The dynamic locking screw (DLS) can increase interfragmentary motion on the near cortex of locked plating constructs by reducing the axial stiffness

BackgroundThe plate–screw interface of an angular stable plate osteosynthesis is very rigid. So far, all attempts to decrease the stiffness of locked plating construct, e.g. the bridged plate technique, decrease primarily the bending stiffness. Thus, the interfragmentary motion increases only on the far cortical side by bending the plate. To solve this problem, the dynamic locking screw (DLS) was developed.Materials and methodsComparison tests were performed with locking screws (LS) and DLS. Axial stiffness, bending stiffness and interfragmentary motion were compared. For measurements, we used a simplified transverse fracture model, consisting of POM C and an 11-hole LCP3.5 with a fracture gap of 3 mm. Three-dimensional fracture motion was detected using an optical measurement device (PONTOS 5 M/GOM) consisting of two CCD cameras (2,448 × 2,048 pixel) observing passive markers.ResultsThe DLS reduced the axial stiffness by approximately 16% while increasing the interfragmentary motion at the near cortical side significantly from 282 µm (LS) to 423 µm (DLS) applying an axial load of 150 N.ConclusionThe use of DLS reduces the stiffness of the plate–screw interface and thus increases the interfragmentary motion at the near cortical side without altering the advantages of angular stability and the strength.

[1]  Brighton Ct The biology of fracture repair. , 1984 .

[2]  W. Ramotowski,et al.  Zespol. An original method of stable osteosynthesis. , 1991, Clinical orthopaedics and related research.

[3]  P. Kelly,et al.  Effect of fracture fixation on cortical bone blood flow , 1990, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[4]  R. Nanda,et al.  Biomechanical testing of the locking compression plate: when does the distance between bone and implant significantly reduce construct stability? , 2007, Injury.

[5]  D Kaspar,et al.  Effects of Mechanical Factors on the Fracture Healing Process , 1998, Clinical orthopaedics and related research.

[6]  Georg N Duda,et al.  Interfragmentary Motion in Tibial Osteotomies Stabilized With Ring Fixators , 2002, Clinical orthopaedics and related research.

[7]  M. Gardner,et al.  Stiffness Modulation of Locking Plate Constructs Using Near Cortical Slotted Holes: A Preliminary Study , 2009, Journal of orthopaedic trauma.

[8]  S M Perren,et al.  Long-term effects of plate osteosynthesis: comparison of four different plates. , 2000, Injury.

[9]  C. Brighton The biology of fracture repair. , 1984, Instructional course lectures.

[10]  A. Patel,et al.  Biomechanical evaluation of the schuhli nut. , 1998, Clinical orthopaedics and related research.

[11]  J Kenwright,et al.  Controlled mechanical stimulation in the treatment of tibial fractures. , 1989, Clinical orthopaedics and related research.

[12]  K. Stürmer Die elastische Plattenosteo-synthese, ihre Biomechanik, Indikation und Technik im Vergleich zur rigiden Osteosynthese , 1996, Der Unfallchirurg.

[13]  S. Perren,et al.  Strength recovery in fractured sheep tibia treated with a plate or an internal fixator: an experimental study with a two-year follow-up. , 1997, Journal of orthopaedic trauma.

[14]  L. Claes,et al.  Early dynamization by reduced fixation stiffness does not improve fracture healing in a rat femoral osteotomy model , 2009, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[15]  J Cordey,et al.  Developments of compression plate techniques for internal fixation of fractures. , 1973, Progress in surgery.

[16]  J Kenwright,et al.  The influence of induced micromovement upon the healing of experimental tibial fractures. , 1985, The Journal of bone and joint surgery. British volume.

[17]  M. Swiontkowski,et al.  A comparative biomechanical evaluation of a noncontacting plate and currently used devices for tibial fixation. , 1996, The Journal of trauma.

[18]  L. Claes,et al.  The effects of external mechanical stimulation on the healing of diaphyseal osteotomies fixed by flexible external fixation. , 1998, Clinical biomechanics.

[19]  Erik N. Kubiak,et al.  Biomechanics of Locked Plates and Screws , 2004, Journal of orthopaedic trauma.

[20]  H. Uhthoff,et al.  The role of rigidity in fracture fixation. An overview. , 1984, Archives of orthopaedic and traumatic surgery. Archiv fur orthopadische und Unfall-Chirurgie.

[21]  P. Kloen,et al.  Locking Compression Plates for Osteoporotic Nonunions of the Diaphyseal Humerus , 2004, Clinical orthopaedics and related research.

[22]  P Augat,et al.  Effect of dynamization on gap healing of diaphyseal fractures under external fixation. , 1995, Clinical biomechanics.

[23]  Ulrich Dieter,et al.  Biomechanical testing of the LCP--how can stability in locked internal fixators be controlled? , 2003, Injury.

[24]  J Kenwright,et al.  The role of fixator frame stiffness in the control of fracture healing. An experimental study. , 1993, Journal of biomechanics.

[25]  K. Stürmer [Elastic plate osteosynthesis, biomechanics, indications and technique in comparison with rigid osteosynthesis]. , 1996, Der Unfallchirurg.

[26]  S. Döbele,et al.  Therapieresistente Unterschenkelpseudarthrose , 2009, Der Unfallchirurg.

[27]  Philippe Poitras,et al.  Internal plate fixation of fractures: short history and recent developments , 2006, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[28]  A. E. Goodship,et al.  EFFECT OF CONTROLLED AXIAL MICROMOVEMENT ON HEALING OF TIBIAL FRACTURES , 1986, The Lancet.

[29]  A. T. Berman,et al.  The use of the Hickman catheter in orthopaedic infections. Brief note. , 1985, The Journal of bone and joint surgery. American volume.

[30]  H. Uhthoff,et al.  The role of rigidity in fracture fixation , 2004, Archives of Orthopaedic and Trauma Surgery.

[31]  Michael Bottlang,et al.  Far cortical locking can reduce stiffness of locked plating constructs while retaining construct strength. , 2009, Journal of Bone and Joint Surgery. American volume.