lower than the RA model. Compared to the healthy model, significant improvements were observed for the TWA model with minor variations in the stress distribution. In conclusion, the modelled TWA reduced contact pressure between bones but did not restore the stress distribution to the normal healthy condition.
    Matched MeSH terms: Metacarpal Bones/surgery
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