Influence of Screw Angulation on the Mechanical Properties on a Polyaxial Locking Plate Fixation

Abstract

Polyaxial locking systems are widely used for strategic surgical placement, particularly in cases of osteoporotic bones, comminuted fractures, or when avoiding pre-existing prosthetics. However, studies suggest that polyaxiality negatively impacts system stiffness. We hypothesize that a new plate design, combining a narrow plate with asymmetric holes and polyaxial capabilities, could outperform narrow plates with symmetric holes. Three configurations were tested: Group 1 with six orthogonal screws, and Groups 2 and 3 with polyaxiality in the longitudinal and transverse axes, respectively. A biomechanical model assessed the bone/plate/screw interface under cyclic compression (5000 cycles) and torsion loads until failure. Screws were inserted up to 10° angle. None of the groups showed a significant loss of stiffness during compression (p > 0.05). Group 1 exhibited the highest initial stiffness, followed by Group 3 (<29%) and Group 2 (<35%). In torsional testing, Group 1 achieved the most load cycles (29.096 ± 1.342), while Groups 2 and 3 showed significantly fewer cycles to failure (6.657 ± 3.551 and 4.085 ± 1.934). These results confirm that polyaxiality, while beneficial for surgical placement, reduces biomechanical performance under torsion. Despite this, no group experienced complete decoupling of the screw–plate interface, indicating the robustness of the locking mechanism even under high stress.