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Zhang S, Patel D, Brady M, Gambill S, Theivendran K, Deshmukh S, Swadener J, Junaid S, Leslie LJ. Experimental testing of fracture fixation plates: A review. Proc Inst Mech Eng H 2022; 236:1253-1272. [PMID: 35920401 PMCID: PMC9449446 DOI: 10.1177/09544119221108540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Metal and its alloys have been predominantly used in fracture fixation for
centuries, but new materials such as composites and polymers have begun to see
clinical use for fracture fixation during the past couple of decades. Along with
the emerging of new materials, tribological issues, especially debris, have
become a growing concern for fracture fixation plates. This article for the
first time systematically reviews the most recent biomechanical research, with a
focus on experimental testing, of those plates within ScienceDirect and PubMed
databases. Based on the search criteria, a total of 5449 papers were retrieved,
which were then further filtered to exclude nonrelevant, duplicate or
non-accessible full article papers. In the end, a total of 83 papers were
reviewed. In experimental testing plates, screws and simulated bones or cadaver
bones are employed to build a fixation construct in order to test the strength
and stability of different plate and screw configurations. The test set-up
conditions and conclusions are well documented and summarised here, including
fracture gap size, types of bones deployed, as well as the applied load, test
speed and test ending criteria. However, research on long term plate usage was
very limited. It is also discovered that there is very limited experimental
research around the tribological behaviour particularly on the debris’
generation, collection and characterisation. In addition, there is no identified
standard studying debris of fracture fixation plate. Therefore, the authors
suggested the generation of a suite of tribological testing standards on
fracture fixation plate and screws in the aim to answer key questions around the
debris from fracture fixation plate of new materials or new design and
ultimately to provide an insight on how to reduce the risks of debris-related
osteolysis, inflammation and aseptic loosening.
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Affiliation(s)
- Shiling Zhang
- Aston Institute of Materials Research (AIMR), Aston University, Birmingham, UK
| | - Dharmesh Patel
- Invibio Biomaterial Solutions Limited, Hillhouse International, Thornton-Cleveleys, UK
| | - Mark Brady
- Invibio Biomaterial Solutions Limited, Hillhouse International, Thornton-Cleveleys, UK
| | - Sherri Gambill
- Invibio Biomaterial Solutions Limited, Hillhouse International, Thornton-Cleveleys, UK
| | | | - Subodh Deshmukh
- Sandwell and West Birmingham Hospital NHS Trust, Birmingham, UK
| | - John Swadener
- Aston Institute of Materials Research (AIMR), Aston University, Birmingham, UK
| | - Sarah Junaid
- Aston Institute of Materials Research (AIMR), Aston University, Birmingham, UK
| | - Laura Jane Leslie
- Aston Institute of Materials Research (AIMR), Aston University, Birmingham, UK
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Osteosynthesis Metal Plate System for Bone Fixation Using Bicortical Screws: Numerical–Experimental Characterization. BIOLOGY 2022; 11:biology11060940. [PMID: 35741461 PMCID: PMC9219623 DOI: 10.3390/biology11060940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/26/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022]
Abstract
Simple Summary This study addresses an important issue concerning the evaluation of stresses in bone shafts stabilized by osteosynthesis metal plates, following routine surgical procedures to repair severe fractures in bone. It is recognized that bone regeneration following fracture is highly dictated by the stress state in the damaged regions. Since metallic inserts, like plates and screws, are usually employed to assure the stabilization of fractures in bone, it is important to evaluate the effect of those parts on the developed stresses in bone tissue. In the present work fracture was induced in a femoral bone of an animal model, which was suitably stabilized with a dynamic compression plate (DCP) using bicortical screws. This system was submitted to bending to trigger damage in bone tissue in the vicinity of metal inserts. Finite element modelling was then performed to mimic damage initiation and propagation in bone, thus simulating the results observed experimentally. Stress distributions in the vicinity of the screwed regions due to fastening of DCP allowed to identify very significant differences, which can affect bone hilling processes. It can be concluded that the developed procedure may be used to help surgeons to support decisions regarding bone repair using standard DCP. Abstract This study reports the numerical and experimental characterization of a standard immobilization system currently being used to treat simple oblique bone fractures of femoral diaphyses. The procedure focuses on the assessment of the mechanical behavior of a bone stabilized with a dynamic compression plate (DCP) in a neutralization function, associated to a lag screw, fastened with surgical screws. The non-linear behavior of cortical bone tissue was revealed through four-point bending tests, from which damage initiation and propagation occurred. Since screw loosening was visible during the loading process, damage parameters were measured experimentally in independent pull-out tests. A realistic numerical model of the DCP-femur setup was constructed, combining the evaluated damage parameters and contact pairs. A mixed-mode (I+II) trapezoidal damage law was employed to mimic the mechanical behavior of both the screw–bone interface and bone fractures. The numerical model replicated the global behavior observed experimentally, which was visible by the initial stiffness and the ability to preview the first loading peak, and bone crack satisfactorily.
