Abstract
Plate and screw constructs are routinely used in the treatment of long bone fractures. Despite considerable advancements in technology and techniques, there can still be complications in the healing of long bone fractures. Non-unions, delayed unions, and hardware failures are common complications observed in clinical practice following open reduction and internal fixation of fractures [1]. Potential causes of these adverse clinical effects may be disruptive to the periosteal and endosteal blood supply, stress shielding effects, and inadequate mechanical stability. The goal of the present study was to explore the effect of screw position on the fracture healing and formation of new bone tissue with mechanoregulatory algorithms in a computational model. An idealized poroelastic 3D finite element (FE) model of a femur with a 5 mm fracture gap, including a plate-screw construct was developed. Nineteen different plate-screw combinations, created by varying the number and position of screws within the plate, were created to identify a construct with the most favourable attributes for fracture healing. The first phase of the study evaluated constructs through mechanical stress analyses to identify those constructs with high loadsupport capability. The second phase of the study evaluated healing and bone formation with a biphasic mechanoregulatory algorithm to simulate tissue differentiation for fixation within selected constructs. The results of our analysis demonstrated a 4-screw symmetrical construct with the largest distance between screws to provide the most favourable balance of stability and optimized conditions to promote fracture healing.
Highlights
The treatment of long bone fractures is a significant health problem, for femoral fractures [2,3,4,5]
The goal of the present study was to explore the effect of screw position on the fracture healing and formation of new bone tissue with mechanoregulatory algorithms in a computational model
A maximal von Mises stress of ~473 MPa was found for the screws in the 4-screw construct C6b, whereas it was only ~226 MPa for the surrounding plate (Figures 3(a) and (c))
Summary
The treatment of long bone fractures is a significant health problem, for femoral fractures [2,3,4,5]. Internal fixators have been used as the most common treatment technique for open and closed fractures [3,8,9,10]. Despite the advent of intramedullary fixation, there are still clinical indications for plating of long bone fractures (e.g., pulmonary complications, damage control orthopaedics, revision procedures, absence of X-ray, obliterated canal, small canal and periarticular fractures). The two main drawbacks of internal fixations are: 1) disruption of blood supply, and 2) shielding the underlying bone and fracture gap from mechanical stresses. One technique to minimize vascular damage to bone includes reducing the number of screws used to anchor the plate to bone [12]. Reducing the number of screws may not significantly affect the structural stiffness of the fracture, but may increase the strain at the fracture site [12].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
