Cytotoxicity of novel hybrid composite materials for making bone fracture plates

Bone fracture plates are usually made from steel or titanium, which are much stiffer than cortical bone. This may cause bone 'stress shielding' (i.e. bone resorption leading to plate loosening) and delayed fracture healing (i.e. fracture motion is less than needed to stimulate callus formation at the fracture). Thus, the authors previously designed, fabricated, and mechanically tested novel 'hybrid' composites made from inorganic and organic materials as potential bone fracture plates that are more flexible to reduce these negative effects. This is the first study to measure the cytotoxicity of these composites via the survival of rat cells. Cubes of carbon fiber/flax fiber/epoxy and glass fiber/flax fiber/epoxy had better cell survival vs. Kevlar fiber/flax fiber/epoxy (57% and 58% vs. 50%). Layers and powders made of carbon fiber/epoxy and glass fiber/epoxy had higher cell survival than Kevlar fiber/epoxy (96%-100% and 100% vs. 39%-90%). The presence of flax fibers usually decreased cell survival. Thus, carbon and glass fiber composites (with or without flax fibers), but not Kevlar fiber composites (with or without flax fibers), may potentially be used for bone fracture plates.

Outcome Study of Mandibular Fractures Treated by Surgical Stabilization With Plates and Screws

This study aims to assess the outcomes of mandibular fractures treated through surgical stabilization using plates and screws, focusing on factors such as postoperative complications, patient satisfaction, and functional recovery. A total of 42 patients were included in the study. Surgical interventions involved the application of plates and screws at the fracture sites. Postoperative complications, including infection, hardware failure, and malocclusion, were recorded. Surgical stabilization of mandibular fractures using plates and screws demonstrates favorable outcomes in terms of stability, occlusal alignment, and patient satisfaction. The findings of this study contribute valuable insights into the efficacy of this surgical approach, highlighting its role in achieving successful outcomes for mandibular fracture management. Further prospective studies and randomized controlled trials are recommended to strengthen the evidence base and refine treatment protocols.

Self-Assembly of Mixed-Dimensional GeS1- x Sex (1D Nanowire)-(2D Plate) Van der Waals Heterostructures

The integration of dissimilar materials into heterostructures is a mainstay of modern materials science and technology. An alternative strategy of joining components with different electronic structure involves mixed-dimensional heterostructures, that is, architectures consisting of elements with different dimensionality, for example, 1D nanowires and 2D plates. Combining the two approaches can result in hybrid architectures in which both the dimensionality and composition vary between the components, potentially offering even larger contrast between their electronic structures. To date, realizing such heteromaterials mixed-dimensional heterostructures has required sequential multi-step growth processes. Here, it is shown that differences in precursor incorporation rates between vapor-liquid-solid growth of 1D nanowires and direct vapor-solid growth of 2D plates attached to the wires can be harnessed to synthesize heteromaterials mixed-dimensional heterostructures in a single-step growth process. Exposure to mixed GeS and GeSe vapors produces GeS1- x Sex van der Waals nanowires whose S:Se ratio is considerably larger than that of attached layered plates. Cathodoluminescence spectroscopy on single heterostructures confirms that the bandgap contrast between the components is determined by both composition and carrier confinement. These results demonstrate an avenue toward complex heteroarchitectures using single-step synthesis processes.

Quality of Life after Mandibular Reconstruction Using Free Fibula Flap and Customized Plates: A Case Series and Comparison with the Literature

A single-center retrospective study was conducted to assess health-related quality of life (HRQoL) in 23 consecutive patients undergoing mandibular reconstruction using the computer-aided design (CAD) and computer-aided manufacturing (CAM) technology, free fibula flap, and titanium patient-specific implants (PSIs). HRQoL was evaluated after at least 12 months of surgery using the University of Washington Quality of Life (UW-QOL) questionnaire for head and neck cancer patients. In the 12 single question domains, the highest mean scores were found for "taste" (92.9), "shoulder" (90.9), "anxiety" (87.5), and "pain" (86.4), whereas the lowest scores were observed for "chewing" (57.1), "appearance" (67.9), and "saliva" (78.1). In the three global questions of the UW-QOL questionnaire, 80% of patients considered that their HRQoL was as good as or even better than it was compared to their HRQoL before cancer, and only 20% reported that their HRQoL had worsened after the presence of the disease. Overall QoL during the past 7 days was rated as good, very good or outstanding by 81% of patients, respectively. No patient reported poor or very poor QoL. In the present study, restoring mandibular continuity with free fibula flap and patient-specific titanium implants designed with the CAD-CAM technology improved HRQoL.

