Biomechanical Comparison of a Notched Head Locking T-Plate and a Straight Locking Compression Plate in a Juxta-Articular Fracture Model

Abstract

Objective This investigation compared the biomechanical properties of a 2.0 mm locking compression notched head T-plate (NHTP) and 2.0 mm straight locking compression plate (LCP), in a simple transverse juxta-articular fracture model.

Study Design Two different screw configurations were compared for the NHTP and LCP, modelling short (configuration 1) and long working length (configuration 2). Constructs were tested in compression, perpendicular and tension non-destructive four point bending and torsion. Plate surface strain was measured at 12 regions of interest (ROI) using three-dimensional digital image correlation. Stiffness and strain were compared between screw configurations within and between each plate.

Results The LCP was stiffer than the NHTP in all three planes of bending and torsion (p < 0.05). The NHTP had greater strain than the LCP during compression bending and torsion at all ROI (p < 0.0005). The short working length was stiffer in all three planes of bending and in torsion (p < 0.05) than the longer working length for both plates. The long working length showed greater strain than the short working length at most ROI.

Conclusion In this experimental model, a 2.0 mm LCP with two screws in the short fragment was significantly stiffer and had lower plate strain than a 2.0 mm NHTP with three screws in the short fragment. Extending the working length significantly reduced construct stiffness and increased plate strain. These findings may guide construct selection.

Keywords

T-plate - plate strain - locking compression - working length - juxta-articular - fracture model

Note

An abstract of this paper was presented at the annual meeting of the ECVS, Athens, Greece, July 5, 2018.

Authors' Contributions

All authors contributed to conception and design of study, acquisition of data, data analysis and interpretation, and approval of the submitted manuscript. G.B., M.G., G.H. and R.D. drafted and revised submitted manuscript. G.B., M.G., and G.H. are publically accountable for relevant content.

