Proximal Screw Configuration Alters Peak Plate Strain Without Changing Construct Stiffness in Comminuted Supracondylar Femur Fractures.

Objectives: Assess the effect of proximal screw configuration on the strain in lateral plating of a simulated comminuted supracondylar femur fracture.

Methods: Fractures were simulated in 12 synthetic femurs by removing a 200-mm section of bone, located 60 mm from the intercondylar fossa and repaired using a 16-hole locked lateral plate instrumented with 8 uniaxial strain gauges. Three proximal screw type configurations were evaluated: (1) 4 nonlocking screws, (2) 4 locking screws, and (3) a hybrid configuration of 2 nonlocking screws flanked by a locking screw at each end of the proximal fragment. Each screw type was compared for 2 working lengths (∼90 and 160 mm). The longer working length was created by removing the proximal screw closest to the fracture gap. Testing consisted of a vertical load (500 N) applied to the head of femur. Configurations were compared using plate strain, construct stiffness, and fracture gap displacement as outcome measures.

Results: Plate strain immediately above the fracture gap was reduced with nonlocking screws compared with the other screw types. Plate strains were reduced around the fracture gap with the longer working length but increased for the nonlocking construct at the location of the removed screw. Construct stiffness was not altered by screw type or working length. An increase in fracture gap displacement was only evident in shear translation with the longer working length.

Conclusions: Plate strain in lateral plating of supracondylar femur fractures is decreased using nonlocking screws proximal to the fracture. Increasing the working length reduces plate strains over the working length yet should be cautioned because of increased interfragmentary shear motion.