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Winkelstabile karbonverstärkte Polymerkompositplatte zur Versorgung einer distalen Radiusfraktur

Pilotstudie zur klinischen Anwendung

Fixed angle carbon fiber reinforced polymer composite plate for treatment of distal radius fractures

Pilot study on clinical applications

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Zusammenfassung

Hintergrund

Die Behandlung der distalen Radiusfraktur erfolgt heute zunehmend operativ, wobei die metallene Plattenosteosynthese als Standardverfahren gilt.

Fragestellung

In dieser Studie soll eine neuartige, faserverstärkte thermoplastische Polyetheretherketon(PEEK)-Platte hinsichtlich der operativen Praktikabilität und klinischen Ergebnisse mit einer konventionellen Titanplatte verglichen werden.

Material und Methoden

Es handelt sich um eine prospektive klinische Untersuchung, bei welcher 26 Patienten mit einer distalen Radiusfraktur (Arbeitsgemeinschaft für Osteosynthesefragen [AO] 23-A2-C) mit einer winkelstabilen (polyaxialen) Titanplatte (Fa. DePuy Synthes) oder einer winkelstabilen (monoaxialen) Polyetheretherketon(PEEK)-Platte (Fa. Icotec) behandelt wurden. Postoperativ, nach 6 Wochen und nach einem Jahr wurde die gesundheitsbezogene Lebensqualität mithilfe des Questionnaire Disability of the Arm, Shoulder and Hand (DASH), Mayo-Wrist- und VAS-Schmerzscore (visuelle Analogskala) erhoben. Weiterhin wurden radiologische Kriterien, der Bewegungsumfang des Handgelenks und der Erfolg der beruflichen Wiedereingliederung dokumentiert.

Ergebnisse

Der operationstechnische Umgang mit der PEEK-Plattenosteosynthese konnte schnell und komplikationsarm an unserer Klinik implementiert werden. Die Versorgung mit der PEEK-Platte zeigte tendenziell äquivalente klinische Ergebnisse gegenüber der konventionellen Titanplatte. Im DASH- und Mayo-Wristscore fanden sich moderate Effektstärken zugunsten der PEEK-Platte. Nach 6 Wochen ergaben beide Platten gleichwertige radiologische und funktionelle Ergebnisse.

Schlussfolgerung

Die PEEK-Platte zeigt in dieser Pilotstudie im Vergleich zur konventionellen Titanplatte ebenbürtige klinisch-radiologische Ergebnisse mit leichten Vorteilen bei der Patientenzufriedenheit und Gelenkbeweglichkeit.

Abstract

Background

The clinical implementation of a new carbon-fiber-reinforced polyetheretherketon (PEEK) plate for distal radius fractures might offer advantageous properties over the conventional metallic devices. This includes similar elastic modulus to cortical bone, radiolucency, low artifacts on MRI scans and the lack of metal allergies.

Objective

The aim of this study was to evaluate the clinical results at 6-week and 12-month follow-up using either a new fixed angle (monoaxial) PEEK plate system or a fixed angle (polyaxial) titanium plate.

Methodes

We included 26 patients (mean age 59.3) with displaced fractures of the distal radius (all AO types). Radiological and functional outcomes were measured prospectively at a 6-week and 12 month follow-up.

Results

We documented no cases of hardware breakage or significant loss of the surgically achieved fracture reduction with the usage oft the new PEEK device. Operating time was 101.0 min using PEEK versus 109.3 min in titanium plates, recorded times were including preparation, draping, and postoperative processing (ns, p 0.156). At the 6-week follow up the PEEK plate showed a trend for better range of motion and functional results (DASH-score, Mayo-wrist score, VAS) with no statistical significance. Results of 12 month follow up with PEEK showed comparable results with corresponding studies examining titanium plate after this period.

Conclusion

First experience with PEEK plate osteosynthesis demonstrate quick clinical implementation with good clinical outcome and the advantage of excellent postoperative radiological assessment. At early follow-up PEEK even showed a trend for improved functional results.

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Literatur

  1. Arora R, Lutz M, Deml C et al (2011) A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am 93:2146–2153

    Article  PubMed  Google Scholar 

  2. Asadollahi S, Keith PP (2013) Flexor tendon injuries following plate fixation of distal radius fractures: a systematic review of the literature. J Orthopaedics Traumatol 14:227–234

    Article  Google Scholar 

  3. Bader R, Steinhauser E, Rechl H et al (2003) [Carbon fiber-reinforced plastics as implant materials]. Orthopade 32:32–40

    Article  CAS  PubMed  Google Scholar 

  4. Bartl C, Stengel D, Bruckner T et al (2011) Open reduction and internal fixation versus casting for highly comminuted and intra-articular fractures of the distal radius (ORCHID): protocol for a randomized clinical multi-center trial. Trials 12:84

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bronstein A, Heaton D, Tencer AF et al (2014) Distal radius malunion and forearm rotation: a cadaveric study. J Wrist Surg 3:7–11

    Article  PubMed  PubMed Central  Google Scholar 

  6. Costa ML, Achten J, Parsons NR et al (2014) Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius: randomised controlled trial. BMJ 349:g4807

    Article  PubMed  PubMed Central  Google Scholar 

  7. Elmi A, Tabrizi A, Rouhani A et al (2014) Treatment of neglected malunion of the distal radius: a cases series study. Med J Islam Repub Iran 28:7

    PubMed  PubMed Central  Google Scholar 

  8. Farner S, Malkani A, Lau E et al (2014) Outcomes and cost of care for patients with distal radius fractures. Orthopedics 37:e866–e878

