Comparison of Bending Stiffness between String of Pearls Plate-Bone Substitute Constructs with and without Bending Tees in a Fracture Gap Model.

Objective:  The aim of this study was to compare the bending properties of String of Pearls plate-bone substitute constructs with and without bending tees in the nodes over a simulated fracture gap. It is hypothesized that the constructs with tees will have higher bending stiffness.

Study Design:  Acetal polymer tubes and 12-hole, 3.5-mm String of Pearls plates were used to create plate-bone substitute constructs simulating stabilization in a bridging fashion over a 45-mm gap. Twenty-four constructs were made with 12 containing tees in the nodes over the fracture gap. Single-cycle load-to-failure 4-point bending was performed in mediolateral and craniocaudal planes. Bending stiffness was compared with a -test ( < 0.05).

Results:  All plate-bone substitute constructs had a permanent loss of structural integrity via plastic deformation of the plate. The bending stiffness (mean ± standard deviation) of the craniocaudal group was 59.11 ± 1.98 N/mm with tees and 59.25 ± 1.69 N/mm without tees ( = 0.88). In the mediolateral group, the bending stiffness was 43.17 ± 0.75 N/mm with tees and 41.09 ± 0.91 N/mm without tees ( = 0.0042).

Conclusion:  In 4-point bending, the plate-bone substitute constructs with tees had equivalent bending stiffness in the craniocaudal plane and increased bending stiffness in the mediolateral plane. However, with a small absolute difference in values, the clinical significance is unclear. Future studies for cyclic bending, torsional, and axial compression tests should be performed to further investigate the value of tees in the nodes over a comminuted or gap fracture repaired in a bridging fashion.