Review Question - QID 3121

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Orthopaedic Implants Plate Variations Locking plates QID: 3121 (OBQ10.33)

QID 3121 (Type "3121" in App Search)

A surgeon chooses a periarticular locking plate with unicortical proximal locking screws for an extra-articular distal femur fracture as seen in Figure A. Compared to an identical construct with bicortical unlocked proximal screw fixation, the periarticular locking plate with unicortical locking screws has which biomechanical properties?

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Greater torsional and axial fixation strength

14%

584/4311

Less torsional but greater axial fixation strength

45%

1949/4311

Equal torsional and axial fixation strength

167/4311

Greater torsional but less axial fixation strength

18%

788/4311

Less torsional and axial fixation strength

19%

803/4311

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Unicortical locking plates have characteristically less torsional strength than bicortical locking plates and bicortical non-locking plates. Axial strength is improved with locking plate fixation.

Zlowodzki et al studied the LISS periarticular locking plate with unicortical proximal fixation in a distal femur model and found superior axial fixation strength (134%) but worse torsional strength (68%) compared to a fixed angle blade plate with non-locking bicortical screw fixation.

Locked plating was reviewed by Haidukewych and Ricci which highlighted the added cost, unique complications, and they recommended the use of locked plating only in situations when unlocked constructs have demonstrated poor outcomes.