Abstract
BackgroundMidshaft 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.MethodsFinite 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.ResultsThe 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.ConclusionThe 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.
Highlights
Midshaft clavicular fractures are common fractures and generally treated conservatively
A recent finite element analysis study on clavicle fracture fixation showed that the maximum stress in the precontoured superior reconstruction plate fixation without lag screws occurred at the edge of screw holes above fracture zone (SHFZ) [12]
The comparison of peak stress values (Figs. 2a, 3a, and 4a) and the von Mises stress patterns between the SHFZ and No-SHFZ plates in cantilever bending (Fig. 2b-c), axial compression (Fig. 3b-c), and axial torsion (Fig. 4b-c) loads are illustrated in Figs. 2, 3, and 4, respectively
Summary
Midshaft clavicular fractures are common fractures and generally treated conservatively. This study aimed to test the biomechanical property of the superior clavicle locking plate (SCLP) with and without SHFZ in comminuted midshaft clavicular fracture. The majority of clavicle fractures occur at the midshaft of the clavicle (81%), which associates with displacement in 48% of cases and with comminuted patterns in 19% [1] These fractures are generally treated conservatively [2], but those with severely displaced or comminuted patterns have high risk for delayed union or nonunion and are indicated for surgical treatment [3,4,5]. A recent finite element analysis study on clavicle fracture fixation showed that the maximum stress in the precontoured superior reconstruction plate fixation without lag screws occurred at the edge of screw holes above fracture zone (SHFZ) [12]. The aim of this study was to perform a comparative stress analysis between the SCLP with and without SHFZ in comminuted midshaft clavicular fracture fixation
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