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Frictional Forces on Screws01:17

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A nonlocking end screw can decrease fracture risk caused by locked plating in the osteoporotic diaphysis.

Michael Bottlang1, Josef Doornink, Gregory D Byrd

  • 1Legacy Biomechanics Laboratory, 1225 N.E. 2nd Avenue, Portland, OR 97215, USA.

The Journal of Bone and Joint Surgery. American Volume
|March 4, 2009
PubMed
Summary
This summary is machine-generated.

Locked plating increases periprosthetic fracture risk in osteoporotic bone under bending loads. Replacing the end locking screw with a conventional screw significantly improves bending strength, reducing fracture risk.

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Area of Science:

  • Orthopedic surgery
  • Biomechanical engineering
  • Materials science in medicine

Background:

  • Locking plates utilize fixed-angle screws, differing from conventional plates that rely on plate-to-bone compression.
  • This mechanism may concentrate stress at the screw-bone interface, potentially increasing fracture risk.

Purpose of the Study:

  • To investigate if locked plating in osteoporotic diaphyseal bone increases periprosthetic fracture risk compared to conventional plating.
  • To evaluate the impact of replacing the outermost locking screw with a conventional screw on construct strength.

Main Methods:

  • Three bridge-plate constructs were tested on a validated osteoporotic femoral diaphysis surrogate.
  • Dynamic testing in bending, torsion, and axial loading determined failure loads and modes.
  • Comparisons included locked plating, conventional plating, and locked plating with the end screw replaced by a conventional screw.

Main Results:

  • Locked plating was 22% weaker in bending and 15% stronger in axial compression than conventional plating.
  • Replacing the end locking screw increased bending strength by 40% but did not significantly affect torsion or compression strength.
  • All constructs failed via periprosthetic fracture under bending loads.

Conclusions:

  • Focused load transfer in locked plates can elevate periprosthetic fracture risk in osteoporotic femurs under bending.
  • Substituting the terminal locking screw with a conventional screw mitigates stress concentration and enhances bending strength.
  • This modification offers a potential strategy to improve fixation construct stability in specific clinical scenarios.