Effect of an Orthogonal Locking Plate and Primary Plate Working Length on Construct Stiffness and Plate Strain in an In vitro Fracture-Gap Model

Abstract

Objective The aim of this study was to compare stiffness and strain of an in vitro fracture-gap model secured with a primary 3.5-mm locking compression plate (LCP) at three primary plate working lengths without and with an orthogonal 2.7-mm LCP.

Study Design Primary plate screw configurations modeled short working length (SWL), medium working length (MWL), and long working length (LWL) constructs. Construct stiffness with and without an orthogonal plate during nondestructive four-point bending and torsion, and plate surface strain measured during bending, was analyzed.

Results Single plate construct stiffness was significantly, incrementally, lower in four-point bending and torsion as working length was extended. Addition of an orthogonal plate resulted in significantly higher bending stiffness for SWL, MWL, and LWL (p < 0.05) and torsional stiffness for MWL and LWL (p < 0.05). Single plate construct strain was significantly, incrementally, higher as working length was extended. Addition of an orthogonal plate significantly lowered strain for SWL, MWL, and LWL constructs (p < 0.01).

Conclusion Orthogonal plate application resulted in higher bending and torsional construct stiffness and lower strain over the primary plate in bending in this in vitro model. Working length had an inverse relationship with construct stiffness in bending and torsion and a direct relationship with strain. The inverse effect of working length on construct stiffness was completely mitigated by the application of an orthogonal plate in bending and modified in torsion.

Keywords

orthogonal plates - working length - construct stiffness - plate strain - locking plates

Note

An abstract of this study was presented at the Annual ECVS Congress, July 7, 2022, Porto, Portugal.

Authors' Contribution

All authors contributed to conception of the study, study design, acquisition of data, data analysis and interpretation, and manuscript preparation and review. All authors revised and approved the submitted manuscript.

