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Should Plate-Bone Gap be Preserved in Far-Cortical Locking Technique? A Biomechanical Study

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Abstract

Purpose

The use of a locking plate eliminates excessive pressure on bone for anatomical reduction and thus preserves the periosteal blood supply, which is important for fracture healing. The far-cortical locking technique with a semi-rigid locking screw reduces structural stiffness and parallel motion, allowing uniform callus formation at the fracture site. Although previous studies demonstrated the superior clinical and biomechanical outcomes of semi-rigid locking screws over rigid ones, it is unclear whether a gap between the plate and bone should be preserved in the far-cortical locking technique.

Methods

The present study conducted finite element analyses with mechanical calibration to clarify the influence of a plate-bone gap on the biomechanical performance of the far-cortical locking technique. A simulated mid-shaft fracture model was fixed using a locking plate and six semi-rigid locking screws. The plate-bone distance was 0 to 2 mm and the axial compressive load was 500 N.

Results

Gliding guidance at the plate-bone interface enhanced parallel intersegmental motion but reduced intersegmental movement, which is a mechanical stimulant for callus formation, and may increase pressure on the bone. Screw stresses increased with increasing plate-bone gap distance.

Conclusion

For the far-cortical locking technique, the results suggest a minor plate-bone gap should be preserved. Engagement between the plate and bone should be avoided both before and after the application of mechanical load.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan

    Shun-Ping Wang, Cheng-En Hsu & Chao-Ping Chen

  2. Sports Recreation and Health Management Continuing Studies—Bachelor’s Degree Completion Program, Tunghai University, Taichung, Taiwan

    Shun-Ping Wang & Cheng-En Hsu

  3. Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan

    Shun-Ping Wang

  4. Department of Orthopedics, National Taiwan University Hospital Yun-Lin Branch, No. 579, Sec. 2, Yun-Lin Rd. 640, Douliou City, Yunlin County, Taiwan

    Yang-Chen Chou, Chi-Wen Chou & Chen-Chiang Lin

  5. Department of Public Health, China Medical University, Taichung, Taiwan

    Chao-Ping Chen

  6. Jen-Teh Junior College of Medicine, Nursing and Management, Houlong Township, Miaoli County, Taiwan

    Chao-Ping Chen

  7. Department of Product Research and Development, A-Plus Biotechnology Corp., Taichung, Taiwan

    Kun-Jhih Lin

  8. Department of Computer Science, Tunghai University, Taichung, Taiwan

    Fuu-Cheng Jiang

  9. Technology Translation Center for Medical Device, Chung Yuan Christian University, Taoyuan, Taiwan

    Wen-Chuan Chen

Authors
  1. Shun-Ping Wang
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  2. Yang-Chen Chou
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  3. Cheng-En Hsu
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  4. Chi-Wen Chou
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  5. Chao-Ping Chen
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  6. Kun-Jhih Lin
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  7. Fuu-Cheng Jiang
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  8. Wen-Chuan Chen
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  9. Chen-Chiang Lin
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by S-PW and C-CL. The first draft of the manuscript was written by C-CL and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Chen-Chiang Lin.

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Wang, SP., Chou, YC., Hsu, CE. et al. Should Plate-Bone Gap be Preserved in Far-Cortical Locking Technique? A Biomechanical Study. J. Med. Biol. Eng. 42, 318–324 (2022). https://doi.org/10.1007/s40846-022-00702-x

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  • DOI: https://doi.org/10.1007/s40846-022-00702-x

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