A comparison of unicortical and bicortical end screw attachment of fracture fixation plates

Plate fixation is considered by many clinicians to be the treatment of choice for displaced diaphyseal fractures of the forearm. One possible complication associated with plate fixation is refracture with the plate in situ or after plate removal. With the plate in situ, refracture typically occurs through the last screw hole near the end of the plate. Some clinicians have advocated the use of unicortical end screws to minimize the risk of such refractures. In this study, we performed a series of in vitro tests to compare the breaking strength of plated bone analogues that used either unicortical or bicortical end screws. The plated constructs that used unicortical end screws were significantly weaker in the two most important physiologic loading modes. Based on these results, we conclude that the use of unicortical end screws may result in a greater risk of refracture with the plate in situ.