Mechanical Performance of Monoaxial Versus Polyaxial Locked Plates for Bone Fracture Repair: A Review
Bibliographic record
Abstract
Widely used "locking" bone fracture plates include standard monoaxial locking plates (MLPs) that allow a single screw insertion angle relative to the plate, as well as newer polyaxial locking plates (PLPs) that permit various screw insertion angles relative to the plate. This is the first review of all studies that compared the mechanical performance of MLPs vs. PLPs. PubMed and Web of Science were searched using the phrases "locked plate polyaxial" and "locked plate variable." Eligibility criteria were applied: mechanical studies, rather than clinical studies, that directly compared MLPs vs. PLPs; bone fracture studies, rather than spine fusion or joint arthroplasty studies; studies published in English; and studies from any date. The 32 studies used experimental testing or computational modeling to compare MLPs vs. different types of PLPs either as implant-bone constructs or isolated implants. The studies employed different bone sites (humerus, radius, femur, tibia, calcaneus, "generic" long bone, implant only), bone qualities (normal, osteoporotic, unknown), fracture sites (proximal, midshaft, distal), and loading modes (axial, bending, torsional). The studies reported mechanical outcome metrics like stiffness, strength, fragment or fracture motion, bone or plate peak stress, and cyclic fatigue life; but no studies reported screw peak stress or bone "stress shielding" risk. The highest mechanical stability was obtained by different implants for the humerus (PLP with "cap" locking), radius (MLP or PLP with "bushing" or "flange" locking), femur (PLP with "cap" locking), tibia (PLP with "bushing" locking), calcaneus (PLP with "flange" or "score" locking), "generic" long bone (PLP with "cap" locking), and isolated implant without bone (PLP with "cap" locking). General trends in results, tabulated numerical data, practical "key concepts," clinical aspects, and recommendations for future work were also given in this review. PLPs almost always provided greater mechanical stability than MLPs for various bone fracture applications, but the specific type of PLP depended on the bone site.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.007 | 0.006 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".