Stress protection due to plates: myth or reality? A parametric analysis made using the composite beam theory

A generally accepted idea has been that plate fixation of fractures may result in the structural adaptation of bone (bone loss) to reduced stress (stress protection) with the subsequent danger of refracture after implant removal. This was the negative aspect of stress protection. For this reason, it was proposed that plates made from more deformable materials be used (titanium, polymers or carbon fibres). A theoretical analysis using composite beam theory, with different loading conditions (axial load and bending), demonstrates that stress protection, i.e. early temporary porosis, is a myth. Mechanics of materials shows that when an over-large plate is fixed to small bones (as in small animals, e.g. rabbits), the reduction of bone strain is exaggerated; in contrast, using plates of varying flexibility (steel, titanium or carbon fibre) on large bones leads to strain reduction with an astonishingly similar amplitude.