    Article  PubMed  Google Scholar 

  9. Figl M, Weninger P, Liska M et al (2009) Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results. Arch Orthop Trauma Surg 129:661–669

    Article  PubMed  Google Scholar 

  10. Jellad A, Salah S, Ben Salah Frih Z (2014) Complex regional pain syndrome type I: incidence and risk factors in patients with fracture of the distal radius. Arch Phys Med Rehabil 95:487–492

    Article  PubMed  Google Scholar 

  11. Jockisch KA, Brown SA, Bauer TW et al (1992) Biological response to chopped-carbon-fiber-reinforced peek. J Biomed Mater Res 26:133–146

    Article  CAS  PubMed  Google Scholar 

  12. Kurtz SM, Devine JN (2007) PEEK biomaterials in trauma, orthopedic, and spinal implants. Biomaterials 28:4845–4869

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Michelitsch C, Acklin YP, Sommer C (2013) [Multidirectional locking volar plate in distal radius fractures. Secondary loss of reduction – correct implantation is essential]. Unfallchirurg 116:1123–1127

    Article  CAS  PubMed  Google Scholar 

  14. Moseley GL, Herbert RD, Parsons T et al (2014) Intense pain soon after wrist fracture strongly predicts who will develop complex regional pain syndrome: prospective cohort study. J Pain 15:16–23

    Article  PubMed  Google Scholar 

  15. Nellans KW, Kowalski E, Chung KC (2012) The epidemiology of distal radius fractures. Hand Clin 28:113–125

    Article  PubMed  PubMed Central  Google Scholar 

  16. Nguyen ND, Ahlborg HG, Center JR et al (2007) Residual lifetime risk of fractures in women and men. J Bone Miner Res 22:781–788

    Article  PubMed  Google Scholar 

  17. Orbay J (2005) Volar plate fixation of distal radius fractures. Hand Clin 21:347–354

    Article  PubMed  Google Scholar 

  18. Poigenfurst J, Tuchmann A (1978) [Significance of ulnar ligament injuries in typical radius fractures]. Handchirurgie 10:121–125

    CAS  PubMed  Google Scholar 

  19. Radzi S, Cowin G, Robinson M et al (2014) Metal artifacts from titanium and steel screws in CT, 1.5 T and 3 T MR images of the tibial Pilon: a quantitative assessment in 3D. Quant Imaging Med Surg 4:163–172

    PubMed  PubMed Central  Google Scholar 

  20. Rueger JM, Hartel MJ, Ruecker AH et al (2014) [Fractures of the distal radius]. Unfallchirurg 117:1025–1034. (quiz 1035–1026)

    Article  CAS  PubMed  Google Scholar 

  21. Schneiders W, Biewener A, Rammelt S et al (2006) [Distal radius fracture. Correlation between radiological and functional results]. Unfallchirurg 109:837–844

    Article  CAS  PubMed  Google Scholar 

  22. Siebert HR, Klonz A (2005) [Fracture of the distal radius]. Unfallchirurg 108:135–152. (quiz 153)

    Article  CAS  PubMed  Google Scholar 

  23. Skinner HB (1988) Composite technology for total hip arthroplasty. Clin Orthop Relat Res 235:224–236

    CAS  Google Scholar 

  24. Steinberg EL, Rath E, Shlaifer A et al (2013) Carbon fiber reinforced PEEK Optima–a composite material biomechanical properties and wear/debris characteristics of CF-PEEK composites for orthopedic trauma implants. J Mech Behav Biomed Mater 17:221–228

    Article  CAS  PubMed  Google Scholar 

  25. Vande Berg B, Malghem J, Maldague B et al (2006) Multi-detector CT imaging in the postoperative orthopedic patient with metal hardware. Eur J Radiol 60:470–479

    Article  PubMed  Google Scholar 

  26. Westphal T, Piatek S, Schubert S et al (2002) [Reliability and validity of the upper limb DASH questionnaire in patients with distal radius fractures]. Z Orthop Ihre Grenzgeb 140:447–451

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, UNIVERSITÄTSKLINIKUM Schleswig-Holstein, Campus Kiel, Haus 18, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland

    P. Behrendt, E. Kruse, T. Klüter, S. Fitschen-Oestern, M. Weuster, L. Menzdorf, J. Finn, D. Varoga, A. Seekamp, M. Müller & S. Lippross

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  1. P. Behrendt
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  2. E. Kruse
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  3. T. Klüter
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  4. S. Fitschen-Oestern
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  5. M. Weuster
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  6. L. Menzdorf
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  7. J. Finn
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  9. A. Seekamp
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  10. M. Müller
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  11. S. Lippross
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Correspondence to P. Behrendt.

Ethics declarations

Interessenkonflikt

M. Müller und S. Lippross weisen auf folgende Beziehung hin: Sie haben gelegentlich beraterische Tätigkeiten für die Firma Icotec wahrgenommen. P. Behrendt, E. Kruse, T. Klüter, S. Fitschen-Oestern, M. Weuster, L. Menzdorf, J. Finn, D. Varoga, A. Seekamp geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethikkomission, im Einklang mit dem nationalen Recht sowie gemäß der Deklaration von Helsinki von 1975 durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Redaktion

W. Mutschler, München

V. Braunstein, München

H. Polzer, München

P. Behrendt und E. Kruse haben zu gleichen Teilen zur Erstellung des Manuskripts beigetragen.

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Behrendt, P., Kruse, E., Klüter, T. et al. Winkelstabile karbonverstärkte Polymerkompositplatte zur Versorgung einer distalen Radiusfraktur. Unfallchirurg 120, 139–146 (2017). https://doi.org/10.1007/s00113-015-0088-6

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