Background: It is hypothesized that the working length influences the implants fatigue behavior. However, few studies addressing this issue came to contrary results. Therefore, we tested systematically the influence of working length and implant material on the plate's endurance.
Methods: We used an artificial model providing the substantial angle and length conditions of a human femur. A fracture gap of 10mm was bridged with identical shaped plate implants made of stainless steel and grade-2 titanium. The fatigue strength was tested for a short, medium and long working length. Aiming at an implant failure within 80,000 loading cycles the upper load threshold was set to 265N for the titanium plates and to 420N for the steel plates. The lower load threshold was -20N for both plates.
Findings: For the steel plates there was no correlation between fatigue strength and working length. The construct stiffness did not differ at short and medium working length and was reduced by 10% (P=0.047) at long working length. For the titanium plates the fatigue strength tends to increase with the working length but this correlation was not significant (τ=0.417, P=0.051). Further there was a negative correlation between working length and construct stiffness (τ=0.552; P=0.01).
Interpretation: The working length has no appreciable effect on the endurance of the steel plates. Compared to the grade 2-titanium plates the stainless steel plates sustain a larger amount of cyclic load. However, for the titanium plates a larger working length tends to improve the endurance.
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