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Biomechanical evaluation of Nice Knot cerclage for fixation of oblique fractures of the hand
Samuel McGuire Brimmer, MD
1, Vicki Wang, MS
1, Justin Nemec, BS
2; Victor Greco, MD
1(1)Allegheny Health Network, Pittsburgh, PA, (2)Drexel University College of Medicine, Philadelphia, PA
Introduction: Multiple studies have evaluated the effectiveness and biomechanical strength of the Nice knot elsewhere in the upper extremity, including rotator cuff repair, and clavicle fixation. The Nice knot has also been proven to provide superiority to other knots, including the sliding Nicky's knot, under dynamic stress. To our knowledge, no other study has evaluated the biomechanical strength of the Nice knot in its use in fracture fixation in the hand. Using the Nice knot in hand fractures was recently published as a technique for fracture fixation in long oblique fractures of the proximal phalanx. This study aims to evaluate the biomechanical strength of this fixation technique.
Materials and Methods: Twenty-three 3D printed models of the 2nd metacarpal, designed to replicate the natural anatomy of the human bone, were produced for biomechanical testing. The metacarpals then underwent fixation via a single lag screw vs. lag screw with the addition of 2 nice knot suture cerclage. All specimens underwent biomechanical evaluation using a standardized 3-point bending apparatus. The testing protocol was designed to simulate the bending forces encountered during hand function, thereby providing relevant data on the comparative stability of the two fixation methods. Primary outcome measures of failure were measured and defines as: (1)Force to Bending Displacement: defined as the amount of force required to achieve incremental bending displacements, (2) Clinical Failure: Defined as the point at which a 2 mm displacement was observed, (3) Strength to Total Failure: The force at which either hardware failure occurred or a displacement of 10 mm was reached, whichever came first.
Results: Lag screw + Nice Knot cerclage [70.1 N +/- 20.6] required significantly greater force for clinical load to failure compared to Lag screw alone [50.5 N +/- 14.9]. Lag screw + Nice Knot [ 367.2 +/-74.5] also required significantly greater force for total load to failure compared to lag screw alone [79.9 +/- 28.9]. Using a Two-Tailed T-test for comparison, Lag screw alone vs Lag screw + Nice Knot cerclage, analysis demonstrated that the addition of the Nice Knot cerclage provided a statistically significant increase in load to failure compared to screw fixation alone in both the primary outcomes of clinical failure and strength to total failure.
Conclusion: The addition of the Nice knot provides a biomechanical advantage when fixing oblique fractures of the hand and provides a possible additional alternative fixation technique for oblique fractures of the hand.
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