Diatom-inspired stiffness optimization for plates and cellular solids

Diatoms, a class of aquatic autotrophic microorganisms, are characterized by silicified exoskeletons with highly complex architectures. These morphologies have been shaped by the selection pressure that the organisms have been subjected to during their evolutionary history. Two properties which are highly likely to have contributed to the evolutionary success of current diatom species are lightweightness and structural strength. Thousands of diatom species are present in water bodies today, and although each has its unique shell architecture, a strategy that is common across species is the uneven and gradient solid material distribution across their shells. The aim of this study is to present and evaluate two novel structural optimization workflows inspired by material grading strategies in diatoms. The first workflow mimics theAuliscus intermidusdiatoms' surface thickening strategy and generates continuous sheet structures with optimal boundaries and local sheet thickness distributions when applied to plate models subjected to in-plane boundary conditions. The second workflow mimics theTriceratium sp.diatoms' cellular solid grading strategy, and produces 3D cellular solids with optimal boundaries and local parameter distributions. Both methods are evaluated through sample load cases, and prove to be highly efficient in transforming optimization solutions with non-binary relative density distributions into highly performing 3D models.

Similar Clinical Outcome in Locking and Conventional Plate Osteosynthesis for the Treatment of AO 44-B2 Ankle Fractures

INTRODUCTION

Biomechanical studies have proved that locking plates have better primary stability besides versatility regarding fracture pattern while reducing bone contact and bridging the gap, whereas conventional nonlocking plates (plus lag screw) depend on bone-plate compression. The clinical benefit of locking plates over nonlocking plates remains unanswered, however. Therefore, this retrospective cohort study was set up to test the hypothesis that the use of locking plates for unstable ankle fractures will result in fewer re-displacements, superior bony healing, and functional and clinical outcomes better than observed in the nonlocking cohort.

METHODS

Bimalleolar ankle fractures (AO 44-B2) without syndesmotic injury treated with either a locking or a nonlocking plate were included. Groups were compared for complications, bone healing, secondary dislocation, progressions of osteoarthritis, and clinical outcome using patient-reported outcome measures.

RESULTS

Data revealed no clinical outcome differences (Olerud-Molander Ankle Score: nonlocking 88.2 ± 14.4, locking 88.8 ± 12.3, P = .69, robust two 1-sided test for equality (RTOST): P = .03; American Orthopaedic Foot and Ankle Score: nonlocking 91.2 ± 12.9, locking 91.8 ± 11.3, P = .96, RTOST: P = .04). Nevertheless, a significant postoperative progression of osteoarthritis was detected in both groups (P = .04). This was independent of implant (P = .16). Although difference was not significant, locking plates were preferred in older (P = .78) and sicker patients (P = .63) and in cases with severer osteoarthritis (P = .16), and were associated with a higher complication rate (P = .42) and secondary dislocation (nonlocking 9.4%, locking 18.2%; P = .42). Re-displacement, however, was not a compelling reason for revision.

CONCLUSIONS

The present study shows statistically significant equality of both types of implants. Contrary to our expectation, locking plates seemed to be associated with a higher risk for re-displacement. Overall, the use of either locking or nonlocking plates for unstable AO 44-B2 fractures is safe and successful despite significant progression of osteoarthritis.

LEVEL OF EVIDENCE

III, Retrospective observational cohort study.

Proposition for Determining the Residual Strength of Fiber-Reinforced Cement Composite

Designing bending elements made of fiber composites requires knowledge of the residual strengths. Residual strengths determined according to PN-EN 14651, regardless of the type of matrix and the fibers used, are characterized by a very-high coefficient of variation, about 30%. The variability of this feature is so large that the normal distribution adopted in statistical analyses, which is consistent for compressive strength or tensile strength, may, in the case of residual strengths, result in a significant overdesign of the elements. Therefore, the article proposes a novel method of determining the residual strength with the use of centrally bent square plates simply supported at the perimeter. The coefficient of variation of this characteristic in the case of plate testing is about 8%.

