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J Foot Ankle Surg. 2016 May-Jun;55(3):567-71. doi: 10.1053/j.jfas.2016.01.020. Epub 2016 Feb 9.

Comparison of the Mechanical Characteristics of a Universal Small Biplane Plating Technique Without Compression Screw and Single Anatomic Plate With Compression Screw.

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UnityPoint Clinic; and Assistant Professor, Des Moines University College of Podiatric Medicine and Surgery, Fort Dodge, IA. Electronic address:
Treace Medical Concepts, Inc., Ponte Vedra Beach, FL.
Surgical Director, Northern Colorado Podiatric Medicine and Surgery Residency, Greeley, CO.
Chief, Department of Foot and Ankle Surgery, West Virginia School of Medicine, Morgan Town, WV.
Director, Foot and Ankle Division, Moore Center for Orthopedics, Lexington, SC.


To better understand the mechanical characteristics of biplane locked plating in small bone fixation, the present study compared the stability under cyclic cantilever loading of a 2-plate locked biplane (BPP) construct without interfragmentary compression with that of a single-plate locked construct with an additional interfragmentary screw (SPS) using surrogate bone models simulating Lapidus arthrodesis. In static ultimate plantar bending, the BPP construct failed at significantly greater load than did the SPS construct (556.2 ± 37.1 N versus 241.6 ± 6.3 N, p = .007). For cyclic failure testing in plantar bending at a 180-N starting load, the BPP construct failed at a significantly greater number of cycles (158,322 ± 50,609 versus 13,718 ± 10,471 cycles) and failure load (242.5 ± 25.0 N versus 180.0 ± 0.0 N) than the SPS construct (p = .002). For cyclic failure testing in plantar bending at a 120-N starting load, the results were not significantly different between the BPP and SPS constructs for the number of cycles (207,646 ± 45,253 versus 159,334 ± 69,430) or failure load (205.0 ± 22.4 N versus 185.0 ± 33.5 N; p = .300). For cyclic testing with 90° offset loading (i.e., medial to lateral bending) at a 120-N starting load, all 5 BPP constructs (tension side) and 2 of the 5 SPS constructs reached 250,000 cycles without failure. Overall, the present study found the BPP construct to have superior or equivalent stability in multiplanar orientations of force application in both static and fatigue testing. Thus, the concept of biplane locked plating, using 2 low profile plates and unicortical screw insertion, shows promise in small bone fixation, because it provides consistent stability in multiplanar orientations, making it universally adaptable to many clinical situations.


Lapidus; arthrodesis; internal fixation; multiplane; twin plate

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