Introduction: The Locking Compression Plate (LCP) system is a versatile technology that can be used either through conventional compression plating techniques or as an internal fixator with locking head screws. There have been only a few biomechanical studies examining the role of locked screw configuration on construct stability with most recommendations based upon empirical evidence or data from compression plating. This study will attempt to determine how different locked screw configurations, fracture gaps (distance between bone fragments), and interface gaps (distance between plate and bone) will affect the peak stress(von Mises stress) experienced by the plate-screw construct and, thereby, look at ways to minimize the risk of hardware failure. Materials Methods: A finite element model (FEM) was developed of a transverse mid shaft femoral fracture bridged by an eight-hole titanium LCP. Seven different screw configurations were investigated. Three different fracture gaps and three different interface gaps were studied as well. Results: The 1368 configuration was found to experience the least peak stress of 2.10 GPa while the 2367, 2457, and all filled configurations were found to have the highest peak stress (25.29 GPa, 22.78 GPa, and 23.54 GPa, respectively). Peak stress increased when the interface gap increased. Peak stress also increased as the fracture gap increased, with the largest jump between the 1 mm and 2 mm gaps. Conclusions: Every fracture is unique, and has a vast amount of parameters that must be considered when the surgeon is developing a treatment plan. For transverse femoral shaft fractures, the results of this study suggest that a working length of 2 screw holes on either side of the fracture may also lead to lower peak stress. In addition, our results demonstrate that minimizing the fracture gap and interface gap will lead to decreased stress in the plate-screw construct.

Background: Surgical management of unstable distal clavicle fractures (DCFs) remains controversial. Traditional open techniques result in acceptable union rates but are fraught with complications. In response to these limitations, arthroscopic techniques have been developed; however, clinical outcome data are limited. Purpose: The primary purpose was to systematically evaluate the clinical and radiographic outcomes of arthroscopic fixation of unstable DCFs. The secondary purpose was to characterize the overall complication rate, focusing on major complications and subsequent reoperations. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included a search of the PubMed, Web of Science, Cochrane Register of Controlled Trials, EMBASE, and Scopus databases. English-language studies between 2008 and 2019 that reported on outcomes of patients with DCFs who underwent operative fixation using an arthroscopic or arthroscopically assisted surgical technique were included. Data consisted of patient characteristics, fracture type, surgical technique, concomitant injuries, union rates, functional outcomes, and complications. Results: A total of 15 studies consisting of 226 DCFs treated using an arthroscopically based technique were included in the systematic review. The majority of fractures were classified as Neer type II. Most (97%) of the fractures underwent arthroscopic fixation using a cortical button coracoclavicular stabilization surgical technique. Bony union was reported in 94.1% of the fractures. Good to excellent outcomes were recorded in most patients at the final follow-up. The Constant-Murley score was the most widely used functional outcome score; the pooled mean Constant score was 93.06 (95% CI, 91.48-94.64). Complications were reported in 14 of the 15 studies, and the overall complication rate was 27.4%. However, only 12% of these were considered major complications, and only 6% required a reoperation for hardware-related complications. Conclusion: Arthroscopic fixation of DCFs resulted in good functional outcomes with union rates comparable to those of traditional open techniques. While the overall complication profile was similar to that of other described techniques, there was a much lower incidence of major complications, including hardware-related complications and reoperations.