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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2019

Open Access 01-12-2019 | Research article

Finite element analysis comparison between superior clavicle locking plate with and without screw holes above fracture zone in midshaft clavicular fracture

Authors: Nachapan Pengrung, Natthaphop Lakdee, Chedtha Puncreobutr, Boonrat Lohwongwatana, Paphon Sa-ngasoongsong

Published in: BMC Musculoskeletal Disorders | Issue 1/2019

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Abstract

Background

Midshaft clavicular fractures are common fractures and generally treated conservatively. Among the surgical options, plate fixation is the most popular and has been biomechanically and clinically proven in numerous studies. However, implant failures caused by plate deformations or breakage still occur in up to 16.7% of cases, and recent studies showed that screw holes above fracture zone (SHFZ) might be the at-risk location. Using finite element analysis, this study aimed to test the biomechanical property of the superior clavicle locking plate (SCLP) with and without SHFZ in comminuted midshaft clavicular fracture.

Methods

Finite element models of comminuted midshaft clavicular fracture fixed with standard 8-hole titanium SCLP with screw holes (SHFZ plate) and without screw holes above fracture zone (No-SHFZ plate) were built. Both groups were tested under three different loading models (100-N cantilever bending, 100-N axial compression, and 1-Nm torsion). The average peak stress on medial clavicle, fracture zone, and lateral clavicle, and the peak stress on each screw hole (or the same position in the No-SHFZ plate) were measured and compared.

Results

The highest average peak stress on the fracture zone was higher than those on medial and lateral clavicles under all loading conditions in both plates. However, the No-SHFZ plate significantly reduced the average peak stress value on the fracture zone, compared to the SHFZ plate (45.0% reduction in cantilever bending, 52.2% reduction in axial compression, and 54.9% reduction in axial torsion). The peak stress value on the maximal stress point in the SHFZ and No-SHFZ plates with cantilever bending, axial compression, and torsion loads were 1257.10 MPa vs. 647.21 MPa, 186.42 MPa vs. 131.63 MPa, and 111.86 MPa vs. 82.41 MPa, respectively.

Conclusion

The weakest link of the SCLP construct in comminuted midshaft clavicular fracture fixation is the SHFZ, especially in the cantilever bending load. Additionally, the biomechanical property of the SCLP without SHFZ model (No-SHFZ plate) is superior to the standard SCLP model (SHFZ plate), with a significantly lower peak stress on the SHFZ location in all loading conditions. We recommend a new SCLP design with SHFZ to prevent implant failure and improve surgical outcomes.
Literature
1.
Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elb Surg. 2002;11(5):452–6.CrossRef
2.
Naveen BM, Joshi GR, Harikrishnan B. Management of mid-shaft clavicular fractures: comparison between non-operative treatment and plate fixation in 60 patients. Strategies Trauma Limb Reconstr. 2017;12(1):11–8.CrossRef
3.
Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Evidence-based Orthopaedic trauma working G. treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the evidence-based Orthopaedic trauma working group. J Orthop Trauma. 2005;19(7):504–7.CrossRef
4.
Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg (Br). 1997;79(4):537–9.CrossRef
5.
Woltz S, Krijnen P, Schipper IB. Plate fixation versus nonoperative treatment for displaced Midshaft Clavicular fractures: a meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2017;99(12):1051–7.CrossRef
6.
Nourian A, Dhaliwal S, Vangala S, Vezeridis PS. Midshaft fractures of the clavicle: a meta-analysis comparing surgical fixation using Anteroinferior plating versus superior plating. J Orthop Trauma. 2017;31(9):461–7.CrossRef
7.
Meeuwis MA, Pull Ter Gunne AF, Verhofstad MH, van der Heijden FH. Construct failure after open reduction and plate fixation of displaced midshaft clavicular fractures. Injury. 2017;48(3):715–9.CrossRef
8.
Lv H, Chang W, Yuwen P, Yang N, Yan X, Zhang Y. Are there too many screw holes in plates for fracture fixation? BMC Surg. 2017;17(1):[about 10p].
9.
Alzahrani M, Cota A, Alkhelaifi K, Aleidan A, Berry G, Reindl R, et al. Are clinical outcomes affected by type of plate used for management of mid-shaft clavicle fractures? J Orthop Traumatol. 2018;19(1):[about 6p].
10.
Fridberg M, Ban I, Issa Z, Krasheninnikoff M, Troelsen A. Locking plate osteosynthesis of clavicle fractures: complication and reoperation rates in one hundred and five consecutive cases. Int Orthop. 2013;37(4):689–92.CrossRef
11.
Hulsmans MH, van Heijl M, Houwert RM, Burger BJ, Verleisdonk EJM, Veeger DJ, et al. Surgical fixation of midshaft clavicle fractures: a systematic review of biomechanical studies. Injury. 2018;49(4):753–65.CrossRef
12.
Marie C. Strength analysis of clavicle fracture fixation devices and fixation techniques using finite element analysis with musculoskeletal force input. Med Biol Eng Comput. 2015;53(8):759–69.CrossRef
13.
Ni M, Niu W, Wong DW, Zeng W, Mei J, Zhang M. Finite element analysis of locking plate and two types of intramedullary nails for treating mid-shaft clavicle fractures. Injury. 2016;47(8):1618–23.CrossRef
14.
Huang TL, Chen WC, Lin KJ, Tsai CL, Lin KP, Wei HW. Conceptual finite element study for comparison among superior, anterior, and spiral clavicle plate fixations for midshaft clavicle fracture. Med Eng Phys. 2016;38(10):1070–5.CrossRef
15.
Bellapianta J, Dow K, Pallotta NA, Hospodar PP, Uhl RL, Ledet EH. Threaded screw head inserts improve locking plate biomechanical properties. J Orthop Trauma. 2011;25(2):65–71.CrossRef
16.
Hung LW, Chao CK, Huang JR, Lin J. Screw head plugs increase the fatigue strength of stainless steel, but not of titanium, locking plates. Bone Joint Res. 2018;7(12):629–35.CrossRef
17.
Grau L, Collon K, Alhandi A, Kaimrajh D, Varon M, Latta L, et al. Filling open screw holes in the area of Metaphyseal Comminution does not affect fatigue life of the Synthes variable angle distal femoral locking plate in the AO/OTA 33-A3 fracture model. Surg Technol Int. 2018;32:293–7.PubMed
18.
Lal H, Patralekh MK. 3D printing and its applications in orthopaedic trauma: a technological marvel. J Clin Orthop Trauma. 2018;9(3):260–8.CrossRef
19.
Yang JC, Lin KJ, Wei HW, Tsai CL, Lin KP, Lee PY. Morphometric Analysis of the Clavicles in Chinese Population. Biomed Res Int. 2017;2017:[about 5p].
Metadata
Title
Finite element analysis comparison between superior clavicle locking plate with and without screw holes above fracture zone in midshaft clavicular fracture
Authors
Nachapan Pengrung
Natthaphop Lakdee
Chedtha Puncreobutr
Boonrat Lohwongwatana
Paphon Sa-ngasoongsong
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2019
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-019-2847-y

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