title: Biomechanical considerations in plate osteosynthesis: the effect of plate-to-bone compression with and without angular screw stability.
abstract: OBJECTIVE
  We compared the biomechanical stability of bone-plate constructs using a compression plate (CP), an internal fixator (IF), and a combination plate (CP/IF).
  
  
  METHODS
  Standardized simulated shaft fractures with a segmental defect in composite bones (n=60) and intraarticular distal femur fractures with a comminuted supracondylar zone in fresh frozen cadaveric femurs (n=36) were stabilized by CP, IF, and CP/IF. Construct stiffness, plastic deformation, and fixation strength were measured under axial compression and torsion using a biaxial testing machine.
  
  
  RESULTS
  The experimental results indicate for the distal femur fracture model that IF has less loss of reduction by plastic deformation under axial load compared to CP (IF 61% of CP). Under torsion, the CP showed significantly (P<0.05) decreased plastic deformation compared to the IF (CP 51% of IF). The combination (CP/IF) of the 2 fixation principles generally resulted in a higher load to failure under axial compression and torsion (145% failure load of CP and 118% of IF under axial compression, 88% of CP and 109% of IF under torsion). Results were similar between the 2 fracture models.
  
  
  CONCLUSIONS
  Under compression, IF provides similar fixation in comminuted fractures and was better than the CP for avoiding loss of reduction, whereas under torsional loading, CP was more important for stiffness, plastic deformation, and load to failure than IF. However, combination (CP/IF) fixation seems advisable in intraarticular and extraarticular fractures of long bones with a metaphyseal comminution. These data may be utilized by surgeons to build a more specific treatment plan in patients with these fracture types.
authors.affiliation: Fremantle Orthopaedic Unit, University of Western Australia, and Orthopaedic Department, Kantonsspital St.Gallen, Switzerland. nkstoffel@hotmail.com
authors.forename: Karl
authors.initials: K
authors.lastname: Stoffel
authors.forename: Kai-Uwe
authors.initials: KU
authors.lastname: Lorenz
authors.forename: Markus S
authors.initials: MS
authors.lastname: Kuster
mesh_terms: D001860:Bone Plates; D001863:Bone Screws; D019245:Compressive Strength; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D017102:Fracture Healing; D006801:Humans; D016268:Internal Fixators; D008422:Materials Testing / Q000379:methods