Metacarpal Fractures, Management Techniques, and Outcomes in Our Center

Introduction/background

Metacarpal fractures comprise approximately 35.5% of cases in daily emergencies, mostly due to road traffic accidents (RTA), fall, and assault. The classification is based on the site and pattern of fracture. High-level evidence is lacking for the management of metacarpal fractures. The primary goals of treatment are to achieve acceptable alignment, stable reduction, strong bony union, and unrestricted motion. It can be managed by non-operative methods like close reduction and splintage. Operative management will be required if there is shortening, rotation, and angulation in different planes including close reduction and fixation with percutaneous intramedullary pining/k-wires and open reduction and fixation with screws, plates (compression/locking), and external fixators. This study was done to compare the efficacy of k-wire, screws, and plates in the management of metacarpal fractures and their outcomes based on their union, postoperative pain, range of movement, and grip strength in a tertiary care center, i.e., Liaquat National Hospital and Medical College.

Methods

It was a retrospective study conducted at the Department of Plastics and Reconstruction Surgery, of a tertiary care hospital. A total of 113 patients who were operated upon for metacarpal fracture were included in the study (open/close) without soft tissue loss or tendon injury, were divided into three groups according to the technique of fracture fixation, i.e., group 1 (k-wire), group 2 (screw), and group 3 (plates). The data like post-operative pain (visual analog scale, VAS) and radiological evidence of union were extracted from the registry. All the patients were called for follow-up in the outpatient department. Out of 113, 97 patients showed up for follow-up and were examined by a hand surgeon, and range of movement (goniometer) and grip strength (sphygmomanometer method) were assessed.

Results

A total of 97 patients were included in the study (male 66%, female 34%). Group 1 (K-wire) includes n = 61 (62.9%), group 2 (screw) n = 15 (15.5%), and group 3 (plate) n = 21 (21.6%). The mean follow-up time was 12 + 2 weeks after the surgery for post-operative pain and radiological evidence of union while 24 + 6 months for a range of movement and grip strength. Less post-operative pain was noted in group 1 patients while no significant difference was noted in the evidence of radiological union in all groups. Range of movement was better in group 1 patients (89.74 + 0.750) than in group 2 (80 + 0.37°) or group 3 (80.2 + 0.62°). The grip strength (compared to the normal contralateral hand) was normal in the majority of the patients in group 1, i.e., 94% while it was 80% in group 2 and 82% in group 3.

Conclusion

The significance of these reported findings suggests that open reduction and internal fixation with screw or plate might be a less preferable surgical technique in comparison to k-wire fixation in the treatment of a metacarpal fracture.

The plate-to-rod transition in trabecular bone loss is elusive

Changes in trabecular micro-architecture are key to our understanding of osteoporosis. Previous work focusing on structure model index (SMI) measurements have concluded that disease progression entails a shift from plates to rods in trabecular bone, but SMI is heavily biased by bone volume fraction. As an alternative to SMI, we proposed the ellipsoid factor (EF) as a continuous measure of local trabecular shape between plate-like and rod-like extremes. We investigated the relationship between EF distributions, SMI and bone volume fraction of the trabecular geometry in a murine model of disuse osteoporosis as well as from human vertebrae of differing bone volume fraction. We observed a moderate shift in EF median (at later disease stages in mouse tibia) and EF mode (in the vertebral samples with low bone volume fraction) towards a more rod-like geometry, but not in EF maximum and minimum. These results support the notion that the plate to rod transition does not coincide with the onset of bone loss and is considerably more moderate, when it does occur, than SMI suggests. A variety of local shapes not straightforward to categorize as rod or plate exist in all our trabecular bone samples.

Long-Term Functional Results of Intra- and Extra-Articular Hand Fractures Treatment With Titanium Miniature Plates and Screws With Minimum Follow-Up of 24 Months

Introduction

The purpose of this study was to evaluate the long-term outcome of an extended range of hand fractures treated with titanium, low profile plates, and screws.

Materials and methods

This retrospective study included adult patients with at least one phalangeal and/or metacarpal fracture, treated with mini titanium plates and screws, between 2004-2016, in a single trauma center, that were followed-up for at least 24 months and with complete, intact medical records.

Results

90 patients (79 men and 11 women) with 114 hand (46 phalangeal, 68 metacarpal) fractures fulfilled the inclusion criteria. Thirty-two fractures were open (28.07%), 27 were intra-articular (23.68%), and 12 were both open and intra-articular fractures. The mean age of the patients was 36.02 years (range 17-75). Mean follow-up was 95.3 months (range 24 to 138). Open fractures had a reduced mean grip strength and total active motion. No difference was observed between intra-articular and extra-articular fractures (for grip strength and total active motion). Predictors of the final outcome included the severity of the initial injury (open vs closed) and not the anatomic location (intra- or extra-articular, metacarpal, or phalangeal) of the fracture.

