Are there too many screw holes in plates for fracture fixation?

Abstract

BackgroundImplant breakage after the fixation of traumatic fractures is rare; however, when it occurs, it is debilitating for the patients and a challenge for surgeons. The purpose of this study was to analyze and identify the independent risk factors for implant breakage of traumatic fractures treated with plate osteosynthesis.MethodsWe reviewed the medical records of patients with a fracture to any part of their four extremities, clavicle, hand or foot, who underwent surgical plate osteosynthesis from January 2005 to January 2015, and who sustained a subsequent implant breakage. Kaplan–Meier univariate and multivariate Cox regressions were performed to identify independent associations of potential risk factors for implant breakage in this cohort.ResultsWe identified 168 patients who underwent plate osteosynthesis surgery and had subsequent internal fixator breakage. The mean patient age was 40.63 ± 16.71 years (range, 3 to 78 years), with 72.0% (121) males and 28.0% (47) females. The average time between surgery and implant breakage was 12.85 ± 12.42 months (range, 1 to 60 months). In the final regression model, we show that inserting screws close to the fracture line is an independent predictive risk factor for implant breakage (HR, 2.165, 95%CI, 1.227 to 3.822; P = 0.008).ConclusionsWe found that inserting screws close to the fracture line is related to an increased risk of internal fixator breakage in patients treated with plate osteosynthesis after fracture. Plates with additional holes likely lead to an increased risk of implant breakage, presumably because surgeons cannot resist inserting extra screws into the holes adjacent to the fracture line, which reduces the stiffness of the plate. We have addressed this problem by designing a plate without holes adjacent to the fracture line.

Biomechanical Evaluation of Dual Plate Configurations for Femoral Shaft Fracture Fixation

“…Eight bicortical 4.5 mm screws per plate were then inserted with a torque wrench into each of the pilot holes, securing the plate to the synthetic bone. After instrumentation of the lateral plate, a hacksaw was used to create a 1 cm osteotomy gap in the middiaphysis of the femur and center of each 10-hole plate so that the closest holes to the defect could be left empty as per the surgical protocol [14, 18]. The second plate was then instrumented on the femur.…”

“…In surgical reduction of distal femoral fractures, shorter plate length (<9 holes) correlated with higher implant breakage rates [13]. Conversely, keeping the plate hole adjacent to the fracture unfilled with a screw extended the time interval for implant failure [14].…”

Osteosynthesis of diaphyseal tibia fracture with locking compression plates: A numerical investigation using Taguchi and ANOVA

“…Numerous studies have attempted to determine efficient control parameters for plates and screws. For example, effects of screw's arrangement on the risk of plate breakage, 16 the influence of plate working length upon the interfragmentary movement across the fracture site, 17 the correlation between plate working length and fatigue‐related mechanisms, 18 the relevance of various screws configuration and bone healing, 19 and the effects of elastic modulus and cross‐sectional profile of plates on the stress shielding 20–22 have been investigated to date. Nearly, all of these previous studies were concerned with a specific complication with particular emphasis on the association between a single design parameter of LCP and only one aspect of prosperous fracture fixation.…”

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

“…The locking plates allow for the use of the biological osteosynthesis (BO) fixation principle that emphasizes preservation of blood supply. However, clinical complications such as nonunion, delay union, and plate breakage are not uncommon, accounting for about 3.5–13.3% of all cases [ 6 – 12 ].…”