Fixation of Diaphyseal Fractures with a Segmental Defect: A Biomechanical Comparison of Locked and Conventional Plating Techniques

Abstract

These results support the use of plating with bicortical locked screws as an alternative to conventional plating for comminuted diaphyseal fractures in osteoporotic bone. Bicortical locked screws with minimal displacement from the bone surface provide the most stable construct in the tested synthetic comminuted diaphyseal fracture model. The results of this study suggest use of plates with unicortical screws for the described fracture is not recommended.

Outcomes of distal humerus diaphyseal injuries fixed with a single-column anatomic plate

“…Laboratory studies of locking plate constructs have shown superior fixation compared to standard compression plates for tibial and femoral metaphyseal and diaphyseal fractures [11,12]. In a biomechanical study, Korner et al demonstrated that both two standard reconstruction plates and two pre-contoured locking plates provide adequate fixation in an extra-articular distal humerus model [7].…”

Biomechanical Analysis of Locking Reconstruction Plate Using Mono- or Bicortical Screws

“…This limitation is due to decreased working length of screw in osteoporotic bone, or the screw length in contact with the bone 7,12 . For example, in a study of synthetic ulna to simulate osteoporotic cortex, the constructs fixed by locking compression plate (combi-holes) with bicortical locked screws had less displacement after cyclic axial loading, and required a greater number of cycles to failure in cycling bending than the constructs with monocortical locked screws 27 . In addition, another study of an osteoporotic femoral diaphysis model found that unicortical locking plate constructs remained weaker than bicortical locking plate constructs in torsion 28 .…”

Selection of Plate in Internal Fixation of Fractures: Locking Plate and Compression Plate

“…잠김 금속판은 잠김나사의 특성으로 각 골절편에 움직임 이 발생하지 않게 되어 나사가 빠져 나오는 현상(pull out) 에 상대적으로 강하다 13) . 따라서, 수술 후 경과 관찰 시에 전위가 발생하는 이차 정복 소실(secondary reduction loss) 현상이 덜 발생하게 되며, 구조의 안정 강도가 나사가 뼈에 고정된 것에 의존하지 않기 때문에 복합 골절(communited fracture)이나 골다공성 골절(osteoporotic fracture) 등에서 매우 유용하다 9,10,13,19) . 특히, 피질골의 강도가 매우 약하여 안정된 고정을 위한 회전모멘트(torque)가 나사가 피질골에 서 빠져 나오는 회전모멘트보다 강한 골다공성 골(osteoporotic bone)에서 유용하다 36) .…”