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Fang S, Zhang L, Yang Y, Wang Y, Guo J, Mi L. Finite element analysis comparison of Type 42A2 fracture fixed with external titanium alloy locking plate and traditional external fixation frame. J Orthop Surg Res 2023; 18:815. [PMID: 37907959 PMCID: PMC10619248 DOI: 10.1186/s13018-023-04307-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/21/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND At present, not all Type AO/OTA 42A2 open fractures can be treated by external fixation brackets, not to mention the inconvenience of this technique in clinical practice. External titanium alloy locking plates, which are lightweight and easy-to-operate, can be used as an alternative treatment option for such patients. However, there are few reports of finite element biomechanical analysis on the titanium alloy locking plates and fixation brackets being placed on the medial side of the tibial fracture. In this study, the biomechanical properties of titanium alloy locking plates and fixation brackets for treating Type AO/OTA 42A2 fractures were compared by applying the finite element method, and the results provided data support for the clinical application of the external titanium alloy locking plate technique. METHODS Type AO/OTA 42A2 fracture models were constructed using CT data of a male volunteer for two external fixation techniques, namely the external titanium alloy locking plate technique and the external fixation bracket technique, according to commonly-used clinical protocols. Then, the four-point bending, axial compression, clockwise rotation and counterclockwise rotation tests under the maximum load were simulated in finite element analysis software. The stress distribution, peak stress and overall tibial displacement data for the two different external fixation techniques were obtained and compared. RESULTS In the four different test conditions (i.e., four-point bending, axial compression, clockwise torsion, counterclockwise torsion) under the maximum load, the two external fixation techniques showed obvious von Mises stress concentration at the contacts between the screw and tibia, between the screw and titanium alloy locking plate, between the self-tapping self-drilling needle and tibia, between the self-tapping self-drilling needle and the external fixation device, as well as around the fracture end and around the cortical bone at the upper and lower ends of the tibia. The peak stress was ranged 26.67-558.77 MPa, all below the yield stress strength of titanium alloy. The peak tibial displacement of the external titanium alloy locking plate model was smaller than that of the fixation bracket model. In terms of structural stability, the external titanium alloy locking plate technique was superior to the external fixation bracket technique. CONCLUSIONS When fixing Type AO/OTA 42A2 fractures, external titanium alloy locking plates are not only lightweight and easy-to-operate, but also have better performance in terms of axial compression, bending and torsion resistance. According to the finite element biomechanical analysis, external titanium alloy locking plates are superior to traditional external fixation brackets in treating Type AO/OTA 42A2 fractures and can better meet the needs of clinical application.
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Affiliation(s)
- Shitao Fang
- Department of Orthopaedic Medicine Center, Brain Hospital of Hunan Provincial (The Second People's Hospital of Hunan Province), Clinical Medical College of Hunan University of Chinese Medicine, Changsha, 410007, China
| | - Ling Zhang
- Department of Nursing, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Yunqi Yang
- Department of Orthopaedic Medicine Center, Brain Hospital of Hunan Provincial (The Second People's Hospital of Hunan Province), Clinical Medical College of Hunan University of Chinese Medicine, Changsha, 410007, China
| | - Yun Wang
- Department of Orthopaedic Medicine Center, Brain Hospital of Hunan Provincial (The Second People's Hospital of Hunan Province), Clinical Medical College of Hunan University of Chinese Medicine, Changsha, 410007, China
| | - Jinkun Guo
- Department of Orthopaedic Medicine Center, Brain Hospital of Hunan Provincial (The Second People's Hospital of Hunan Province), Clinical Medical College of Hunan University of Chinese Medicine, Changsha, 410007, China
| | - Lei Mi
- Department of Orthopaedic Medicine Center, Brain Hospital of Hunan Provincial (The Second People's Hospital of Hunan Province), Clinical Medical College of Hunan University of Chinese Medicine, Changsha, 410007, China.
