title: The effects of screw orientation in severely osteoporotic bone: a comparison with locked plating.
abstract: BACKGROUND
  Techniques such as varying screw insertion angles and the use of locked plating have been shown to improve the strength of fixation in bone. The effects of these methods is less clearly understood in bone of exceedingly poor quality.
  
  
  METHODS
  Forty plate-bone constructs were assembled and divided into four groups of ten. Perpendicularly placed screws were placed in one group, convergently placed crossing screws were placed in a second group, an oblique end screw was placed in a third group, and a fourth group utilized perpendicularly placed locking screws in a locking plate. All test subjects were mounted and loaded in cantilever bending to the point of failure. Stiffness, initial load to failure, and maximal load tolerated were all analyzed.
  
  
  RESULTS
  All four groups demonstrated evidence of failure at similar loads (21.8-26.1N). The locked group was able to tolerate significantly higher loads overall (37.3N, P=.044). All three non-locked groups demonstrated similar failure patterns and load to failure. Locking constructs demonstrated a distinctly different failure pattern. No significant differences were detected with regard to screw orientation and load to failure. The group with an oblique end screw was significantly less stiff than the other three constructs (P=.017).
  
  
  CONCLUSIONS
  In a severely osteoporotic model, failure in cantilever bending at low forces will take place regardless of fixation methods used. The mechanism of failure is different in locked constructs compared to traditional constructs. The added benefit of oblique screw placement observed in healthy bone is not observed in osteoporotic bone.
authors.affiliation: St. Louis University School of Medicine, Department of Orthopedic Surgery, 3635 Vista at Grand Blvd, St. Louis, MO 63104, USA. zehnders@slu.edu
authors.forename: Scott
authors.initials: S
authors.lastname: Zehnder
authors.forename: J Gary
authors.initials: JG
authors.lastname: Bledsoe
authors.forename: Aki
authors.initials: A
authors.lastname: Puryear
mesh_terms: D001860:Bone Plates; D001863:Bone Screws; D019544:Equipment Failure Analysis; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D017276:Friction; D006801:Humans; D010024:Osteoporosis / Q000503:physiopathology* / Q000601:surgery*; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D013314:Stress, Mechanical