Brandon G Santoni1, Jazmine R Aira2, Miguel A Diaz3, T Kyle Stoops3, Peter Simon4. 1. Foundation for Orthopaedic Research and Education, 13020 N. Telecom Parkway, Tampa, FL 33637, USA; Department of Orthopaedics and Sports Medicine, University of South Florida, 13330 USF Laurel Drive, Tampa, FL 33612, USA. Electronic address: bsantoni@foreonline.org. 2. Foundation for Orthopaedic Research and Education, 13020 N. Telecom Parkway, Tampa, FL 33637, USA; Department of Chemical and Biomedical Engineering, University of South Florida, 4202 E. Fowler Avenue, ENB 118, Tampa, FL 33612, USA. 3. Foundation for Orthopaedic Research and Education, 13020 N. Telecom Parkway, Tampa, FL 33637, USA. 4. Foundation for Orthopaedic Research and Education, 13020 N. Telecom Parkway, Tampa, FL 33637, USA; Department of Chemical and Biomedical Engineering, University of South Florida, 4202 E. Fowler Avenue, ENB 118, Tampa, FL 33612, USA; Department of Orthopaedics and Sports Medicine, University of South Florida, 13330 USF Laurel Drive, Tampa, FL 33612, USA.
Abstract
BACKGROUND: Distal radius fractures are common musculoskeletal injuries and many can be treated non-operatively with cast immobilization. A thermo-formable brace has been developed for management of such fractures, but no data exist regarding its comparative stabilizing efficacy to fiberglass casting. METHODS: A worst-case distal radius fracture was created in 6 cadaveric forearms. A radiolucent loading fixture was created to apply cantilever bending/compression loads ranging from 4.5N to 66.7N across the simulated fracture in the: (1) non-stabilized, (2) braced; and (3) casted forearms, each forearm serving as its own control. Fracture fragment translations and rotations were measured radiographically using orthogonal radiographs and a 2D-3D, CT-based transformation methodology. FINDINGS: Under 4.5N of load in the non-stabilized condition, average sagittal plane rotation and 3D center of mass translation of the fracture fragment were 12.3° and 5.3mm, respectively. At the 4.5N load step, fragment rotation with the brace (avg. 0.0°) and cast (0.1°) reduced sagittal plane rotation compared to the non-stabilized forearm (P<0.001). There were no significant differences in measured sagittal plane fracture fragment rotations or 3D fragment translations between the brace or cast at any of the four load steps (4.5N, 22.2N, 44.5N, and 66.7N, P≥0.138). INTERPRETATION: In this in vitro radiographic study utilizing 6 cadaveric forearms with simulated severe-case, unstable and comminuted distal radius fractures, the thermo-formable brace stabilized the fracture in a manner that was not radiographically or biomechanically different from traditional fiberglass casting. Study results support the use of the thermo-formable brace clinically.
BACKGROUND: Distal radius fractures are common musculoskeletal injuries and many can be treated non-operatively with cast immobilization. A thermo-formable brace has been developed for management of such fractures, but no data exist regarding its comparative stabilizing efficacy to fiberglass casting. METHODS: A worst-case distal radius fracture was created in 6 cadaveric forearms. A radiolucent loading fixture was created to apply cantilever bending/compression loads ranging from 4.5N to 66.7N across the simulated fracture in the: (1) non-stabilized, (2) braced; and (3) casted forearms, each forearm serving as its own control. Fracture fragment translations and rotations were measured radiographically using orthogonal radiographs and a 2D-3D, CT-based transformation methodology. FINDINGS: Under 4.5N of load in the non-stabilized condition, average sagittal plane rotation and 3D center of mass translation of the fracture fragment were 12.3° and 5.3mm, respectively. At the 4.5N load step, fragment rotation with the brace (avg. 0.0°) and cast (0.1°) reduced sagittal plane rotation compared to the non-stabilized forearm (P<0.001). There were no significant differences in measured sagittal plane fracture fragment rotations or 3D fragment translations between the brace or cast at any of the four load steps (4.5N, 22.2N, 44.5N, and 66.7N, P≥0.138). INTERPRETATION: In this in vitro radiographic study utilizing 6 cadaveric forearms with simulated severe-case, unstable and comminuted distal radius fractures, the thermo-formable brace stabilized the fracture in a manner that was not radiographically or biomechanically different from traditional fiberglass casting. Study results support the use of the thermo-formable brace clinically.
Authors: Brett Walker; Chad Amato; Olena Palyvoda; Sharada Vangipuram; Martin Weaver; Zain Sayeed; Muhammad Talha Padela; Walid K Yassir Journal: Int J Pediatr Date: 2020-01-21