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Makelov B, Mischler D, Varga P, Apivatthakakul T, Fletcher JWA, Veselinov D, Berk T, Raykov D, Gueorguiev B. Single-Stage Externalized Locked Plating for Treatment of Unstable Meta-Diaphyseal Tibial Fractures. J Clin Med 2023; 12:jcm12041600. [PMID: 36836132 PMCID: PMC9961641 DOI: 10.3390/jcm12041600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/05/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
(1) Background: Unstable meta-diaphyseal tibial fractures represent a heterogeneous group of injuries. Recently, good clinical results have been reported when applying a technique of externalized locked plating in appropriate cases, highlighting its advantage in terms of less additional tissue injury compared with conventional methods of fracture fixation. The aims of this prospective clinical cohort study were, firstly, to investigate the biomechanical and clinical feasibility and, secondly, to evaluate the clinical and functional outcomes of single-stage externalized locked plating for treatment of unstable, proximal (intra- and extra-articular) and distal (extra-articular), meta-diaphyseal tibial fractures. (2) Methods: Patients, who matched the inclusion criteria of sustaining a high-energy unstable meta-diaphyseal tibial fracture, were identified prospectively for single-stage externalized locked plating at a single trauma hospital in the period from April 2013 to December 2022. (3) Results: Eighteen patients were included in the study. Average follow-up was 21.4 ± 12.3 months, with 94% of the fractures healing without complications. The healing time was 21.1 ± 4.6 weeks, being significantly shorter for patients with proximal extra- versus intra-articular meta-diaphyseal tibial fractures, p = 0.04. Good and excellent functional outcomes in terms of HSS and AOFAS scores, and knee and ankle joints range of motion were observed among all patients, with no registered implant breakage, deep infection, and non-union. (4) Conclusions: Single-stage externalized locked plating of unstable meta-diaphyseal tibial fractures provides adequate stability of fixation with promising clinical results and represents an attractive alternative to the conventional methods of external fixation when inclusion criteria and rehabilitation protocol are strictly followed. Further experimental studies and randomized multicentric clinical trials with larger series of patients are necessary to pave the way of its use in clinical practice.
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Affiliation(s)
- Biser Makelov
- University Multiprofile Hospital for Active Treatment, Trakia University, 6003 Stara Zagora, Bulgaria
| | | | - Peter Varga
- AO Research Institute Davos, 7270 Davos, Switzerland
| | | | - James W. A. Fletcher
- AO Research Institute Davos, 7270 Davos, Switzerland
- Department for Health, University of Bath, Bath BA2 7AY, UK
| | - Deyan Veselinov
- Bulgarian Academy of Sciences, Institute of Metal Science ‘Acad. A. Balevski’, 1574 Sofia, Bulgaria
| | - Till Berk
- AO Research Institute Davos, 7270 Davos, Switzerland
- University Hospital Zurich, 8091 Zurich, Switzerland
| | - Dimitur Raykov
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Medical University Varna, 9002 Varna, Bulgaria
| | - Boyko Gueorguiev
- AO Research Institute Davos, 7270 Davos, Switzerland
- Correspondence:
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Su H, Zhong S, Ma T, Wu W, Lu Y, Wang D. Biomechanical study of the stiffness of the femoral locking compression plate of an external fixator for lower tibial fractures. BMC Musculoskelet Disord 2023; 24:39. [PMID: 36650508 PMCID: PMC9847071 DOI: 10.1186/s12891-023-06150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A locking compression plate (LCP) of the distal femur is used as an external fixator for lower tibial fractures. However, in clinical practice, the technique lacks a standardized approach and a strong biomechanical basis for its stability. METHODS In this paper, internal tibial LCP fixator (Group IT-44), external tibial LCP fixator (Group ET-44), external distal femoral LCP fixator (Group EF-44, group EF-33, group EF-22), and conventional external fixator (Group CEF-22) frames were used to fix unstable fracture models of the lower tibial segment, and anatomical studies were performed to standardize the operation as well as to assess the biomechanical stability and adjustability of the distal femoral LCP external fixator by biomechanical experiments. RESULTS It was found that the torsional and flexural stiffnesses of group EF-44 and group EF-33 were higher than those of group IT-44 and group ET-44 (p < 0.05); the flexural stiffness of group EF-22 was similar to that of group IT-44 (p > 0.05); and the compressive stiffness of all three EF groups was higher than that of group ET-44 (p < 0.05). In addition, the flexural and compressive stiffnesses of the three EF groups decreased with the decrease in the number of screws (p < 0.05), while the torsional stiffness of the three groups did not differ significantly between the two adjacent groups (p > 0.05). Group CEF-22 showed the highest stiffnesses, while group ET-44 had the lowest stiffnesses (P < 0.05). CONCLUSIONS The study shows that the distal femoral LCP has good biomechanical stability and adjustability and is superior to the tibial LCP as an external fixator for distal tibial fractures, as long as the technique is used in a standardized manner according to the anatomical studies in this article.
