The influence of different degrees of stiffness of fixation plates on experimental bone healing

In order to throw some light on the controversial issue of the optimal stiffness in fracture fixation, the effects on bone healing of rabbit tibial osteotomies fixed by plates with four different degrees of stiffness were studied. The least stiff plate was made of glass fiber-reinforced epoxy; the other three were made of stainless steel. The median bending stiffness in vitro of tibial osteotomies fixed with the various plates were 13%, 17%, 61%, and 74%, related to the stiffness of intact tibiae. Transverse midshaft unilateral tibial osteotomies were fixed by the various plates, and the animals were killed after 6 weeks. The amount of periosteal callus was inversely related to the stiffness of the plates. A marked trend toward decreased strength and stiffness occurred in tibiae where the most rigid plate was used, compared with the values of those with the less rigid plates. This indicates that the stress-protecting effect of very stiff plates begins early in the healing period and is pronounced even at 6 weeks and that a steel plate of lower stiffness is more appropriate for bone healing. However, too flexible plates involve increased risk of redislocation and mechanical failure.