Mechanical Testing of Sliding on Pivot-Locking Clamp (SOP-LC) Fracture Repair System in Four-Point Bending and Torsion

OBJECTIVES

 The first objective of this study was to compare the mechanical performance of a straight and contoured rod for the sliding on pivot-locking clamp (SOP-LC) system. The second objective was to compare single-cycle bending and torsion of the SOP-LC rod-bone constructs to a bone gap model between two clamp configurations.

STUDY DESIGN

 First experiment, 5 mm diameter rods from the 3.5 mm SOP-LC system, 4 straight and 4 bent rods were mechanically compared in four-point bending. The second experiment, 8 constructs with clamps on a single side of the rod and 8 constructs with clamps on alternating sides were compared in four-point bending and torsion. A torque limiting screwdriver at 2.5N was used for all constructs.

RESULTS

 There were not significant differences between the noncontoured versus contoured rods. Constructs with clamps on a single side had a significantly higher yield load, yield displacement and bending strength, but the constructs with alternating clamps had a significantly higher initial torsional stiffness. There were no other significant differences. Mild clamp slippage and mild screw bending were noted in all the torsion tested constructs graphically with multiple stiffness slopes and visually on the post-tested constructs.

CONCLUSION

 Torque applied to initial screw placement may play a role in reducing clamp slippage. Although bending yield load, bending yield displacement, bending strength and torsional stiffness were improved by different clamp placement, clinically this will depend on fracture type. Further studies are needed for clinical significance.

Biomechanical Comparison of Use of Two Screws versus Three Screws Per Fragment with Locking Plate Constructs under Cyclic Loading in Compression in a Fracture Gap Model

OBJECTIVES

 The aim of this study was to measure and compare the stiffness and cyclic fatigue of two plate-bone model constructs, with either two or three locking screws per fragment, under cyclic compression.

METHODS

 A 10-hole 3.5 mm stainless steel locking compression plate (LCP) was fixed 1 mm from a synthetic bone model in which the fracture gap was 47 mm. Two groups of 10 constructs, prepared with either two or three bicortical locking screws placed at the extremities of each fragment, were tested in a load-controlled compression test until failure.

RESULTS

 The three-screw constructs were stiffer than the two-screw constructs (196.75 ± 50.48 N/mm and 102.43 ± 22.93 N/mm, respectively) and the actuator displacements of the two-screw constructs were higher (18.02 ± 1.07 mm) than those of the three-screw constructs (14.48 ± 2.25 mm). The number of cycles to failure of the two-screw constructs was significantly lower (38,337.50 ± 2,196.98) than the that of the three-screw constructs (44,224.00 ± 1,515.24). Load at irreversible deformation was significantly lower in the two-screw constructs (140.93 ± 13.39 N) than in the three-screw constructs (184.27 ± 13.17 N). All constructs failed by plate bending at the gap between the two cylinders.

CLINICAL SIGNIFICANCE

 Omission of the third innermost locking screw during bridging osteosynthesis subjected to compression forces led to a 13.3% reduction in the number of cycles to failure and a 23.5% reduction of the load withstood by the plate before plastic deformation occurred.

Comparison between Areas of Bone Visualization Using Radiolucent Hybrid Fixator Frames and Graphically Simulated Metallic Frames: An Ex Vivo Study

The objective of this study is to evaluate the difference between the amount of bone visible with the superimposition of a radiolucent hybrid external fixator and a graphically simulated metallic frame. Eighteen frames were applied to eighteen bone specimens. The fracture area (FA), the radiolucent area (RLA) and the radiopaque area (ROA) inside the FA were calculated for each construct on both postoperative views. The ratio between the RLA and FA and between the ROA and FA was used to evaluate the amount of bone visible in the FA with a radiolucent and a radiopaque fixator, respectively. Finally, the areas of RLA and ROA were compared using the Wilcoxon test and Friedman test to evaluate the effect of the radiolucent material on the amount of bone visible. Differences were considered significant if p < 0.5. In every specimen p was <0.5. The amount of bone visible was significantly higher with the radiolucent frame compared to the radiopaque frame. Based on the results of this study, the use of radiolucent materials can be a valuable option for external fixation, in order to decrease the radiographic interference of the frame, allowing better assessment of fracture reduction and bone healing on postoperative radiographs.

Biomechanical Comparison of Tibial Plateau Leveling Osteotomy Performed With a Novel Titanium Alloy Locking Plate Construct vs. an Established Stainless-Steel Locking Plate Construct

A novel canine tibial plateau leveling osteotomy (TPLO) fixation device was recently developed with design features such as titanium alloy (TA) material, distal monocortical screw fixation, and a point contact undersurface specifically targeted to reduce surgical site infection rates by ensuring tissue perfusion under the plate. The strength of the novel TPLO construct was compared with that of a predicate stainless steel (SS) locking plate construct with bicortical screws in 16 paired cadaveric canine limbs. The mean loads to failure were 716.71 ± 109.50 N (range 455.69–839.69 N) and 629.50 ± 176.83 N (range 272.58–856.18 N) in the TA and SS groups, respectively. The average ratio of the loads to failure of the paired specimens was 1.18 (p = 0.031). No failure of the TA constructs involved the distal fixation with monocortical screws. Substantial mechanical equivalence of this novel TA monocortical/bicortical fixation construct to an established SS bicortical screw fixation construct is demonstrated. Clinical investigation of potential merits of this novel TA, monocortical/bicortical locking screw/plate system is now warranted.

Stiffness of a type II external skeletal fixator and locking compression plate in a fracture gap model

OBJECTIVE

To compare the stiffness of constructs fixed with a type II external skeletal fixator (ESF) or a 3.5-mm locking compression plate (LCP) in axial compression and bending with a fracture gap model.

STUDY DESIGN

Quasi-static four-point bending and axial compression tests.

SAMPLE POPULATION

Ten LCP and 10 ESF immobilizing epoxy cylinders with a 40-mm fracture gap.

METHODS

Five constructs of each type were tested in nondestructive mediolateral (ML) four-point bending and then rotated and tested in nondestructive craniocaudal (CC) four-point bending. Five additional constructs of each type were tested in nondestructive axial compression. Stiffness was compared between loading modes by construct type and between construct types by loading mode.

RESULTS

Type II ESF were stiffer than LCP in ML bending (difference, 1474 N/mm, P < .0001) and in axial compression (difference, 458 N/mm, P = .008) but not in CC bending (P = .1673). Type II ESF were stiffer in ML bending than in CC bending (difference, 999 N/m, P < .0001), while LCP were stiffer in CC bending than in ML bending (difference, 634 N/mm, P < .0001).

CONCLUSION

Type II ESF generated stiffer constructs compared with LCP in ML bending and in axial compression without a difference in CC bending. External skeletal fixator and LCP bending stiffness varied by loading direction.

CLINICAL SIGNIFICANCE

A type II ESF should be considered in a comminuted fracture requiring increased stability in ML and axial directions.