title: Comparison of crossed screw versus plate fixation for radial neck fractures.
abstract: BACKGROUND
  Fixation of radial neck fractures can be achieved with a plate and screw construct or, in absence of comminution, with two obliquely-oriented screws. This study investigated the mechanical properties, specifically the stiffness and load to failure, of these two fixation strategies in a cadaver model.
  
  
  METHODS
  Ten matched-pair radii were removed from fresh cadaver arms. A transverse osteotomy was created at the neck of each radius. Right-sided radii were fixed with two oblique headless compression screws; left-sided radii were fixed with a radial neck plate. The distal aspect of each radius was potted in urethane casting resin. The radial head was loaded in shear in 4 different planes (medial to lateral, lateral to medial, posterior to anterior, and anterior to posterior) using an Instron machine. Stiffness and load to failure were recorded.
  
  
  RESULTS
  The stiffness of both constructs was similar in all planes except for loading from medial to lateral where the screw construct was 1.8 times stiffer. Average ultimate failure occurred at 229N for the screws and 206N for the plate. Failure strength was not statistically different. However, mode of failure differed for both fixation constructs, the plate failed in bending while the screws failed by pullout and fracture.
  
  
  CONCLUSIONS
  The two strategies provide similar strength and stiffness for the fixation of transverse, non-comminuted radial neck fractures. While plate and screw constructs are more appropriate for axially unstable or comminuted fractures, two oblique screws might be preferred for simple transverse neck fractures since this strategy requires less exposure and the implant is buried.
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, 1025 Walnut Street, College Building Rm. 516, Philadelphia, PA 19107, USA. Electronic address: gutowski1@gmail.com.
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Gutowski
authors.affiliation: Department of Mechanical Engineering, Temple University, 1947 N. 12th Street, Philadelphia, PA 19122, USA. Electronic address: kdarvish@temple.edu.
authors.forename: Kurosh
authors.initials: K
authors.lastname: Darvish
authors.affiliation: Rothman Institute Orthopaedics, 925 Chestnut St., 5th Floor, Philadelphia, PA 19107, USA. Electronic address: aimd@yahoo.com.
authors.forename: Asif M
authors.initials: AM
authors.lastname: Ilyas
authors.affiliation: Rothman Institute Orthopaedics, 925 Chestnut St., 5th Floor, Philadelphia, PA 19107, USA. Electronic address: cmj224@gmail.com.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Jones
mesh_terms: D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D002102:Cadaver; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D018460:Fractures, Comminuted / Q000601:surgery; D006801:Humans; D008297:Male; D008422:Materials Testing; D011885:Radius Fractures / Q000601:surgery*; D013718:Tensile Strength
keywords: Plates; Radial neck fracture; Screws; Stiffness; Strength