Open Access

Biomechanical analysis of four augmented fixations of plate osteosynthesis for comminuted mid‑shaft clavicle fracture: A finite element approach

  • Authors:
    • Ming Ni
    • Fangfang Zhang
    • Jiong Mei
    • Chia‑Ying James Lin
    • Stacey   M.S. Gruber
    • Wenxin Niu
    • Duo Wai‑Chi Wong
    • Ming Zhang
  • View Affiliations

  • Published online on: June 17, 2020     https://doi.org/10.3892/etm.2020.8898
  • Pages: 2106-2112
  • Copyright: © Ni et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Sufficient stabilization of comminuted mid‑shaft clavicle fractures via plate fixation is difficult to achieve. Various augmentations, including interfragmentary screws and cerclage wiring, have been adopted to reinforce fixation stability. The present study aimed to assess the biomechanical stability of augmented plate fixations using the finite element method. First, a clavicle fracture model was created from CT data. Fixation was then induced using a locking compressive plate (LCP) with the following four augmentations: i) Double inner cerclage wirings (DICW), ii) double outer cerclage wirings (DOCW), iii) a single interfragmentary screw (SIS) and iv) double interfragmentary screws (DIS). Compressive and bending forces of 100 N were subsequently applied at the acromial region of the clavicle. The stress distribution, displacement and fracture micro‑motions of the model were assessed and compared. The DOCW resulted in the highest stress exerted on the LCP, followed by SIS, DICW and DIS. For the clavicle fracture, DICW, DOCW and SIS resulted in high stress levels. However, DIS fixation alone resulted in levels of stress that were below the yield strength of cortical bone. Displacement analysis revealed that DOCW fixation resulted in the greatest degree of displacement and fracture micro‑motions, followed by SIS, DICW and DIS. The results indicated that SIS, DIS and DOCW may be used as augmentations of LCP fixation for comminuted mid‑shaft clavicle fractures. However, DIS was the recommended augmentation due to it exerting the lowest stress and the highest stability compared with the other fixations. The DICW may be used to aid fracture reduction and plate placement in surgery but should be avoided for permanent fixation.

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September-2020
Volume 20 Issue 3

Print ISSN: 1792-0981
Online ISSN:1792-1015

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Spandidos Publications style
Ni M, Zhang F, Mei J, Lin CYJ, Gruber SM, Niu W, Wong DW and Zhang M: Biomechanical analysis of four augmented fixations of plate osteosynthesis for comminuted mid‑shaft clavicle fracture: A finite element approach . Exp Ther Med 20: 2106-2112, 2020
APA
Ni, M., Zhang, F., Mei, J., Lin, C.J., Gruber, S.M., Niu, W. ... Zhang, M. (2020). Biomechanical analysis of four augmented fixations of plate osteosynthesis for comminuted mid‑shaft clavicle fracture: A finite element approach . Experimental and Therapeutic Medicine, 20, 2106-2112. https://doi.org/10.3892/etm.2020.8898
MLA
Ni, M., Zhang, F., Mei, J., Lin, C. J., Gruber, S. M., Niu, W., Wong, D. W., Zhang, M."Biomechanical analysis of four augmented fixations of plate osteosynthesis for comminuted mid‑shaft clavicle fracture: A finite element approach ". Experimental and Therapeutic Medicine 20.3 (2020): 2106-2112.
Chicago
Ni, M., Zhang, F., Mei, J., Lin, C. J., Gruber, S. M., Niu, W., Wong, D. W., Zhang, M."Biomechanical analysis of four augmented fixations of plate osteosynthesis for comminuted mid‑shaft clavicle fracture: A finite element approach ". Experimental and Therapeutic Medicine 20, no. 3 (2020): 2106-2112. https://doi.org/10.3892/etm.2020.8898