Biomechanical evaluation of an intramedullary clavicle screw in simple oblique and butterfly wedge fractures

This biomechanical study evaluates the performance of a solid titanium-alloy intra-medullary (IM) clavicular screw in torsion and cantilever bending in cadaveric clavicle specimens with simulated simple oblique and butterfly wedge midshaft fractures. Thirty-two fresh-frozen male clavicles were sorted into six experimental groups: Torsion Control, Torsion Simple Oblique Fracture, Torsion Butterfly Wedge Fracture, Bending Control, Bending Simple Oblique Fracture, and Bending Butterfly Wedge Fracture. The experimental groups were controlled for density, length, diameter, and laterality. All other samples were osteotomy-induced and implanted with a single 90 mm × 3 mm clavicle screw. All groups were tested to physiologically relevant cutoff points in torsion or bending. There were no statistically significant differences in the performance of the oblique and butterfly wedge fracture models for any torsion or bend testing measures, including maximum torsional resistance (p = 0.66), torsional stiffness (p = 0.51), maximum bending moment (p = 0.43), or bending stiffness (p = 0.73). Torsional testing of samples in the direction of thread tightening tended to be stronger than samples tested in loosening, with all groups either approaching or achieving statistical significance. There were no significant differences between the simple oblique or the butterfly-wedge fracture groups for any of the tested parameters, suggesting that there is no difference in the gross biomechanical properties of the bone-implant construct when the IM clavicle screw is used in either a simple midshaft fracture pattern or a more complex butterfly wedge fracture pattern.