title: Biplanar fixation of a locking plate in the diaphysis improves construct strength.
abstract: BACKGROUND
  Elevation of a locking plate over the bone surface not only supports biological fixation, but also decreases the torsional strength of the fixation construct. Biplanar fixation by means of a staggered screw hole arrangement may combat this decreased torsional strength caused by plate elevation. This biomechanical study evaluated the effect of biplanar fixation on the torsional strength of locking plate fixation in the femoral diaphysis.
  
  
  METHODS
  Custom titanium plates were manufactured with either a linear or staggered hole pattern to evaluate planar and biplanar fixation, respectively. Fixation strength under torsional loading was evaluated in surrogates of the femoral diaphysis representative of osteoporotic and non-osteoporotic bone. Furthermore, fixation strength was determined for plate fixation with unicortical or bicortical locking screws. Five specimens per configuration were loaded to failure in torsion to determine their strength, stiffness, and failure mode.
  
  
  RESULTS
  In osteoporotic bone, biplanar fixation was 32% stronger (P=0.01) than planar fixation when unicortical screws were used and 9% stronger (P=0.02) when bicortical screws were used. In non-osteoporotic bone, biplanar fixation was 55% stronger (P<0.001) than planar fixation when unicortical screws were used and 42% (P<0.001) stronger when bicortical screws were used.
  
  
  CONCLUSIONS
  A biplanar screw configuration improves the torsional strength of diaphyseal plate fixation relative to a planar configuration in both osteoporotic and normal bone. With biplanar fixation, unicortical screws provide the same fixation strength as bicortical screws in non-osteoporotic bone.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR 97232, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Denard
authors.forename: Josef
authors.initials: J
authors.lastname: Doornink
authors.forename: Daniel
authors.initials: D
authors.lastname: Phelan
authors.forename: Steven M
authors.initials: SM
authors.lastname: Madey
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Fitzpatrick
authors.forename: Michael
authors.initials: M
authors.lastname: Bottlang
mesh_terms: D001860:Bone Plates; D055119:Elastic Modulus; D005264:Femoral Fractures / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D010024:Osteoporosis / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D013718:Tensile Strength; D016896:Treatment Outcome