{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T07:11:55Z","timestamp":1773645115976,"version":"3.50.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Locking screws typically provide more stable fixation than conventional cortical screws. However, the rigid connection between the locking screw head and plate hole can cause stress concentrations and lead to early failure under cyclic loading. This study aimed to compare the mechanical stability of a continuous (headless) locking screw with standard locking screws and cortical screws, either in a standard (flush with the bone) or in far cortical locking constructs, using biomechanical testing and finite element analysis (FEA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Trident Distal Radial Locking Plate (A-Plus Biotechnology Co., Ltd., Taiwan) was used to repair a simulated distal radial diaphysis fracture and was secured to the bone using different screw types. The fracture gap was bridged with the plate placed flush with the bone and with the plate offset from the bone surface by 4 mm (far cortical locking (FCL)). The constructs were subjected to static compression and cyclic axial loading tests to assess construct stiffness and yield load, as well as endurance and failure mechanisms under cyclic loading, while FEA was used to evaluate the von Mises stress distribution on the plates and screws.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The Group 3a (flush with bone, continuous locking screws) had a significantly higher yield load than Groups 2b (FCL with locking screws) and 3b (FCL with continuous locking screws) (p &amp;lt; 0.05). In addition, Group 1 (flush with bone, cortical screws) was found to be significantly stiffer than Groups 2b and 3b (p &amp;lt; 0.01). For the dynamic testing, Group 3a showed intermediate endurance and failed predominantly by screw pull-out, whereas Groups 1 and 2 primarily failed by plate deformation. The FEA results showed stress concentrations at the screw neck of the standard locking screws and around the threaded regions of the continuous locking screws.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Continuous locking screws placed flush with the bone had the greatest fixation strength of all configurations tested. However, using continuous locking screws in an FCL configuration may redirect stress to the threaded region of the screw neck, potentially increasing the risk of failure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fbioe.2026.1736372","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T06:40:02Z","timestamp":1773643202000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Are continuous locking headless bone screws with locking plate fixation effective for bridging fracture gaps in far cortical locking constructs? An in vitro biomechanical and finite element study under simplified axial loading"],"prefix":"10.3389","volume":"14","author":[{"given":"Chen-Chiang","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Orthopedics, National Taiwan University Hospital Yun-Lin Branch","place":["Douliou, Yunlin, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ya-Han","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, National Yang Ming Chaio Tung University","place":["Hsinchu, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Po-Feng","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Changhua Christian Hospital","place":["Changhua, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1016\/J.INJURY.2006.08.058","article-title":"Biomechanical testing of the locking compression plate: when does the distance between bone and implant significantly reduce construct stability?","volume":"38","author":"Ahmad","year":"2007","journal-title":"Injury"},{"key":"B2","unstructured":"ASTM International. Specification and Test Method for Metallic Bone Plates\n          \n          10.1520\/F0382-24\n          West Conshohocken, PA: ASTM International\n          \n          2024"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1985","DOI":"10.2106\/JBJS.H.01038","article-title":"Far cortical locking can reduce stiffness of locked plating constructs while retaining construct strength","volume":"91","author":"Bottlang","year":"2009","journal-title":"J. Bone Jt. Surg. Am. Volume"},{"key":"B4","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1115\/1.2746369","article-title":"Fracture toughness and fatigue crack propagation rate of short fiber reinforced epoxy composites for analogue cortical bone","volume":"129","author":"Chong","year":"2007","journal-title":"J. Biomechanical Eng."