Biomechanical evaluation of the Schuhli nut : Advances in operative fracture treatment: A tribute to Martin Allgöwer and Hans Robert Willenegger

The schuhli nut is a device designed to lock an AO 4.5-mm cortical screw to a 4.5-mm dynamic compression plate independent of bony contact with the plate. The nut engages the screw below the plate, elevating the plate, and locking the screw at a 90° angle, thus preventing toggling. Photoelastic modeling and biomechanical testing on sheep tibias were done to determine the mechanical properties of constructs using schuhli nuts. Use of schuhli nuts was shown to decrease stress in the bone below the plate. The initial axial stiffness of a construct fixed with schuhli nuts is less than a construct with standard screws, but the rate of loss of stiffness with cyclic loading is similar. When a cortical defect is present at the near cortex and the screw engages the far cortex only, the use of a schuhli nut significantly improves the stability of the construct compared with a standard screw alone, and behaves mechanically the same as a standard construct with intact cortices. This indicates that the schuhli nut acts as a substitute for a deficient cortex. The schuhli nut can be useful in osteoporotic bone because it prevents the screw from stripping the threads in the bone as the screw is advanced. It also serves to lock the screw to help prevent the screw from backing out. The schuhli nut may be a useful tool to improve stability in the treatment of complex fractures, reconstructions, or in pathologic bone.