The Strain Paradox: How small changes can make big differences

One aspect of the Strain Paradox is that in large gap / comminuted fractures, increasing plate working length increases plate strain and thereby decrease plate fatigue life, as demonstrated by the OSapp models.

An expert panel in fracture biomechanics examines a common misconception in optimizing biomechanical performance of plated diaphyseal gap fractures: that guidelines for screw position and plate working length change depending on the size of the fracture gap. This misconception has been termed the Strain Paradox.

It is important for trauma surgeons to understand this misconception for two key reasons:

Firstly , their decisions on screw distribution in plated fractures have a significant effect on implant fatigue life.
Secondly, it is important that AO faculty have a clear understanding of the evidence base behind plate decision-making, how this should inform clinical practice and the advice they give course participants and surgeons in training.

The panel was led by Simon Lambert and comprised Mark Glyde, Mike Kowaleski and Peter Varga.