},{"key":"B5","doi-asserted-by":"publisher","first-page":"967430","DOI":"10.3389\/FBIOE.2022.967430","article-title":"Optimal design and biomechanical analysis of sandwich composite metal locking screws for far cortical locking constructs","volume":"10","author":"Deng","year":"2022","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"e91933","DOI":"10.1371\/JOURNAL.PONE.0091933","article-title":"DLS 5.0 - the biomechanical effects of dynamic locking screws","volume":"9","author":"D\u00f6bele","year":"2014","journal-title":"PLoS ONE"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1572","DOI":"10.1007\/S11999-012-2733-5","article-title":"Surgical technique: simple technique for removing a locking recon plate with damaged screw heads shoulder","volume":"471","author":"Gopinathan","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1492","DOI":"10.3390\/JCM13051492","article-title":"Severity of complications after locking plate osteosynthesis in distal femur fractures","volume":"13","author":"Gurung","year":"2024","journal-title":"J. Clin. Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e911","DOI":"10.3928\/01477447-20170602-01","article-title":"New technique for removal of screws with damaged heads","volume":"40","author":"Iwata","year":"2017","journal-title":"Orthopedics"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2725","DOI":"10.1016\/J.INJURY.2020.02.094","article-title":"Can locking plate fixation of symphyseal disruptions allow early weight bearing?","volume":"52","author":"Kankanalu","year":"2021","journal-title":"Injury"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1672989","DOI":"10.3389\/FBIOE.2025.1672989","article-title":"Biomechanical comparison of the anterior reverse PHILOS and locking compression plate extra-articular distal humerus plates for extra-articular distal humeral fractures","volume":"13","author":"Kritsaneephaiboon","year":"2025","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1681460","DOI":"10.3389\/FBIOE.2025.1681460","article-title":"Mechanical optimization of plate-screw interfaces in variable-angle locking systems: a parametric study","volume":"13","author":"Lin","year":"2025","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"6189","DOI":"10.3390\/ma14206189","article-title":"Mechanical comparison of a novel hybrid and commercial dorsal double plating for distal radius fracture: in vitro fatigue four-point bending and biomechanical testing","volume":"14","author":"Liu","year":"2021","journal-title":"Mater. Basel, Switz."},{"key":"B14","doi-asserted-by":"publisher","first-page":"2176","DOI":"10.1016\/J.INJURY.2019.11.002","article-title":"Late screw-related complications in locking plating of proximal humerus fractures: a systematic review","volume":"50","author":"Panagiotopoulou","year":"2019","journal-title":"Injury"},{"key":"B15","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/J.IJSCR.2019.03.046","article-title":"An inexpensive and rapid method for removal of multiple stripped locking screws following locking plating: a case report","volume":"57","author":"Park","year":"2019","journal-title":"Int. J. Surg. Case Rep."},{"key":"B16","doi-asserted-by":"publisher","first-page":"188.e1","DOI":"10.1016\/J.JHSA.2021.04.008","article-title":"Weight-bearing restrictions with distal radius wrist-spanning dorsal bridge plates","volume":"47","author":"Raducha","year":"2022","journal-title":"J. Hand Surg."},{"key":"B17","doi-asserted-by":"publisher","first-page":"499","DOI":"10.3390\/BIOENGINEERING10040499","article-title":"Biomechanical investigation of hallux valgus deformity treated with different osteotomy methods and kirschner wire fixation strategies using the finite element method","volume":"10","author":"Shih","year":"2023","journal-title":"Bioengineering"},{"key":"B18","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1177\/1758573220961025","article-title":"Biomechanics of axial load transmission across the native human elbow","volume":"13","author":"Smithson","year":"2020","journal-title":"Shoulder & Elb."},{"key":"B19","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1007\/s11552-007-9074-y","article-title":"Biomechanical comparison of different volar fracture fixation plates for distal radius fractures","volume":"3","author":"Sobky","year":"2008","journal-title":"Hand (New York, N.Y.)"},{"key":"B20","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/J.MEDENGPHY.2018.04.006","article-title":"Importance of a moderate plate-to-bone distance for the functioning of the far cortical locking system","volume":"56","author":"Yang","year":"2018","journal-title":"Med. Eng. Phys."}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2026.1736372\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T06:40:05Z","timestamp":1773643205000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2026.1736372\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,16]]},"references-count":20,"alternative-id":["10.3389\/fbioe.2026.1736372"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2026.1736372","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,16]]},"article-number":"1736372"}}