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Beirami S, Nikkhoo M, Hassani K, Karimi A. A comparative finite element simulation of locking compression plate materials for tibial fracture treatment. Comput Methods Biomech Biomed Engin 2021; 24:1064-1072. [PMID: 33393809 DOI: 10.1080/10255842.2020.1867114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The locking compression plate (LCP) system has several advantages in fracture fixation combining angular stability with the use of locking screws with traditional fixation techniques. However, the system is complex and requiring careful attention to biomechanical principles and good surgical technique. Due to the set of complicate stresses and strains in the LCP system after implantation, the material, which is being used here, is deemed important. However, so far the materials have been limited to the stainless steel (SS) or titanium (Ti). This study was therefore aimed at investigate the biomechanical performance of the internal tibial locked plates at different material properties, including SS, Ti, carbon/polyether ether ketone (PEEK) composite, in treating medial tibial fracture using patient-specific finite element (FE) model of the human tibia. The carbon/PEEK composite materials were used at three different fiber plies configurations. Simulated loading was applied at 60:40 ratios on the medial:lateral aspect. The model was fixed distally in all degrees of freedom. The results revealed the highest stress (307.10 MPa) and the lowest strain (0.14%) at Ti LCP system. The carbon/PEEK LCP system at configuration I and III showed low stress (∼60 MPa) and high strain (0.70%), which are suitable points for designing of an internal LCP system. On the other hand, the highest value of stress in callus region was 4.78 MPa (Carbon PEEK/Configuration I) and the strain variations of callus region were between 1.46% and 3.82% among all materials. These results implied the advantage of carbon/PEEK composite materials in LCP system as they can tolerate higher strains at lower stresses.
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Affiliation(s)
- Sami Beirami
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Nikkhoo
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Kamran Hassani
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Alireza Karimi
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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Mahmoudi M, Mahbadi H. Numerical investigation of mechanical behavior of human femoral diaphysis in normal and defective geometry: experimental evaluation. Comput Methods Biomech Biomed Engin 2020; 24:637-652. [PMID: 33164564 DOI: 10.1080/10255842.2020.1843639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Failure and major reoperation after internal fixation (IF) in mature femoral bones are common and proper selection of fixation method may reduce the rate of reoperations. Investigating the mechanical behavior of the human femoral diaphysis, this article studies effect of mechanical properties and geometry of the bone on selection of IF method. To this aim, we calculated the bone mineral density in human femurs, and then, using computed tomography scan, we obtained geometry and nonhomogeneous properties of the bone. Finite element (FE) models of osteotomised femurs were reinforced using four types of screws with a locking compression plate (LCP). We performed buckling and 4-point bending simulations, and results of these simulations represent critical buckling loads, maximum von Mises stresses, and strains around the screws and the central defect. To evaluate FE analysis, we employed the compressive experiments and compared load vs. displacement curves with FE results. Results corresponding to intact, osteotomised, and reinforced states are compared together, and the effect of cortical and unicortical screws in LCPs is studied. The FE results showed that application of identical prophylactic IF for two persons with identical injuries in the same conditions bring quite inverse results. As a consequence, evaluation of osteoporosis, elastic modulus, and morphometric data are required before fixation and screw selection. Besides, for short diaphysis, unicortical screws have maximum strengthening factor in bending. While for long samples, these types of screws can be the worst option, application of cortical screws results to maximum strength in comparison with other types.