Publikationsverlauf

Eingereicht: 27. April 2020

Angenommen: 14. September 2020

Artikel online veröffentlicht:
29. November 2020

• References

• 1 Larsen LJ, Roush JK, McLaughlin RM. Bone plate fixation of distal radius and ulna fractures in small- and miniature-breed dogs. J Am Anim Hosp Assoc 1999; 35 (03) 243-250
• 2 De Arburn Parent R, Benamou J, Gatineau M, Clerfond P, Planté J. Open reduction and cranial bone plate fixation of fractures involving the distal aspect of the radius and ulna in miniature- and toy-breed dogs: 102 cases (2008-2015). J Am Vet Med Assoc 2017; 250 (12) 1419-1426
• 3 Gibert S, Ragetly GR, Boudrieau RJ. Locking compression plate stabilization of 20 distal radial and ulnar fractures in toy and miniature breed dogs. Vet Comp Orthop Traumatol 2015; 28 (06) 441-447
• 4 Aikawa T, Miyazaki Y, Shimatsu T, Iizuka K, Nishimura M. Clinical outcomes and complications after open reduction and internal fixation utilizing conventional plates in 65 distal radial and ulnar fractures of miniature- and toy-breed dogs. Vet Comp Orthop Traumatol 2018; 31 (03) 214-217
• 5 Stoffel K, Dieter U, Stachowiak G, Gächter A, Kuster MS. Biomechanical testing of the LCP--how can stability in locked internal fixators be controlled?. Injury 2003; 34 (02) (Suppl. 02) B11-B19
• 6 Pearson T, Glyde M, Hosgood G, Day R. The effect of intramedullary pin size and monocortical screw configuration on locking compression plate-rod constructs in an in vitro fracture gap model. Vet Comp Orthop Traumatol 2015; 28 (02) 95-103
• 7 Hulse D, Hyman W, Nori M, Slater M. Reduction in plate strain by addition of an intramedullary pin. Vet Surg 1997; 26 (06) 451-459
• 8 Vallefuoco R, Le Pommellet H, Savin A. et al. Complications of appendicular fracture repair in cats and small dogs using locking compression plates. Vet Comp Orthop Traumatol 2016; 29 (01) 46-52
• 9 Ricci W, Tornetta P, Zheng Y. et al. Biomechanical investigation of plate working length on fatigue characteristics of locking plate constructs in human cadaveric distal metaphyseal femoral fracture models. 56th Annual Meeting of the Orthopaedic Research Society (Poster No. 1754) New Orleans, LA: March 6-9, 2010
• 10 Lee CH, Shih KS, Hsu CC, Cho T. Simulation-based particle swarm optimization and mechanical validation of screw position and number for the fixation stability of a femoral locking compression plate. Med Eng Phys 2014; 36 (01) 57-64
• 11 MacLeod AR, Serrancoli G, Fregly BJ, Toms AD, Gill HS. The effect of plate design, bridging span, and fracture healing on the performance of high tibial osteotomy plates: an experimental and finite element study. Bone Joint Res 2019; 7 (12) 639-649
• 12 Smith WR, Ziran BH, Anglen JO, Stahel PF. Locking plates: tips and tricks. J Bone Joint Surg Am 2007; 89 (10) 2298-2307
• 13 Gautier E, Sommer C. Guidelines for the clinical application of the LCP. Injury 2003; 34 (02) (Suppl. 02) B63-B76
• 14 Miller DL, Goswami T. A review of locking compression plate biomechanics and their advantages as internal fixators in fracture healing. Clin Biomech (Bristol, Avon) 2007; 22 (10) 1049-1062
• 15 Johnson AL, Vannini R, Houlton JE. AO Principles of Fracture Management in the Dog and Cat. Vol 148. 1st edition.. Davos Platz, Switzerland: AO Publishing; 2005
• 16 Veterinary Product Catalog Implants. Instruments, Sets. DePuy Synth Vet; 2017. . Accessed November 6, 2020 at: http://synthes.vo.llnwd.net/o16/LLNWMB8/US%20Mobile/Synthes%20North%20America/Product%20Support%20Materials/Catalogs/2017%20Vet%20Catalog.pdf
• 17 Pearson T, Glyde MR, Day RE, Hosgood GL. The effect of intramedullary pin size and plate working length on plate strain in locking compression plate-rod constructs under axial load. Vet Comp Orthop Traumatol 2016; 29 (06) 451-458
• 18 Sztefek P, Vanleene M, Olsson R, Collinson R, Pitsillides AA, Shefelbine S. Using digital image correlation to determine bone surface strains during loading and after adaptation of the mouse tibia. J Biomech 2010; 43 (04) 599-605
• 19 Väänänen SP, Amin Yavari S, Weinans H, Zadpoor AA, Jurvelin JS, Isaksson H. Repeatability of digital image correlation for measurement of surface strains in composite long bones. J Biomech 2013; 46 (11) 1928-1932
• 20 Helgason B, Gilchrist S, Ariza O. et al. Development of a balanced experimental-computational approach to understanding the mechanics of proximal femur fractures. Med Eng Phys 2014; 36 (06) 793-799
• 21 Dickinson AS, Taylor AC, Browne M. The influence of acetabular cup material on pelvis cortex surface strains, measured using digital image correlation. J Biomech 2012; 45 (04) 719-723
