title: Mechanical behaviour of low-cost dynamic compression plates correlates with manufacturing quality standards.
abstract: OBJECTIVE
  This study compares the mechanical properties of low-cost stainless steel dynamic compression plates (DCPs) from developing-world manufacturers, adhering to varying manufacturing quality standards, with those of high-cost DCPs manufactured for use in the developed world.
  
  
  METHODS
  Standard-design ten-hole DCPs from six developing-world manufacturers and high-cost DCPs from two manufacturers in the developed world were studied. Nine plates from each manufacturer underwent mechanical testing: six in four-point monotonic bending to assess strength and stiffness and three in four-point bending fatigue. Statistical comparisons of the group means of monotonic bending test data were made, and a qualitative comparison was performed to assess failures in fatigue.
  
  
  RESULTS
  Low-cost DCPs from manufacturers with at least one manufacturing quality standard had significantly higher bending strength and fewer failures in fatigue than did those from low-cost manufacturers with no recognised quality standards. High-cost DCPs demonstrated greater bending strength than did those in both low-cost groups. There were no differences in stiffness and fatigue failure between high-cost DCPs and those low-cost DCPs with quality standards. However, high-cost DCPs were significantly less stiff and had fewer fatigue failures than low-cost DCPs manufactured without such standards.
  
  
  CONCLUSIONS
  Significant differences were found in the mechanical properties of ten-hole DCP plates from selected manufacturers in the developing and developed worlds. These differences correlated with reported quality certification in the manufacturing process. Mechanical analysis of low-cost implants may provide information useful in determining which manufacturers produce implants with the best potential for benefit relative to cost.
authors.affiliation: Biomechanics Laboratory of San Francisco General Hospital, San Francisco, CA, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Aluede
authors.forename: Erik
authors.initials: E
authors.lastname: McDonald
authors.forename: Harry
authors.initials: H
authors.lastname: Jergesen
authors.forename: Thomas
authors.initials: T
authors.lastname: Penoyar
authors.forename: Kayla
authors.initials: K
authors.lastname: Calvert
mesh_terms: D001860:Bone Plates / Q000191:economics* / Q000592:standards*; D003365:Costs and Cost Analysis; D003906:Developing Countries; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D016268:Internal Fixators / Q000191:economics* / Q000592:standards*; D008420:Manufactured Materials / Q000191:economics* / Q000592:standards*; D008422:Materials Testing; D011786:Quality Control; D013314:Stress, Mechanical; D014481:United States