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

Ni,Ming; Zhang,Fangfang; Mei,Jiong; Lin,Chia‑Ying   James; Gruber,Stacey   M.S.; Niu,Wenxin; Wong,Duo   Wai‑Chi; Zhang,Ming

doi:10.3892/etm.2020.8898

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
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Affiliations: Department of Orthopaedics, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201299, P.R. China, Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, P.R. China, Department of Biomedical Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, OH 45221, USA, Research Center of Disabled Rehabilitation Medicine, Yangzhi Rehabilitation Hospital, Tongji University School of Medicine, Shanghai 200129, P.R. China, Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR 999077, P.R. China
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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