Publikationsverlauf

Eingereicht: 11. September 2023

Angenommen: 08. Januar 2024

Artikel online veröffentlicht:
08. Februar 2024

• References

• 1 Craig A, Witte PG, Moody T, Harris K, Scott HW. Management of feline tibial diaphyseal fractures using orthogonal plates performed via minimally invasive plate osteosynthesis. J Feline Med Surg 2018; 20 (01) 6-14
• 2 Higuchi M, Katayama M. Clinical outcomes of orthogonal plating to treat radial and ulnar fractures in toy-breed dogs. J Small Anim Pract 2021; 62 (11) 1001-1006
• 3 Brown G, Kalff S, Gemmill TJ. et al. Highly comminuted, articular fractures of the distal antebrachium managed by pancarpal arthrodesis in 8 dogs: highly comminuted, articular fractures of the canine distal antebrachium. Vet Surg 2016; 45 (01) 44-51
• 4 Glyde M, Day R, Deane B. Biomechanical comparison of plate, plate-rod and orthogonal locking plate constructs in an ex-vivo canine tibial fracture gap model. Presented at: The ECVS Annual Scientific Meeting; July, 2011; Ghent, Belgium
• 5 Schmierer PA, Smolders LA, Zderic I, Gueorguiev B, Pozzi A, Knell SC. Biomechanical properties of plate constructs for feline ilial fracture gap stabilization. Vet Surg 2019; 48 (01) 88-95
• 6 Kosmopoulos V, Nana AD. Dual plating of humeral shaft fractures: orthogonal plates biomechanically outperform side-by-side plates. Clin Orthop Relat Res 2014; 472 (04) 1310-1317
• 7 El Beaino M, Morris RP, Lindsey RW, Gugala Z. Biomechanical evaluation of dual plate configurations for femoral shaft fracture fixation. BioMed Res Int 2019; 2019: 5958631
• 8 Choi JK, Gardner TR, Yoon E, Morrison TA, Macaulay WB, Geller JA. The effect of fixation technique on the stiffness of comminuted Vancouver B1 periprosthetic femur fractures. J Arthroplasty 2010; 25 (6, Suppl): 124-128
• 9 Chao P, Lewis DD, Kowaleski MP, Pozzi A. Biomechanical concepts applicable to minimally invasive fracture repair in small animals. Vet Clin North Am Small Anim Pract 2012; 42 (05) 853-872, v
• 10 Bird G, Glyde M, Hosgood G, Hayes A, Day R. Biomechanical comparison of a notched head locking T-plate and a straight locking compression plate in a juxta-articular fracture model. Vet Comp Orthop Traumatol 2021; 34 (03) 161-170
• 11 Pearson T, Glyde M, Hosgood G, Day R. The effect of intramedullary pin size and monocortical screw configuration on locking compression plate-rod constructs in an in vitro fracture gap model. Vet Comp Orthop Traumatol 2015; 28 (02) 95-103
• 12 Pearson T, Glyde MR, Day RE, Hosgood GL. The effect of intramedullary pin size and plate working length on plate strain in locking compression plate-rod constructs under axial load. Vet Comp Orthop Traumatol 2016; 29 (06) 451-458
• 13 Stoffel K, Dieter U, Stachowiak G, Gächter A, Kuster MS. Biomechanical testing of the LCP–how can stability in locked internal fixators be controlled?. Injury 2003; 34 (Suppl. 02) B11-B19
• 14 Evans A, Glyde M, Day R, Hosgood G. Effect of plate–bone distance and working length on 2.0-mm locking construct stiffness and plate strain in a diaphyseal fracture gap model: a biomechanical study. Vet Comp Orthop Traumatol 2024; 37 (01) 001-007
• 15 Reems MR, Beale BS, Hulse DA. Use of a plate-rod construct and principles of biological osteosynthesis for repair of diaphyseal fractures in dogs and cats: 47 cases (1994-2001). J Am Vet Med Assoc 2003; 223 (03) 330-335
• 16 Johnson AL, Houlton JEF, Vannini R. eds. AO Principles of Fracture Management in the Dog and Cat. 1st ed.. Vol. 148. Davos Platz, Switzerland: AO Publishing; 2005
• 17 Dickinson AS, Taylor AC, Browne M. The influence of acetabular cup material on pelvis cortex surface strains, measured using digital image correlation. J Biomech 2012; 45 (04) 719-723
• 18 Carriero A, Abela L, Pitsillides AA, Shefelbine SJ. Ex vivo determination of bone tissue strains for an in vivo mouse tibial loading model. J Biomech 2014; 47 (10) 2490-2497
• 19 Väänänen SP, Amin Yavari S, Weinans H, Zadpoor AA, Jurvelin JS, Isaksson H. Repeatability of digital image correlation for measurement of surface strains in composite long bones. J Biomech 2013; 46 (11) 1928-1932
• 20 Sztefek P, Vanleene M, Olsson R, Collinson R, Pitsillides AA, Shefelbine S. Using digital image correlation to determine bone surface strains during loading and after adaptation of the mouse tibia. J Biomech 2010; 43 (04) 599-605
• 21 Tiossi R, Lin L, Rodrigues RCS. et al. Digital image correlation analysis of the load transfer by implant-supported restorations. J Biomech 2011; 44 (06) 1008-1013
• 22 Tiossi R, Vasco MAA, Lin L. et al. Validation of finite element models for strain analysis of implant-supported prostheses using digital image correlation. Dent Mater 2013; 29 (07) 788-796
• 23 Correlated Solutions. Speckle Pattern Fundamentals. Accessed September 22, 2023 at: https://correlated.kayako.com/article/38-speckle-pattern-fundamentals
• 24 Özkaya N, Leger D, Goldsheyder D, Nordin M. Fundamentals of Biomechanics: Equilibrium, Motion, and Deformation. Cham: Springer International Publishing; 2017
• 25 Gautier E, Perren SM, Cordey J. Effect of plate position relative to bending direction on the rigidity of a plate osteosynthesis. A theoretical analysis. Injury 2000; 31 (Suppl. 03) C14-C20
• 26 Chen G, Schmutz B, Wullschleger M, Pearcy MJ, Schuetz MA. Computational investigations of mechanical failures of internal plate fixation. Proc Inst Mech Eng H 2010; 224 (01) 119-126
• 27 Chao CK, Chen YL, Wu JM, Lin CH, Chuang TY, Lin J. Contradictory working length effects in locked plating of the distal and middle femoral fractures-a biomechanical study. Clin Biomech (Bristol, Avon) 2020; 80 (07) 105198-105198
• 28 Bird G, Glyde M, Hosgood G, Hayes A, Day R. Effect of plate type and working length on a synthetic compressed juxta-articular fracture model. VCOT Open. 2020; 03 (02) e119-e128
• 29 Kanchanomai C, Muanjan P, Phiphobmongkol V. Stiffness and endurance of a locking compression plate fixed on fractured femur. J Appl Biomech 2010; 26 (01) 10-16
• 30 Matres-Lorenzo L, Diop A, Maurel N, Boucton MC, Bernard F, Bernardé A. Biomechanical comparison of locking compression plate and limited contact dynamic compression plate combined with an intramedullary rod in a canine femoral fracture-gap model. Vet Surg 2016; 45 (03) 319-326
• 31 Bichot S, Gibson TWG, Moens NMM, Runciman RJ, Allen DG, Monteith GM. Effect of the length of the superficial plate on bending stiffness, bending strength and strain distribution in stacked 2.0-2.7 veterinary cuttable plate constructs. An in vitro study. Vet Comp Orthop Traumatol 2011; 24 (06) 426-434
• 32 Liu X, Zhang S, Bao Y, Zhang Z, Yue Z. Strain-controlled fatigue behavior and microevolution of 316l stainless steel under cyclic shear path. Materials (Basel) 2022; 15 (15) 5362
• 33 Uematsu Y, Kakiuchi T, Hattori K, Uesugi N, Nakao F. Non-destructive evaluation of fatigue damage and fatigue crack initiation in type 316 stainless steel by positron annihilation line-shape and lifetime analyses. Fatigue Fract Eng Mater Struct 2017; 40 (07) 1143-1153
• 34 Hulse D, Hyman W, Nori M, Slater M. Reduction in plate strain by addition of an intramedullary pin. Vet Surg 1997; 26 (06) 451-459
• 35 Moreno MR, Zambrano S, Dejardin LM, Saunders BW. Bone biomechanics and fracture biology. In: Johnston S, Tobias K. eds. Veterinary Surgery: Small Animal. 2nd ed.. St. Louis, MO: Elsevier; 2018: 613-649
• 36 Bilmont A, Palierne S, Verset M, Swider P, Autefage A. Biomechanical comparison of two locking plate constructs under cyclic torsional loading in a fracture gap model. Two screws versus three screws per fragment. Vet Comp Orthop Traumatol 2015; 28 (05) 323-330
• 37 Palierne S, Blondel M, Swider P, Autefage A. Biomechanical comparison of use of two screws versus three screws per fragment with locking plate constructs under cyclic loading in compression in a fracture gap model. Vet Comp Orthop Traumatol 2022; 35 (03) 166-174
• 38 Wainberg SH, Moens NMM, Ouyang Z, Runciman J. The effect of working length, fracture, and screw configuration on plate strain in a 3.5-mm LCP bone model of comminuted fractures. VCOT Open. 2023; 06 (02) e122-e135
• 39 Hoffmeier KL, Hofmann GO, Mückley T. Choosing a proper working length can improve the lifespan of locked plates. A biomechanical study. Clin Biomech (Bristol, Avon) 2011; 26 (04) 405-409