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Affiliation(s)
- Moeinoddin Mahmoudi
- Young Researchers and Elite Club, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Hossein Mahbadi
- Department of Mechanical Engineering, Central Tehran Branch, Islamic Azad University, Tehran, Iran
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Fang R, Ji A, Zhao Z, Long D, Chen C. A regression orthogonal biomechanical analysis of internal fixation for femoral shaft fracture. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2020.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alcântara ACS, Assis I, Prada D, Mehle K, Schwan S, Costa-Paiva L, Skaf MS, Wrobel LC, Sollero P. Patient-Specific Bone Multiscale Modelling, Fracture Simulation and Risk Analysis-A Survey. MATERIALS (BASEL, SWITZERLAND) 2019; 13:E106. [PMID: 31878356 PMCID: PMC6981613 DOI: 10.3390/ma13010106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/26/2022]
Abstract
This paper provides a starting point for researchers and practitioners from biology, medicine, physics and engineering who can benefit from an up-to-date literature survey on patient-specific bone fracture modelling, simulation and risk analysis. This survey hints at a framework for devising realistic patient-specific bone fracture simulations. This paper has 18 sections: Section 1 presents the main interested parties; Section 2 explains the organzation of the text; Section 3 motivates further work on patient-specific bone fracture simulation; Section 4 motivates this survey; Section 5 concerns the collection of bibliographical references; Section 6 motivates the physico-mathematical approach to bone fracture; Section 7 presents the modelling of bone as a continuum; Section 8 categorizes the surveyed literature into a continuum mechanics framework; Section 9 concerns the computational modelling of bone geometry; Section 10 concerns the estimation of bone mechanical properties; Section 11 concerns the selection of boundary conditions representative of bone trauma; Section 12 concerns bone fracture simulation; Section 13 presents the multiscale structure of bone; Section 14 concerns the multiscale mathematical modelling of bone; Section 15 concerns the experimental validation of bone fracture simulations; Section 16 concerns bone fracture risk assessment. Lastly, glossaries for symbols, acronyms, and physico-mathematical terms are provided.
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Affiliation(s)
- Amadeus C. S. Alcântara
- Department of Computational Mechanics, School of Mechanical Engineering, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil; (A.C.S.A.); (D.P.)
| | - Israel Assis
- Department of Integrated Systems, School of Mechanical Engineering, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil;
| | - Daniel Prada
- Department of Computational Mechanics, School of Mechanical Engineering, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil; (A.C.S.A.); (D.P.)
| | - Konrad Mehle
- Department of Engineering and Natural Sciences, University of Applied Sciences Merseburg, 06217 Merseburg, Germany;
| | - Stefan Schwan
- Fraunhofer Institute for Microstructure of Materials and Systems IMWS, 06120 Halle/Saale, Germany;
| | - Lúcia Costa-Paiva
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-887, Brazil;
| | - Munir S. Skaf
- Institute of Chemistry and Center for Computing in Engineering and Sciences, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil;
| | - Luiz C. Wrobel
- Institute of Materials and Manufacturing, Brunel University London, Uxbridge UB8 3PH, UK;
- Department of Civil and Environmental Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, Brazil
| | - Paulo Sollero
- Department of Computational Mechanics, School of Mechanical Engineering, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil; (A.C.S.A.); (D.P.)