• 22 Krotscheck U, Nelson SA, Todhunter RJ, Stone M, Zhang Z. Long term functional outcome of tibial tuberosity advancement vs. tibial plateau leveling osteotomy and extracapsular repair in a heterogeneous population of dogs. Vet Surg 2016; 45 (02) 261-268
• 23 Grassi L, Väänänen SP, Amin Yavari S. et al. Experimental validation of finite element model for proximal composite femur using optical measurements. J Mech Behav Biomed Mater 2013; 21: 86-94
• 24 Amin Yavari S, van der Stok J, Weinans H, Zadpoor AA. Full-field strain measurement and fracture analysis of rat femora in compression test. J Biomech 2013; 46 (07) 1282-1292
• 25 Matres-Lorenzo L, Diop A, Maurel N, Boucton MC, Bernard F, Bernardé A. Biomechanical comparison of locking compression plate and limited contact dynamic compression plate combined with an intramedullary rod in a canine femoral fracture-gap model. Vet Surg 2016; 45 (03) 319-326
• 26 Bichot S, Gibson TWG, Moens NMM, Runciman RJ, Allen DG, Monteith GM. Effect of the length of the superficial plate on bending stiffness, bending strength and strain distribution in stacked 2.0-2.7 veterinary cuttable plate constructs. An in vitro study. Vet Comp Orthop Traumatol 2011; 24 (06) 426-434
• 27 Kanchanomai C, Muanjan P, Phiphobmongkol V. Stiffness and endurance of a locking compression plate fixed on fractured femur. J Appl Biomech 2010; 26 (01) 10-16
• 28 Hoffmeier KL, Hofmann GO, Mückley T. Choosing a proper working length can improve the lifespan of locked plates. A biomechanical study. Clin Biomech (Bristol, Avon) 2011; 26 (04) 405-409
• 29 McKeen LW. Fatigue and Tribological Properties of Plastics and Elastomers. 2nd edition.. Oxford: Elsevier Inc.; 2010
• 30 Märdian S, Schaser KD, Duda GN, Heyland M. Working length of locking plates determines interfragmentary movement in distal femur fractures under physiological loading. Clin Biomech (Bristol, Avon) 2015; 30 (04) 391-396
• 31 Döbele S, Horn C, Eichhorn S. et al. The dynamic locking screw (DLS) can increase interfragmentary motion on the near cortex of locked plating constructs by reducing the axial stiffness. Langenbecks Arch Surg 2010; 395 (04) 421-428
• 32 Maxwell M, Horstman CL, Crawford RL, Vaughn T, Elder S, McLaughlin R. The effects of screw placement on plate strain in 3.5 mm dynamic compression plates and limited-contact dynamic compression plates. Vet Comp Orthop Traumatol 2009; 22 (02) 125-131
• 33 Rafiq M, Kadir A. Screws placement effect on locking compression plate (LCP) for tibial oblique fracture fixation. IECBES 2010; x: 236-241
• 34 Ramanauskaite K, Riškevičien V, Grigalevičiene B, Juodžente D. Factors that affect healing in cases of canine antebrachium fractures. Vet Ir Zootech 2017; 75 (97) 58-64
• 35 Schell H, Thompson MS, Bail HJ. et al. Mechanical induction of critically delayed bone healing in sheep: radiological and biomechanical results. J Biomech 2008; 41 (14) 3066-3072
• 36 Hente R, Füchtmeier B, Schlegel U, Ernstberger A, Perren SM. The influence of cyclic compression and distraction on the healing of experimental tibial fractures. J Orthop Res 2004; 22 (04) 709-715
• 37 Stoffel K, Klaue K, Perren SM. Functional load of plates in fracture fixation in vivo and its correlate in bone healing. Injury 2000; 31 (Suppl. 02) S-B37-50
• 38 Wenger R, Oehme F, Winkler J, Perren SM, Babst R, Beeres FJP. Absolute or relative stability in minimal invasive plate osteosynthesis of simple distal meta or diaphyseal tibia fractures?. Injury 2017; 48 (06) 1217-1223
• 39 Strauss EJ, Schwarzkopf R, Kummer F, Egol KA. The current status of locked plating: the good, the bad, and the ugly. J Orthop Trauma 2008; 22 (07) 479-486
• 40 Kubiak EN, Fulkerson E, Strauss E, Egol KA. The evolution of locked plates. J Bone Jt Surg Ser A 2007; 88 (04) 189-200
• 41 Gardner MJ, Helfet DL, Lorich DG. Has locked plating completely replaced conventional plating?. Am J Orthop 2004; 33 (09) 439-446
• 42 Chen G, Schmutz B, Wullschleger M, Pearcy MJ, Schuetz MA. Computational investigations of mechanical failures of internal plate fixation. Proc Inst Mech Eng H 2010; 224 (01) 119-126
• 43 Knudson D. Fundamentals of Biomechanics. 2nd edition.. New York: Springer Science+Business Media; 2003
• 44 Smith K, Watson N, Topper T. A stress – strain function for the fatigue of metals (stress-strain function for metal fatigue including mean stress effect). J Mater 1970; 5 (04) 767-778
• 45 Pesqueira AA, Goiato MC, Filho HG. et al. Use of stress analysis methods to evaluate the biomechanics of oral rehabilitation with implants. J Oral Implantol 2014; 40 (02) 217-228