Conclusions

Low-profile plates and screws can successfully be used to establish union and restore the alignment of the fractured bone while achieving a satisfactory clinical outcome, even in cases of open or intra-articular fractures.

Optimal Design of Plated/Shell Structures under Flutter Constraints-A Literature Review

Aeroelastic optimization has become an indispensable component in the evaluation of divergence and flutter characteristics for plated/shell structures. The present paper intends to review the fundamental trends and dominant approaches in the optimal design of engineering constructions. A special attention is focused on the formulation of objective functions/functional and the definition of physical (material) variables, particularly in view of composite materials understood in the broader sense as not only multilayered laminates but also as sandwich structures, nanocomposites, functionally graded materials, and materials with piezoelectric actuators/sensors. Moreover, various original aspects of optimization problems of composite structures are demonstrated, discussed, and reviewed in depth.

History and advances in spinal neurosurgery

Insight into the historic contributions made to modern-day spine surgery provides context for understanding the monumental accomplishments comprising current techniques, technology, and clinical success. Only during the last century did surgical growth occur in the treatment of spinal disorders. With that growth came a renaissance of innovation, particularly with the evolution of spinal instrumentation and fixation techniques. In this article, the authors capture some of the key milestones that have led to the field of spine surgery today, with an emphasis on the historical advances related to instrumentation, navigation, minimally invasive surgery, robotics, and neurosurgical training.

Fixation of Crescent Pelvic Fracture in a Tertiary Care Hospital: A Steep Learning Curve

Background

Crescent fracture-dislocation of sacroiliac joint is a type of lateral compression pelvic injury associated with instability. These fractures comprise 12% of lateral compression fractures.

Objective

The objective of this study is to share the experience and to assess the functional outcome of fixation in crescent fracture-dislocation.

Methods

We analyzed a descriptive case series with clinical data of 15 patients at the Department of Orthopedics Surgery at the Dr. Ruth K.M. Pfau Civil Hospital at Dow University of Health Sciences in Karachi, Pakistan, from January 2016 to August 2018. The patients were treated by closed and open fracture reduction and fixed with percutaneous screws and reconstruction plates.

Results

A total of 15 patients were included in this study with age ranging from 20 to 60 years (11 men [73%]; four women [27%]). According to the mechanism of injury, five (33%) had motorcycle accidents; four (27%) had collision while sitting in a car; three (20%) were pedestrians hit by a vehicle; four (27%) were injured while sitting in van; two (13%) had bus-related injury, and one (6.5%) presented with a history of wall collapse.

Five (33%) patients had type I fractures, seven (47%) had type II fractures, and three (20%) had type III fractures Associated injuries were midshaft femur fracture in two patients, contralateral superior and inferior rami fracture in three patients, and open tibia fracture in one patient. All fractures were fixed with reconstruction plates and screws. Patients were kept as non-weight-bearing on the injured joint for three weeks, mobilized non-weight-bearing on the contralateral leg after three weeks, and partial weight-bearing was started at eight weeks; full weight-bearing was started after three months. Nine patients (60%) had excellent outcomes, three (20%) had a good outcome, and three (20%) had a poor outcome.

Conclusion

Crescent fracture-dislocations are unstable injuries. These fractures should have proper reduction and fixation that will reduce pain, malunion, and shortening.

Surgical Fixation of Metacarpal Shaft Fractures Using Absorbable Implants: A Systematic Review of the Literature

BACKGROUND

Despite the proven efficacy and advantages of absorbable implants, their use for metacarpal shaft fixation has been limited. This is likely due to the high reported complication rates in early studies with polyglycolic acid (PGA) implants, notably high rates of noninfectious inflammatory reaction (5%-25%), occurring up to 30 weeks after fixation. The objective of this study was to assess the clinical outcomes of newer absorbable plates and screws in the treatment of metacarpal shaft fractures.

METHODS

The authors performed a systematic search of the PubMed, Ovid MEDLINE, and EMBASE databases dating from 1946 to 2017. Primary outcome measures were the development of noninfectious inflammatory reaction and implant failure.

RESULTS

A total of 42 metacarpal shaft fractures in 35 patients were included. The average follow-up time was 20.4 months (n = 24; range: 3.6-61 months). Only 1 case (2.4%) of noninfectious inflammatory reaction was reported with polylactic acid (PLA) plates and PLA/PGA compounds. Noninfectious inflammatory reaction was observed in 4 out of the 9 patients (44.4%) with a trimethylene carbonate/PLA compound. Symptoms appeared after an average time of 15.8 months (range: 12-19 months) post-fixation. Painless prolonged inflammation that resolved spontaneously within 6 months was reported in 7.1% of cases (n = 3). Implant failure with loss of fracture reduction was reported in 9.5% of cases (n = 4).