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Kucukguven MB, Akkocaoğlu M. Finite element analysis of stress distribution on reconstructed mandibular models for autogenous bone grafts. Technol Health Care 2019; 28:249-258. [PMID: 31594270 DOI: 10.3233/thc-191809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are several challenges in terms of mandibular reconstruction. The defect size, graft materials, and plate combinations should be taken into consideration in surgical planning. OBJECTIVE The aim of this study was to evaluate the effect of different reconstruction variations on the stress distribution of segmental resected mandibles with two different defect sizes using finite element analysis (FEA). METHODS Computerized tomography images of a human mandible, fibula, and iliac crest were used as references to build three-dimensional (3D) models on a PC. The virtual plates and screws were used to simulate reconstruction of the mandibular defects. The models were divided into two groups based on the longitudinal defect size. Different osteosynthesis variations and autogenous graft material combinations were used to reconstruct the mandibles. RESULTS In all models, higher von Mises stress values occurred on the mandibles reconstructed with the fibula than those with the iliac crest. Fixation of the bone grafts with a reconstruction plate for the 10-mm defects and using a mini-plate in addition to the reconstruction plate for the 30-mm defects decreased stresses on the grafted bones. CONCLUSIONS Mandibular reconstruction with the iliac grafts is biomechanically superior to that with the fibular grafts. In addition, osteosynthesis methods and the defect size affect the stress distribution.
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Bujtár P, Simonovics J, Váradi K, Sándor GK, Avery C. The biomechanical aspects of reconstruction for segmental defects of the mandible: A finite element study to assess the optimisation of plate and screw factors. J Craniomaxillofac Surg 2014; 42:855-62. [DOI: 10.1016/j.jcms.2013.12.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/09/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022] Open
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Bujtár P, Simonovics J, Zombori G, Fejer Z, Szucs A, Bojtos A, Batista WO, Váradi K, Sándor GK. Internal or in-scan validation: a method to assess CBCT and MSCT gray scales using a human cadaver. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:768-79. [DOI: 10.1016/j.oooo.2014.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 01/29/2014] [Accepted: 02/04/2014] [Indexed: 11/25/2022]
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Bujtar P, Simonovics J, Váradi K, Sándor GKB, Pan J, Avery CME. Refinements in osteotomy design to improve structural integrity: a finite element analysis study. Br J Oral Maxillofac Surg 2012; 51:479-85. [PMID: 23084459 DOI: 10.1016/j.bjoms.2012.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
Abstract
Osteotomy cuts are typically made using a saw, and the meeting point acts as a focus for the concentration of stress and failure. We have studied the impact of different designs of osteotomy cut. Cadaver sheep tibias were scanned by computed tomography (CT) and transformed into a computer-aided design (CAD) model. A standard marginal resection defect was created and then modified, and a finite element analysis made. The relative stress concentrations at the intersection of osteotomy cuts were recorded using principal stresses S1, S3, and von Mises stress, von Mises under both 4-point bending and torsion testing. The osteotomy designs studied were: right-angled and bevelled osteotomy end cuts, overcutting, and a stop drill hole. Peak stress values for 4-point bending and torsion were 24-30% greater at the right-angled osteotomy than the bevelled end cut. Overcutting dramatically increased peak stress values caused by bending and torsion by 48% and 71%, respectively. Substantially lower concentrations of stress were noted with a stop hole using both a 90° (bending 38% and torsion 56%), and a tangential (bending 58% and torsion 60%) cut. A bevelled osteotomy has substantially lower concentrations of stress than a right-angled osteotomy. It is important to avoid creating an overcut as this causes an appreciable increase in the concentration of stress, while a stop drill hole substantially reduces the stress. The creation of a stop hole and the use of judicious bevelling techniques are modifications in the design of an osteotomy that are readily applicable to surgical practice.
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Affiliation(s)
- P Bujtar
- Department of Maxillofacial Surgery, University Hospitals of Leicester, Leicester, UK.
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