Summary
Objective: To investigate the effect of intramedullary pin size and plate working length on
plate strain in locking compression plate-rod constructs.
Methods: A synthetic bone model with a 40 mm fracture gap was used. Locking compression plates
with monocortical locking screws were tested with no pin (LCP-Mono) and intramedullary
pins of 20% (LCPR-20), 30% (LCPR-30) and 40% (LCPR-40) of intramedullary diameter.
Two screws per fragment modelled a long (8-hole) and short (4-hole) plate working
length. Strain responses to axial compression were recorded at six regions of the
plate via three-dimensional digital image correlation.
Results: The addition of a pin of any size provided a significant decrease in plate strain.
For the long working length, LCPR-30 and LCPR-40 had significantly lower strain than
the LCPR-20, and plate strain was significantly higher adjacent to the screw closest
to the fracture site. For the short working length, there was no significant difference
in strain across any LCPR constructs or at any region of the plate. Plate strain was
significantly lower for the short working length compared to the long working length
for the LCP-Mono and LCPR-20 constructs, but not for the LCPR-30 and LCPR-40 constructs.
Clinical significance: The increase in plate strain encountered with a long working length can be overcome
by the use of a pin of 30–40% intramedullary diameter. Where placement of a large
diameter pin is not possible, screws should be placed as close to the fracture gap
as possible to minimize plate strain and distribute it more evenly over the plate.
Keywords
Plate-rod - intramedullary pin - locking compression plate - plate working length
- fracture gap - plate strain