[The effect of an angle-stable plate-screw connection and various screw diameters on the stability of plate osteosynthesis. An FE model study].

In a finite element model of a human femur with an attached stainless steel six-hole plate exposed to a load equivalent to that set up by standing on one leg, pressures on the face of the screw holes, bending stresses in the screws, and axial bone stresses in the mid-plate transverse section were determined. The calculations were performed for minor thread diameters of 3 mm, 5 mm and 8 mm. Further calculations were done assuming a fixator-like rigid screw-plate connection. As a model of a fracture a medial bone defect was chosen. The results show a definitive influence of the screw diameter and the screw-plate connection on the load distribution in the system. Increasing screw diameter makes for lower bone stresses combined with increased bending stability, a larger part of the load being carried by the plate. The rigid screw-plate connection (plate fixator) causes less bone stresses, but high bending stresses are set up the points of screw-plate fixation. Maximal stresses for screw and bone are found at the end of the plate, caused by the large difference in the E-module between the steel plate and the bone. End-plate bone and screws are loaded in excess of their material limits when 3 mm core diameters are used, and sometimes when 5 mm core diameters are used, under the assumed conditions. When a medial bone defect reducing the bone cross-sectional area by 44% is present, the loads on the inner screws increase by a factor of 3 and the loads of the distant screws, by a factor of only 1.3. The maximal pressure in the bone cross section increases 4-fold.