CONCLUSIONS

Newer absorbable materials appear to have significantly lower rates of noninfectious inflammatory reaction than previously reported. When compared with metallic fixation of the metacarpal shaft, absorbable fixation appears to have comparable complication rates and biomechanical properties.

[Thoracic inestability fixed with bioabsorbable screws and plates]

BACKGROUND

Flail chest is managed with mechanical ventilation or inhaloteraphy and analgesia. Little has been published on the use of bioabsorbable material and its evolution in flail chest fixation.

METHODS

This is a descriptive study of patients with unstable chest undergoing fixation with bioabsorbable plates and screws in a period from February 2009 to December 2011.

RESULTS

We report 18 cases, aged 33-74 years (mean 53), three with bilateral involvement; rib fixation was performed between 1-21 days of the accident (mean 1.5). They started walking the next day in 14 cases; postoperative stay was four days (range 3-14). The heart rate of patients prior to surgery was 90 per minute (range 82-100) and lowered to 84 after fixation (range 82-92), preoperative respiratory rate was 26 per minute (range 22-28) and below 22 per minute (range 20 to 26) in postoperative period.

CONCLUSIONS

The use of bioabsorbable material for osteosynthesis of costal fractures did not show side effects in our period of study.

Surgical treatment of displaced midshaft clavicular fractures with precontoured plates

BACKGROUND

Plate fixation of displaced midshaft clavicular fractures has been shown to decrease nonunion, symptomatic malunion, and residual shoulder disability compared with nonoperative treatment. However hardware-related complications are a problem. The new features of the precontoured locking plates may reduce the need for hardware removal, thus maintaining the advantages of plate fixation. This study evaluated the clinical outcomes of patients with displaced midshaft clavicular fractures treated with precontoured locking plates.

MATERIALS AND METHODS

From November 2008 to December 2012, we surgically treated 72 patients with displaced midshaft clavicular fractures. We retrospectively evaluated 68 patients who underwent 68 interventions. Postoperative functional outcomes were assessed with the Constant score, the 11-item version of the Disabilities of Arm, Shoulder and Hand (QuickDASH) questionnaire, and radiographs. Pain was subjectively assessed with a visual analog scale. Complications were recorded. Patients were asked if they were able to return to their previous employment level.

RESULTS

The mean follow-up period was 23.6 ± 10.7 months. The average values of the Constant, QuickDASH, and visual analog scale scores were 97.8, 1.8, and 0.4 points, respectively. At the last follow-up, 98.5% were able to return to their regular work. Of 15 complications (22.1%) that occurred, only 3 were considered as major: 1 subclavian vein extrinsic compression, 1 nonunion, and 1 hardware loosening. Hardware removal was required in 9 patients (13.2%).

CONCLUSIONS

Satisfactory clinical results with a low rate of complications were achieved with precontoured locking plates for displaced midshaft clavicular fractures and a low rate of hardware removal compared with traditional plates.

Automatic yield-line analysis of slabs using discontinuity layout optimization

The yield-line method of analysis is a long established and extremely effective means of estimating the maximum load sustainable by a slab or plate. However, although numerous attempts to automate the process of directly identifying the critical pattern of yield-lines have been made over the past few decades, to date none has proved capable of reliably analysing slabs of arbitrary geometry. Here, it is demonstrated that the discontinuity layout optimization (DLO) procedure can successfully be applied to such problems. The procedure involves discretization of the problem using nodes inter-connected by potential yield-line discontinuities, with the critical layout of these then identified using linear programming. The procedure is applied to various benchmark problems, demonstrating that highly accurate solutions can be obtained, and showing that DLO provides a truly systematic means of directly and reliably automatically identifying yield-line patterns. Finally, since the critical yield-line patterns for many problems are found to be quite complex in form, a means of automatically simplifying these is presented.

Revision with plates of humeral nonunions secondary to failed intramedullary nailing

PURPOSE

The objective of this study was to evaluate the results achieved after revision with plates of humeral nonunions secondary to failed intramedullary nailing.

