title: Investigation of Kryptonite™ bone cement in hybrid screw configurations of locking plate humeral midshaft fixation: A study of surrogate bone model.
abstract: OBJECTIVE
  Locking compression plates (LCP) allow trauma and orthopedic surgeons to have a variety of options for utilizing locking and non-locking screw features. In this study, the hybrid constructs of mixed unicortical and bicortical screws were investigated for humerus midshaft fractures. The locking and non-locking features were also incorporated into the hybrid LCP constructs. Kryptonite™ bone cement is biocompatible with low exothermic properties and strong metal adhesion. This novel bone cement was incorporated into the non-locking screw feature to compare its mechanical effect with that of a traditional locking screw feature.
  
  
  METHODS
  A total of 24 synthetic bones (Sawbones(®) Inc., USA) were equally divided into three groups (n = 8). The control group obtained traditional LCP fixation (JSM Medimax Inc., India) with bicortical screws, while the hybrid locking constructs employed a mix of bicortical and unicortical screws. The two bicortical screws in hybrid constructs were placed at the end holes of the LCP constructs and the unicortical screws were placed into the remaining holes. The hybrid locking (HL) group contained locking unicortical screws, whereas the hybrid non-locking group (HNK) utilized non-locking screw features incorporating the Kryptonite™ bone cement in the plate/screw bone construct. Specimens were tested by dynamic and static analysis. The eight total constructs were equally divided into two subgroups (n = 4) to conduct axial compression and torsion test individually. The low cyclic test was conducted for dynamic analysis, which included 10,000 cycles at 1 Hz frequency with a cyclic loading of 0-500 N of axial force for the axial compression test and 0-20° of angular displacement for the torsion test. The static analysis was run by a failure test with a nondestructive strain rate of 0.1 mm/s for the axial compression test and 0.5° s(-1) for the torsional test. The construct stiffness of axial compression and torsion were derived from the linear portion of the load-displacement curves. The yield strength of axial compression and torsion was determined by using offset methods. The results of stiffness and yield strength were compared by using both one-way ANOVA and Scheffe and Games-Howell post hoc tests to analyze statically significant differences among the three groups.
  
  
  RESULTS
  Specimens completed 10,000 cycles in the dynamic analysis of axial and torsional cyclic tests without major deformation. To compare with the control group in static analysis, the HL and HNK groups achieved positive effect in axial stiffness, 12.3% and 10.5% greater than the control group respectively. HL obtained axial yield strength about 12% less than the control group. The HNK group was equivalent with the control group in axial yield strength. The torsional stiffness and yield strength were found similar in three groups, which indicated torsional equivalence among them. The stiffness and yield strength from axial compression and torsion were found statically non-significant among three groups.
  
  
  CONCLUSIONS
  Hybrid LCP constructs were initially showed to maintain equivalent axial and torsional stability with the traditional method. Kryptonite™ hosted mechanical and biological advantages for internal plate/screws (PLT) fixation.
authors.affiliation: Biomedical Engineering, School of Engineering, Mercer University, Macon, GA, USA; School of Medicine, Mercer University, Macon, GA, USA.
authors.forename: Trung T
authors.initials: TT
authors.lastname: Le
authors.affiliation: Biomedical Engineering, School of Engineering, Mercer University, Macon, GA, USA; School of Medicine, Mercer University, Macon, GA, USA; Orthopedic Surgery, School of Medicine, Mercer University, Macon, GA, USA.
authors.forename: Ha V
authors.initials: HV
authors.lastname: Vo
authors.affiliation: Biomedical Engineering, School of Engineering, Mercer University, Macon, GA, USA; School of Medicine, Mercer University, Macon, GA, USA; Georgia Orthopedic Trauma Institute, Navicent Health Hospital, Macon, GA, USA; Orthopedic Surgery, School of Medicine, Mercer University, Macon, GA, USA.
authors.forename: Lawrence X
authors.initials: LX
authors.lastname: Webb
keywords: Internal bone fixation; Kryptonite™ bone cement; LCP; Locking vs. non-locking screw; PLT; Unicortical vs. bicortical screw