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Affiliation(s)
- Huan Su
- grid.417409.f0000 0001 0240 6969Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100 China
| | - Siyang Zhong
- grid.417409.f0000 0001 0240 6969Zunyi Medical University Zhuhai Campus, No. 368, Jinwan Road, Jinwan District, Zhuhai, 519041 China
| | - Tianyong Ma
- grid.417409.f0000 0001 0240 6969Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100 China
| | - Weidong Wu
- grid.417409.f0000 0001 0240 6969Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100 China
| | - Yihong Lu
- grid.417409.f0000 0001 0240 6969Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100 China
| | - Dewei Wang
- grid.417409.f0000 0001 0240 6969Second Department of Orthopedics, Fifth Affiliated Hospital of Zunyi Medical University, No. 1439, Zhufeng Avenue, Doumen District, Zhuhai, 519100 China
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Ruhala L, Beck D, Ruhala R, Megal A, Perry M. Development and Testing of an External Fixation Coupling for a Damage Control Orthopedic System1. J Med Device 2018. [DOI: 10.1115/1.4036858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Laura Ruhala
- Department of Mechanical Engineering, Kennesaw State Univeristy, Marietta, GA 30060
| | - Dennis Beck
- Department of Orthopedic Trauma, Deaconess Trauma Center, Evansville, IN 47747
| | - Richard Ruhala
- Department of Mechanical Engineering, Kennesaw State University, Marietta, GA 30060
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Luo P, Xu D, Wu J, Chen YH. Locked plating as an external fixator in treating tibial fractures: A PRISMA-compliant systematic review. Medicine (Baltimore) 2017; 96:e9083. [PMID: 29245327 PMCID: PMC5728942 DOI: 10.1097/md.0000000000009083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This article is a systematic review of the published literature about the biomechanics, functional outcomes, and complications of a locked plate as an external fixator in treating tibial fractures. METHODS We searched the PubMed, Ovid Medline, Embase, ScienceDirect, and Cochrane Library databases to retrieve the relevant studies. Studies published in English and Chinese which assessed adult patients and more than 4 cases who had sustained any type of fresh tibial fracture treated with the external locking plate, provided that they reported functional outcomes, range of motion (ROM), union or complication rates, and the biomechanical studies of external locked plating are also included. RESULTS The electronic search strategy revealed 248 studies, and 2 studies were identified as relevant through manual search of references. Finally, 12 studies were included in this systematic review. These consist of 3 pure biomechanical studies, 8 case series, and 1 study including both of biomechanics and case series. Due to the heterogeneity of biomechanical studies, we can only conclude that external locked plate shows inferior structural stiffness than internal locked plate. The clinical studies reported that external locked plating gave a satisfactory ROM of the knee and ankle, functional outcomes, union rate, and low complication rate. CONCLUSIONS We can only conclude that external locked plate shows inferior structural stiffness than internal locked plate because of the heterogeneity of biomechanical studies. The clinical studies showed locked plating as an external fixator in treating tibial fractures can be considered as a safe and successful procedure. However, as yet, there is unconvincing evidence that it is superior to standard techniques with regards to clinical and functional outcomes. More and well-designed studies about this technique should be carried out.
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Affiliation(s)
- Peng Luo
- Department of Trauma Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
- Zhejiang provincial key lab of orthopaedics, Wenzhou
| | - Ding Xu
- Department of Trauma Orthopedics, Shangyu People's Hospital of Shaoxing City, Shaoxing
| | - Jia Wu
- Key Laboratory for Laboratory Medicine, Ministry of Education, Zhejiang Provincial Key Laboratory of Medical Genetics, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yi-Heng Chen
- Department of Trauma Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
- Zhejiang provincial key lab of orthopaedics, Wenzhou
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