title: A short plate compression screw with diagonal bolts--a biomechanical evaluation performed experimentally and by numerical computation.
abstract: BACKGROUND
  Decreasing the length of the side plate of the dynamic hip screw would theoretically allow a smaller surgical incision, a shorter surgical time, decreased operative blood loss and minimal periosteal stripping. A new design of a very short plate dynamic hip screw based on two diagonal screws has been developed. Our study compares the new design and the four-hole side plate in respect to mechanical properties and bio-mechanical outcomes utilizing the Finite Element Analysis method.
  
  
  METHODS
  Four pairs of fresh frozen cadaveric femora were extracted from male corpses aged 25-43 years (mean 34.8). One femur of each pair was fixated by means of the new system and the other by means of the conventional design. Mechanical loading was applied to all four pairs. The decline which occurred during the periodical loadings and the breakage loads of fixated bones were measured. Mechanical performance and probability of failure was assessed by conducting a mathematical analysis using the finite element method.
  
  
  RESULTS
  The average deflection under excessive cyclic loading was 33% higher in the bones fixated with the very short plate-dynamic hip screw device than in those fixated with the conventional dynamic hip screw. The average load failure during the collapse-loading test was 3120N for the very short plate-dynamic hip screw as compared to 4160N for the regular device. Mechanical testing did not provide decisive results regarding failure. The mathematical analysis performed indicated that the maximal stress in the very short plate-dynamic hip screw reached values 3-4-fold higher than in the regular dynamic hip screw.
  
  
  CONCLUSIONS
  Although the new design offers a minimally invasive approach to subtrochanteric femur fracture fixation, it was found to have insufficient biomechanical performance resulting in high probability of mechanical failure. The authors believe that the finite element method may have the potential to serve as an additional clinical tool for performing surgical preplanning and assist in decision making.
authors.affiliation: Biomedical Engineering, The Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Peleg
authors.forename: Rami
authors.initials: R
authors.lastname: Mosheiff
authors.forename: Meir
authors.initials: M
authors.lastname: Liebergall
authors.forename: Yoav
authors.initials: Y
authors.lastname: Mattan
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena / Q000379:methods; D001860:Bone Plates; D001863:Bone Screws; D002102:Cadaver; D003198:Computer Simulation; D017076:Computer-Aided Design; D019544:Equipment Failure Analysis / Q000379:methods; D005264:Femoral Fractures / Q000503:physiopathology* / Q000601:surgery*; D005269:Femur / Q000503:physiopathology / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008954:Models, Biological; D011379:Prognosis; D011474:Prosthesis Design; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome