Mechanical Performance of a Polyaxial Locking Plate and the Influence of Screw Angulation in a Fracture Gap Model

Kaczmarek, Jakub; Bartkowiak, Tomasz; Schuenemann, Riccarda; Paczos, Piotr; Gapiński, Bartosz; Bogisch, Sandra; Unger, Martin G.

doi:10.1055/s-0039-1698415

Cited by 11 publications

(25 citation statements)

References 22 publications

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“…When constructs with screws inserted perpendicularly were compared to constructs with screws inserted 15 off axis by using four-point cyclic fatigue tests in two bending directions, the number of cycles to failure was not statistically different between groups. 12 The PLS is also designed to be contoured in multiple planes; in our case series, this feature of the PLS was seldom used. Additional research with a focus on these potential advantages is required.…”

Section: Discussionmentioning

confidence: 99%

“…Biomechanical testing of the PLS provided evidence that these plates were, on average, 30% weaker than locking compression plates (LCP). 12 This biomechanical study 12 provides evidence that surgeons should give consideration to ancillary fixation for fracture repairs performed with a PLS when those fractures are exposed to high stress. To the best of the authors' knowledge, no clinical report of the use of PLS to treat fractures in dogs and cats has been published.…”

Section: Introductionmentioning

confidence: 96%

“…Most veterinary locking systems are fixed‐angle constructs that prevent the surgeon from being able to angle locking screws within the plate, thus limiting screw placement adjacent to joints, fracture lines, and other implants 11‐15 . This limitation is overcome in variable‐angle locking systems.…”

Section: Introductionmentioning

confidence: 99%

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Radiographically confirmed outcomes after fracture repair with a PLS polyaxial locking system in 40 dogs and cats

Bassanino

Kaczmarek²,

Boursier

et al. 2021

Veterinary Surgery

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Objective: To report radiographic findings and complications after fracture repair with a new polyaxial locking plate system (PLS polyaxial locking system; Aesculap/B Braun, Tuttlingen, Germany) in dogs and cats. Study design: Retrospective case review from four veterinary practices. Sample population: Twenty-six dogs and 14 cats (40 long bone fractures). Methods: Medical and radiographic records of dogs and cats with long bone fractures treated with the PLS were reviewed. Cases were included when operative records were complete and included documentation of radiographic union or complications. Phone interviews of owners were performed for longterm follow-up. Ancillary methods of fracture fixation and associated complications were recorded. Results: Only two complications were recorded, one of which required a revision surgery. Radiographic follow-up was performed for all fractures. Radiographic union without complications was achieved in 38 of 40 (95%) fractures. Radiographic union was documented before 60 days in 19 of 40 (47.5%) fractures, between 61 and 90 days in 15 of 40 (37.5%) fractures, and after 90 days in six of 40 (15%) fractures. A functional union was observed at a mean time ± SD of 70.8 ± 38.9 days (range, 32-182). One or more ancillary fixation methods were used in 27 of 40 (67.5%) fractures. Conclusion: The PLS polyaxial locking system was often used with adjunct fixation in this series, and radiographically confirmed healing without complications was documented in most cases. Clinical significance: Use of the PLS can result in high success rates for fracture repair in dogs and cats, but ancillary fixation should be strongly considered.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

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Radiographically confirmed outcomes after fracture repair with a PLS polyaxial locking system in 40 dogs and cats

Bassanino

Kaczmarek²,

Boursier

et al. 2021

Veterinary Surgery

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“…The methodology and the results have been previously reported. 21 Acetal rods (Alt Industriebedarf, Neresheim, Germany) (23 mm outer diameter and 150 mm length) used as bone surrogates were aligned in a custom designed jig with a 25 mm spacer between the two segments, simulating a fracture gap model. Acetal rods used in our test were solid, manufactured to high standards of homogeneity what makes them appropriate for experimental designs where a large number of samples is required.…”

Section: Bone-plate Construct and Mechanical Testingmentioning

confidence: 99%

How Do the Locking Screws Lock? A Micro-CT Study of 3.5-mm Locking Screw Mechanism

Kaczmarek¹,

Bartkowiak

Paczos

et al. 2020

Vet Comp Orthop Traumatol

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Objective To quantify the amount of the screw head thread and the plate hole thread connection in two 3.5 mm locking plates: Locking Compression Plate (LCP) and Polyaxial Locking System (PLS). Materials and Methods A micro - CT scan of a screw head - plate hole connection was performed pre- and post destructive tests. Tests were performed on bone surrogates in a fracture gap model. The 3.5 LCP and 3.5 PLS plates, with 3 perpendicular screws per segment were used in a destructive static test. The 3.5 PLS plates with mono- and polyaxial screws were compared in a cyclic fatigue tests in two orthogonal directions. Pre - and post - test scan datasets were compared. Each dataset was converted into serial images depicting sections cut orthogonally to locking screw axis. The amount of engagement was detected through automated image postprocessing. Results The mean amount of the thread connection for the LCP was 28.85% before and 18.55% after destructive static test. The mean amount of the connection for the PLS was 16.20% before and 14.55% after destructive static test. When inserted monoaxially, the mean amount of the connection for the PLS screws was 14.4% before and 19.24% after destructive cyclic test. The mean amount of the connection for the polyaxial inserted PLS screws when loaded against plate thickness was 2.99% before and 2.08% after destructive cyclic test. The mean amount of the connection for the polyaxial inserted PLS screws when loaded against plate width was 3.36% before and 3.93% after destructive cyclic test. The 3D visualization of the thread connection showed that the initial interface points between screw head and plate hole are different for both LCP and PLS after the destructive testing. Depending on the type of applied force, there was either loss or increase of the contact. Clinical Relevance Micro-CT offers news possibilities in locking implant investigation. It might be helpful in better understanding the nature of locking mechanism and prediction of possible mode of failure in different systems.

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“…There are six main reasons for nonunion, delay union, and plate breakage: (1) improper selection of plate, (2) poor reduction of fracture, (3) unstable fixation, (4) improper selection of screw number and configuration, (5) excess early weight-bearing, and (6) infection. For implants, we have done a great deal of research on the length of the plate and the number and configuration of the screws [ 13 , 14 ]. We also replaced stainless steel (316 L) with titanium alloy (Ti6Al4V), which has lower stiffness and induces less soft tissue reaction.…”

mentioning

confidence: 99%

A biomechanical matched-pair comparison of two different locking plates for tibial diaphyseal comminuted fracture: carbon fiber-reinforced poly-ether-ether-ketone (CF-PEEK) versus titanium plates

Zhou

Tao

et al. 2020

J Orthop Surg Res

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Background Several methods have been proposed to reduce plate construct stiffness and promote secondary bone healing. In this study, we explored the stiffness and strength of the new carbon fiber-reinforced poly-ether-ether-ketone (CF 50) plate compared with the titanium alloy plate (Ti6Al4V). Methods Titanium and CF-PEEK locking plates were tested in a tibial non-osteoporotic diaphyseal comminuted fracture model to determine construct stiffness in axial compression, torsion, and bending. Subsequently, constructs were loaded until construct failure to determine construct strength. Results Relative to the titanium locking plate, the stiffness of the CF-PEEK locking plate was 6.8% and 30.8% lower in 200 N and 700 N axial compression, respectively (P < 0.05), 64.9% lower in torsion (P < 0.05), and 48.9% lower in bending (P < 0.05). The strength of the CF-PEEK locking plate was only 2.6% lower under axial compression, 7.8% lower in torsion, and 4.8% lower in bending than the titanium locking plate (P > 0.05). Conclusions The CF-PEEK locking plate significantly reduced axial, torsion, and bending stiffness compared with the titanium locking plate. Nonetheless, axial, torsional, and bending strength showed only a modest reduction. Considering its other advantages, which include radiolucency and artifact-free imaging, the CF-PEEK locking plate therefore deserves further clinical investigation.

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Mechanical Performance of a Polyaxial Locking Plate and the Influence of Screw Angulation in a Fracture Gap Model

Cited by 11 publications

References 22 publications

Radiographically confirmed outcomes after fracture repair with a PLS polyaxial locking system in 40 dogs and cats

Radiographically confirmed outcomes after fracture repair with a PLS polyaxial locking system in 40 dogs and cats

How Do the Locking Screws Lock? A Micro-CT Study of 3.5-mm Locking Screw Mechanism

A biomechanical matched-pair comparison of two different locking plates for tibial diaphyseal comminuted fracture: carbon fiber-reinforced poly-ether-ether-ketone (CF-PEEK) versus titanium plates

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