Biomechanical analysis of polyaxial locking vs. non-locking plate fixation of unstable fractures of the distal fibula: A cadaver study with a bone only model

Hallbauer, Jakob; Gräfenstein, A.; Rausch, Sascha; Knobe, Matthias; Simons, Paul; Mückley, Thomas; Hofmann, Gunther O.; Klos, Kajetan

doi:10.1016/j.fas.2017.03.008

Cited by 4 publications

(2 citation statements)

References 14 publications

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“…6 In human, medicine biomechanical and clinical studies show good results with the use of PLS. [7][8][9][10] For the veterinary PLS, no study so far has evaluated the differences in stability of screws placed in monoaxial compared with polyaxial fashion.…”

Section: Introductionmentioning

confidence: 99%

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

Kaczmarek¹,

Bartkowiak

Schuenemann³

et al. 2019

Vet Comp Orthop Traumatol

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Objective The aim of this study was to compare the locking compression plate (LCP) with polyaxial locking system (PLS) using single cycle to failure 4-point bending test and to investigate the behaviour of PLS with screws inserted mono- and polyaxially using cyclic fatigue test in two bending directions. Materials and Methods Tests were performed on bone surrogates in a fracture gap model. The 3.5 LCP and 3.5 PLS plates were tested in single cycle to failure. The 3.5 PLS plates with mono- and polyaxial screws were compared in a cyclic fatigue tests in two orthogonal directions. For both experiments, micro-computed tomography (CT) scans were performed pre- and post-testing to investigate the connections between the screw head and the plate hole. Means of forces and cycles needed to failure were statistically compared. Results The PLS plates were on average 30% weaker than LCP plates. Mode of failure was plate bending in the single cycle to failure tests, and plate breakage in the cyclic fatigue tests. Neither screw breakage nor loss of the screw–plate interface occurred. Mono- and polyaxial constructs performed similarly when loaded in the same direction. Micro-CT revealed no additional internal cracks in the plates or screws after testing. It also showed for both PLS and LCP that there was only partial contact of the screw head with the plate hole. Clinical Relevance PLS offers a durable locking system, even when the screws are placed polyaxially. The weaker bending properties of the PLS compared with LCP should be considered during preoperative planning.

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Section: Introductionmentioning

confidence: 99%

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

Kaczmarek¹,

Bartkowiak

Schuenemann³

et al. 2019

Vet Comp Orthop Traumatol

View full text Add to dashboard Cite

show abstract

“…A small cadaveric study comparing less costly one-third tubular plates versus lateral locking plates placed in bridge mode without lag screws in a comminuted distal fibula fracture model found no difference in time to failure between groups. 11 A similar study in sawbones found the opposite result: Locking plates are biomechanically superior to standard one-third tubular plates in comminuted Weber B ankle fractures. 3 However, the external validity of both studies is questionable due to mechanical differences between cadaveric bone/sawbone as compared with biologically active in vivo bone with healing potential and distinct modulus of elasticity.…”

Section: Discussionmentioning

confidence: 96%

Lateral Locking Plate Fixation of Simple Weber B Fibula Fractures Without a Lag Screw Yields Excellent Radiographic Results

Mehraban

Lew

Foran

et al. 2021

Foot & Ankle Specialist

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Background The most common first-line fixation technique for simple Weber B fibula fractures is a lag screw with lateral neutralization plate. The most common surgical technique for unstable Weber B fibula fracture is one-third semi-tubular plate and cortical screws, implemented with lag screw when appropriate. However, the lag technique can be technically challenging in osteoporotic bone or within fibulas of smaller diameter, and in some cases can result in fragmentation at the fracture site, malreduction, or peroneal irritation. The purpose of this study is to examine an alternative first-line method for routine treatment of simple Weber B fibula fractures. Methods Fifty-two consecutive patients undergoing open reduction internal fixation (ORIF) of a Weber B fibula fracture by a single surgeon were included in this retrospective study. After reduction, a lateral locking plate was applied with cortical screws proximally and locking screws distally. No screw crossed the fracture in any case. Per published precedent, nonunion was defined as either a gap of >3 mm between fracture surfaces >6 months postoperatively or a fracture line >2 to 3 mm wide and sclerosing of the fracture surfaces. Similarly, malunion was defined as one or more of the following: talar tilt >2º, talar subluxation >2 mm, or tibiofibular clear space ≥5 mm. Results The mean (± standard deviation) age of the 52 included patients was 44.2 ± 16.2 years, the mean body mass index was 27.7 ± 6.6 kg/m2, and 63.5% of patients identified themselves as female sex. The mean follow-up was 6.2 (range: 1.5-15) months. In addition to undergoing fixation of the lateral malleolus, 21 patients also underwent fixation of the posterior malleolus, 27 underwent fixation of the medial malleolus, 29 underwent fixation across the syndesmosis, and 7 underwent repair of the deltoid. In all patients, bony anatomic union of the fibula and congruence of the mortise were achieved with no cases of malunion or nonunion. Conclusions The Arbeitsgemeinschaft für Osteosynthesefragen (AO) fixation technique for simple Weber B fractures with a lag screw and lateral neutralization plating has provided good outcomes for decades. We present an alternative technique for ORIF of these fractures with a lateral locking plate and no lag screw. In our series, we evaluated radiographic union and alignment as our primary outcome measures and found no cases of nonunion or malunion. Prospective cohort testing of lateral locking plates versus traditional fixation in the context of patient-centered value is warranted. Level of Evidence: Level III

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Cost analysis and clinical outcomes of anatomic pre-contoured locking versus conventional plates for distal fibula ankle fractures

Patel,

McCarthy,

Christensen

et al. 2023

Eur J Orthop Surg Traumatol

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Biomechanical analysis of polyaxial locking vs. non-locking plate fixation of unstable fractures of the distal fibula: A cadaver study with a bone only model

Cited by 4 publications

References 14 publications

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

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

Lateral Locking Plate Fixation of Simple Weber B Fibula Fractures Without a Lag Screw Yields Excellent Radiographic Results

Cost analysis and clinical outcomes of anatomic pre-contoured locking versus conventional plates for distal fibula ankle fractures

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