title: Stress Modulation of Fracture Fixation Implants.
abstract: Stress modulation is the concept of manipulating bridge plate variables to provide a flexible fixation construct that allows callus formation through uneventful secondary bone healing. Obtaining absolute stability through the anatomic reduction of all fracture fragments comes at the expense of fracture biology, whereas intramedullary nailing, which is more advantageous for diaphyseal fractures of the lower extremity, is technically demanding and often may not be possible when stabilizing many metaphyseal fractures. Overly stiff plating constructs are associated with asymmetric callus formation, early implant failure, and fracture nonunion. Numerous surgeon-controlled variables can be manipulated to increase flexibility without sacrificing strength, including using longer plates with well-spaced screws, choosing titanium or stainless steel implants, and using locking or nonlocking screws. Axially dynamic emerging concepts, such as far cortical locking and near cortical overdrilling, provide further treatment options when bridge plating techniques are used.
authors: From the Department of Orthopaedics, San Antonio Military Medical Center, Fort Sam Houston, TX (Dr. Beltran), the Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN (Dr. Collinge), and the Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA (Dr. Gardner).
authors: Michael J
authors: MJ
authors: Beltran
authors: Cory A
authors: CA
authors: Collinge
authors: Michael J
authors: MJ
authors: Gardner
mesh_terms: D001672:Biocompatible Materials; D001696:Biomechanical Phenomena; D001860:Bone Plates / Q000009:adverse effects; D016267:External Fixators; D005592:Fracture Fixation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing / Q000502:physiology*; D050723:Fractures, Bone / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008670:Metals; D009038:Motion; D013314:Stress, Mechanical
chemical_list: D001672:Biocompatible Materials; D008670:Metals