METHODS

We retrospectively evaluated 32 patients with humeral nonunions secondary to failed intramedullary nailing, treated by internal fixation with plates between 1998 and 2012. Nonunions were diaphyseal in 19 cases, they were located in the proximal humeral metaphysis in nine cases, and in the distal humeral metaphysis in four cases. There were 11 atrophic nonunions and 21 oligotrophic nonunions. Initial treatment was performed with static locked nails in 12 cases, nails with expansive locking systems in 11 cases, and using thin elastic nails in nine cases. The nails were placed antegrade in 18 cases and retrograde in 14 cases. Time between initial surgery and revision surgery averaged 14.5 months. In seven diaphyseal nonunions, the intramedullary nail was left in-situ. Bone graft was added in 25 cases.

RESULTS

Follow-up averaged 35 months. Union was achieved in all cases, after an average of 3.8 months. Disabilities of the Arm, Shoulder and Hand (DASH) score at last follow-up averaged 14 points, and Constant's score averaged 82 points. The analogue scale of pain averaged 0.8 points. Out of seven patients with radial nerve compromise, six recovered completely and one needed tendon transfers.

CONCLUSIONS

Revision with plates after failed intramedullary humeral nailing achieved union and good predictable objective and subjective results in all cases. Adequate implant selection and meticulous surgical technique are necessary to achieve successful osteosynthesis and bony union.

The Use of 2.4-mm Locking Plate System in Treating Comminuted Mandibular Fracture by Firearm

Maxillofacial trauma caused by firearms has considerably increased, in which the mandibular body is the site of highest incidence of firearm projectiles. In these cases, the use of titanium plates and screws allows the early restoration of form and function of the mandible with stable and predictable results. Recently, conventional plates have been extensively used to treat comminuted mandibular fractures. Nevertheless, the conventional system presents several limitations such as screw compression against the bone interface and the necessity of precise fit of plate to the bone. To overcome such drawbacks, the locking plates have emerged. The present clinical case reported the operative treatment of mandibular fracture caused by firearm projectiles with the use of locking plate. The indications, advantages, and disadvantages of this system are presented.

Effective dimensional reduction algorithm for eigenvalue problems for thin elastic structures: a paradigm in three dimensions

We present a methodology for the efficient numerical solution of eigenvalue problems of full three-dimensional elasticity for thin elastic structures, such as shells, plates and rods of arbitrary geometry, discretized by the finite element method. Such problems are solved by iterative methods, which, however, are known to suffer from slow convergence or even convergence failure, when the thickness is small. In this paper we show an effective way of resolving this difficulty by invoking a special preconditioning technique associated with the effective dimensional reduction algorithm (EDRA). As an example, we present an algorithm for computing the minimal eigenvalue of a thin elastic plate and we show both theoretically and numerically that it is robust with respect to both the thickness and discretization parameters, i.e. the convergence does not deteriorate with diminishing thickness or mesh refinement. This robustness is sine qua non for the efficient computation of large-scale eigenvalue problems for thin elastic structures.

Evaluation of a new monocortical screw for anterior cervical fusion and plating by a combined biomechanical and clinical study

The purpose of this combined study was to evaluate the stability and safety of a new monocortical screw-plate system for anterior cervical fusion and plating (ACFP) according to Caspar in comparison with classical bicortical fixation. In the biomechanical part of the study two groups, each comprising six fresh human cadaveric spines (C4-C7), matched for bone mineral density, additionally resulting in almost the same mean age, were used. Range of motion and neutral zone were analyzed in flexion-extension, rotation (left, right) and lateral bending (left, right) using pure moments of +/- 2.5 Nm for each specimen in the intact state, after discectomy at C5/6 and after discectomy at C 5/6 followed by bone grafting plus plating (Caspar plates), with either monocortical or bicortical screws. For all three motion planes, no significant difference could be found between the new monocortical and the bicortical fixation techniques. The clinical part of the study was performed as a prospective study on 30 patients suffering from symptomatic degenerative cervical disc disease in one segment. At the latest follow-up, no hardware- or graft-related complications were seen in any of the patients. Following these findings monocortical screw fixation can be recommended for the majority of anterior cervical fusion and plating procedures in degenerative disease, making the procedure quicker, easier, and safer. Bicortical screw fixation still has specific indications for multilevel stabilization, poor bone quality (osteoporosis, rheumatoid disease - as bicortical oversized rescue screw), unstable spines (trauma, tumour) and in particular for the realignment of kyphotic deformities (restoration of the normal lordotic curve). Due to the design of the study the results apply only to surgical treatment of monosegmental degenerative disc disease at the time.