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Purpose
The aim of this study was to compare several osteosynthesis techniques (intramedullary headless compression screws, T-plates, and Kirschner wires) for distal epiphyseal fractures of proximal phalanges in a human cadaveric model.
Methods
A total of 90 proximal phalanges from 30 specimens (index, ring, and middle fingers) were used for this study. After stripping off all soft tissue, a transverse distal epiphyseal fracture was simulated at the proximal phalanx. The 30 specimens were randomly assigned to 1 fixation technique (30 per technique), either a 3.0-mm intramedullary headless compression screw, locking plate fixation with a 2.0-mm T-plate, or 2 oblique 1.0-mm Kirschner wires. Displacement analysis (bending, distraction, and torsion) was performed using optical tracking of an applied random speckle pattern after osteosynthesis. Biomechanical testing was performed with increasing cyclic loading and with cyclic load to failure using a biaxial torsion-tension testing machine.
Results
Cannulated intramedullary compression screws showed significantly less displacement at the fracture site in torsional testing. Furthermore, screws were significantly more stable in bending testing. Kirschner wires were significantly less stable than plating or screw fixation in any cyclic load to failure test setup.
Conclusions
Intramedullary compression screws are a highly stable alternative in the treatment of transverse distal epiphyseal phalangeal fractures. Kirschner wires seem to be inferior regarding displacement properties and primary stability.
Clinical relevance
Fracture fixation of phalangeal fractures using plate osteosynthesis may have the advantage of a very rigid reduction, but disadvantages such as stiffness owing to the more invasive surgical approach and soft tissue irritation should be taken into account. Headless compression screws represent a minimally invasive choice for fixation with good biomechanical properties.
Our world is well ordered in measurement and number : or why natural constants are as they are
(2013)
All the important natural constants can be logically explained with and derived from the first four ordinal numbers, 1, 2, 3 and 4, its addition to ten and finally the standard values for obviously maximal feasibility Ω and the optimum in our world, the Golden Section (GS), i.e. the number sequences 273 and 618. They both are the first three numbers of irrational results by an arithmetical transformation of simple geometrical relationships by creating multiplicity out of singularity. Both of them show that the infinite is inherent in finiteness and explain in a simple way the smallest deviations and fluctuations between the physical AS-IS state and the obvious spiritual ideal behind: Wherever we look in this world, and especially in important key-positions, we regularly find these sequences. All of the above mentioned numbers so seem to be key players in our world, what can be demonstrated by the derivation of natural constants.