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Biomechanical Evaluation of Variable-Angle Locking Systems. A Micro-CT Analysis.

Jakub Glowacki1, Tomasz Bartkowiak2, Bartosz Gapinski2

  • 1Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań University of Medical Sciences, Poznan, Poland.

Journal of Orthopaedic Trauma
|October 19, 2023
PubMed
Summary

Polyaxial locking screws offer fixation but off-axis insertion reduces bending strength. Locking cap screws maintain strength regardless of angle, showing superior thread engagement for better construct stability.

Keywords:
cantilever bendingmicro-CTpolyaxial locking screws

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Area of Science:

  • Orthopedic surgery
  • Biomechanical engineering
  • Implantology

Background:

  • Polyaxial locking screws have improved fixation for challenging bone stock and periprosthetic fractures.
  • Traditional polyaxial systems require precise alignment between screw heads and plate holes.
  • Ensuring construct integrity with polyaxial fixation is crucial in orthopedic surgery.

Purpose of the Study:

  • To evaluate the mechanical properties of various polyaxial locking screw systems.
  • To correlate screw-plate engagement parameters with mechanical performance.
  • To assess the impact of insertion angle on construct strength.

Main Methods:

  • Testing polyaxial systems with screws inserted at angles of 0, 5, 10, and 15 degrees.
  • Micro-computed tomography (micro-CT) for quantifying average thread engagement (ATE) at the screw-plate interface.
  • Cantilever bending tests to determine construct strength.
  • Scanning electron microscopy for detailed interface examination.

Main Results:

  • Maximum bending strength was highest with standard (0-degree) insertion across all systems.
  • Off-axis insertion significantly reduced bending strength for point-loading thread-in and cut-in screws.
  • Locking cap screws demonstrated consistent bending strength irrespective of insertion angle.
  • Micro-CT confirmed reduced ATE for off-axis screws, with locking cap mechanisms showing the highest ATE.

Conclusions:

  • The mechanical performance of polyaxial locking plates can be compromised by reduced bending strength with off-axis insertions.
  • Surgeons should consider the specific characteristics of each polyaxial system when determining insertion parameters.
  • Locking cap screw designs appear to offer more robust performance across varying insertion angles.