title: Polyaxial locking plate fixation in distal femur fractures: a biomechanical comparison.
abstract: OBJECTIVE
  Uniaxial, first-generation locking plates have become increasingly popular for fixation of supracondylar femur fractures. Polyaxial plates are currently available, which allow for variable-angle screw insertion; however, the biomechanical integrity of these new locking constructs is yet unproven. This study compares the mechanical stability of a conventional locking plate with that of a new polyaxial design.
  
  
  METHODS
  A comminuted supracondylar femur fracture (AO/OTA33-A3) gap model was created in fourth-generation synthetic composite bones. Fixation was obtained with 2 different plate constructs: (1) a conventional locking plate (uniaxial screw heads threading directly into plate) and (2) a polyaxial locking plate (screw heads are captured and "locked" into a fixed angle using locking caps). Eight specimens of each type were then tested in axial, torsional, and cyclic axial modes on a material testing machine.
  
  
  RESULTS
  The mean axial stiffness for the polyaxial locking plate was 24.4% greater than the conventional locking plate (168.2 vs 127.1 N/mm; P < 0.0001). The mean torsional stiffness was also greater for the polyaxial plate (2.78 vs 2.57 Nm/degree; P = 0.0226). Cyclic axial loading caused significantly less (P = 0.0034) mean irreversible deformation in the polyaxial plate (5.6 mm) than in the conventional plate (8.8 mm). The mean ultimate load to failure was significantly higher (P = 0.0005) for the polyaxial plate (1560 N) than for the conventional plate (1337 N).
  
  
  CONCLUSIONS
  The tested plate construct with its polyaxial locking screw mechanism provides a biomechanically sound fixation option for supracondylar femur fractures. The frictional locking mechanism allows maintenance of angular stability while affording the option of variable screw placement.
authors.affiliation: Mission Hospital Regional Medical Center, Mission Viejo, CA 92691, USA. kenwilkens@cox.net
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Wilkens
authors.forename: Shane
authors.initials: S
authors.lastname: Curtiss
authors.forename: Mark A
authors.initials: MA
authors.lastname: Lee
mesh_terms: D001860:Bone Plates; D055119:Elastic Modulus; D004548:Elasticity; D019544:Equipment Failure Analysis; D005264:Femoral Fractures / Q000503:physiopathology* / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D016896:Treatment Outcome; D016474:Weight-Bearing