Objective: This investigation considers the effect of a variety of screw po
sitions on plate strain in three fracture models.
Design: Dynamic compression plate fixation of in vitro fracture models.
Methods: To model a fracture, a plastic pipe was cut transversely and a twe
nty-hole dynamic compression plate was attached by screws. Eighteen stacked
, rectangular, rosette strain gauges were installed on the plate to evaluat
e strain. Three models were evaluated: two constructs in which there was no
contact between the cut ends of the pipe under the fixation plate (small-
and large-gap models) and a construct in which there was direct apposition
of the cut ends (no-gap model). The pattern and magnitude of strains were a
ssessed as a function of varying combinations of screw position for each mo
del.
Results: Maximal plate strain in the gap models was lowest with screws plac
ed closest to the gap, compared with screws placed away from the gap or spa
ced apart. The no-gap model showed significantly lower strains when screws
were placed further from the osteotomy site than when screws were positione
d close together or spaced apart. In all cases, maximal plate strain occurr
ed adjacent to the most central screw holes and rapidly dissipated along th
e length of the plate.
Conclusion: In a model simulating a comminuted fracture (gap), this study f
ound that screws should be placed as close to the fracture site as possible
to minimize plate strain. In an anatomically reduced two-part fracture mod
el (no gap), widely spaced screws or those placed away from the fracture re
sulted in lower strains.