title: Biomechanical evaluation of locking plate radial shaft fixation: unicortical locking fixation versus mixed bicortical and unicortical fixation in a sawbone model.
abstract: OBJECTIVE
  Compression plating is a commonly accepted technique for treating diaphyseal forearm fractures. The purpose of this study was to evaluate the stabilizing effects of two hybrid fixations that replace the end screws of a locked unicortical fixation with bicortical (locked or unlocked) screws and to compare these hybrid fixations to an unlocked bicortical fixation.
  
  
  METHODS
  Sixteen composite radius sawbones were equally divided into 4 groups. We performed a midshaft osteotomy and plate fixation on the volar surface with 1 of 4 different constructs: 3 unlocked bicortical screws on each side (unlocked bicortical), 3 locked unicortical screws on each side (locked unicortical), or with 2 unicortical locked screws near the fracture and 1 bicortical unlocked (unlocked hybrid) or locked (locked hybrid) screw distant from the fracture on each end (LCP system, Synthes USA, Paoli, PA). Specimens were tested in nondestructive 4-point bending and torsion on a servo-hydraulic material testing system. The construct stiffness was obtained from the linear portion of the load-displacement curves after 3 cycles of preconditioning. The results from all groups were compared using analysis of variance and post hoc Bonferroni tests.
  
  
  RESULTS
  Under torsional loads, replacing the end screws of a locked unicortical configuration with bicortical screws significantly improved the construct stiffness: 57.6% increase for the locked screws and 51.6% increase for the unlocked. In anteroposterior (AP) bending, the highest improvement over the locked unicortical configuration came from the locked hybrid constructs (42.9% increase). When compared with the unlocked bicortical configuration, both hybrid constructs provide equivalent stability in torsion but superior stability in AP bending.
  
  
  CONCLUSIONS
  Replacing a single set of unicortical locked screws with locked or unlocked bicortical screws distant from the fracture site improves torsional stability of the construct by more than 50%, giving stability equal to standard unlocked plating. The hybrid fixation, however, with locked bicortical end screws has the best stability in AP bending.
authors.affiliation: Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226-0099, USA.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Roberts
authors.forename: Steven I
authors.initials: SI
authors.lastname: Grindel
authors.forename: Brandon
authors.initials: B
authors.lastname: Rebholz
authors.forename: Mei
authors.initials: M
authors.lastname: Wang
mesh_terms: D000704:Analysis of Variance; D001860:Bone Plates; D001863:Bone Screws; D018483:Diaphyses / Q000293:injuries / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008422:Materials Testing; D008954:Models, Biological; D011474:Prosthesis Design; D011885:Radius Fractures / Q000601:surgery*; D054159:Torsion, Mechanical