Effect of an Orthogonal Locking Plate and Primary Plate Working Length on Construct Stiffness and Plate Strain in an In vitro Fracture-Gap Model

Objective: The aim of this study was to compare stiffness and strain of an in vitro fracture-gap model secured with a primary 3.5-mm locking compression plate (LCP) at three primary plate working lengths without and with an orthogonal 2.7-mm LCP. Study design: Primary plate screw configurations modeled short working length (SWL), medium working length (MWL), and long working length (LWL) constructs. Construct stiffness with and without an orthogonal plate during nondestructive four-point bending and torsion, and plate surface strain measured during bending, was analyzed. Results: Single plate construct stiffness was significantly, incrementally, lower in four-point bending and torsion as working length was extended. Addition of an orthogonal plate resulted in significantly higher bending stiffness for SWL, MWL, and LWL (p < 0.05) and torsional stiffness for MWL and LWL (p < 0.05). Single plate construct strain was significantly, incrementally, higher as working length was extended. Addition of an orthogonal plate significantly lowered strain for SWL, MWL, and LWL constructs (p < 0.01). Conclusion: Orthogonal plate application resulted in higher bending and torsional construct stiffness and lower strain over the primary plate in bending in this in vitro model. Working length had an inverse relationship with construct stiffness in bending and torsion and a direct relationship with strain. The inverse effect of working length on construct stiffness was completely mitigated by the application of an orthogonal plate in bending and modified in torsion.