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Li Z, Pollard S, Smith G, Deshmukh S, Ding Z. Biomechanical analysis of combi-hole locking compression plate during fracture healing: A numerical study of screw configuration. Proc Inst Mech Eng H 2024; 238:313-323. [PMID: 38372206 PMCID: PMC10941711 DOI: 10.1177/09544119241229157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/12/2024] [Indexed: 02/20/2024]
Abstract
Locking compression plates (LCPs) have become a widely used option for treating femur bone fractures. However, the optimal screw configuration with combi-holes remains a subject of debate. The study aims to create a time-dependent finite element (FE) model to assess the impacts of different screw configurations on LCP fixation stiffness and healing efficiency across four healing stages during a complete fracture healing process. To simulate the healing process, we integrated a time-dependent callus formation mechanism into a FE model of the LCP with combi-holes. Three screw configuration parameters, namely working length, screw number, and screw position, were investigated. Increasing the working length negatively affected axial stiffness and healing efficiency (p < 0.001), while screw number or position had no significant impact (p > 0.01). The time-dependent model displayed a moderate correlation with the conventional time-independent model for axial stiffness and healing efficiency (ρ ≥ 0.733, p ≤ 0.025). The highest healing efficiency (95.2%) was observed in screw configuration C125 during the 4-8-week period. The results provide insights into managing fractures using LCPs with combi-holes over an extended duration. Under axial compressive loading conditions, the use of the C125 screw configuration can enhance callus formation during the 4-12-week period for transverse fractures. When employing the C12345 configuration, it becomes crucial to avoid overconstraint during the 4-8-week period.
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Affiliation(s)
- Zeyang Li
- School of Engineering, Cardiff University, Cardiff, UK
| | - Stuart Pollard
- School of Engineering, University of Birmingham, Birmingham, UK
| | | | | | - Ziyun Ding
- School of Engineering, University of Birmingham, Birmingham, UK
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Basirom I, Daud R, Ijaz MF, Rojan MA, Basaruddin KS. Stability Analysis of Plate-Screw Fixation for Femoral Midshaft Fractures. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5958. [PMID: 37687652 PMCID: PMC10489176 DOI: 10.3390/ma16175958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/25/2023] [Accepted: 08/04/2023] [Indexed: 09/10/2023]
Abstract
An understanding of the biomechanical characteristics and configuration of flexible and locked plating in order to provide balance stability and flexibility of implant fixation will help to construct and promote fast bone healing. The relationship between applied loading and implantation configuration for best bone healing is still under debate. This study aims to investigate the relationship between implant strength, working length, and interfragmentary strain (εIFM) on implant stability for femoral midshaft transverse fractures. The transverse fracture was fixed with a fragment locking compression plate (LCP) system. Finite element analysis was performed and subsequently characterised based on compression loading (600 N up to 900 N) and screw designs (conventional and locking) with different penetration depths (unicortical and bicortical). Strain theory was used to evaluate the stability of the model. The correlation of screw configuration with screw type shows a unicortical depth for both types (p < 0.01) for 700 N and 800 N loads and (p < 0.05) for configurations 134 and 124. Interfragmentary strain affected only the 600 N load (p < 0.01) for the bicortical conventional type (group BC), and the screw configurations that were influenced were 1234 and 123 (p < 0.05). The low steepness of the slope indicates the least εIFM for the corresponding biomechanical characteristic in good-quality stability. A strain value of ≤2% promotes callus formation and is classified as absolute stability, which is the minimum required value for the induction of callus and the maximum value that allows bony bridging. The outcomes have provided the correlation of screw configuration in femoral midshaft transverse fracture implantation which is important to promote essential primary stability.
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Affiliation(s)
- Izzawati Basirom
- Fracture and Damage Mechanics (FDM), Faculty of Mechanical Engineering Technology, University Malaysia Perlis, Arau 02600, Perlis, Malaysia; (I.B.); (R.D.); (M.A.R.); (K.S.B.)
| | - Ruslizam Daud
- Fracture and Damage Mechanics (FDM), Faculty of Mechanical Engineering Technology, University Malaysia Perlis, Arau 02600, Perlis, Malaysia; (I.B.); (R.D.); (M.A.R.); (K.S.B.)
| | - Muhammad Farzik Ijaz
- Mechanical Engineering Department, College of Engineering, King Saud University, P.O. Box 800, Riyadh 11421, Saudi Arabia
| | - Mohd Afendi Rojan
- Fracture and Damage Mechanics (FDM), Faculty of Mechanical Engineering Technology, University Malaysia Perlis, Arau 02600, Perlis, Malaysia; (I.B.); (R.D.); (M.A.R.); (K.S.B.)
| | - Khairul Salleh Basaruddin
- Fracture and Damage Mechanics (FDM), Faculty of Mechanical Engineering Technology, University Malaysia Perlis, Arau 02600, Perlis, Malaysia; (I.B.); (R.D.); (M.A.R.); (K.S.B.)
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Xu S, Ding X, Xiong M, Duan P, Zhang H, Li Z. The optimal design of 3D-printed lattice bone plate by considering fracture healing mechanism. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3682. [PMID: 36625630 DOI: 10.1002/cnm.3682] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/22/2022] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
The biomechanical stimulus is the most important factor for fracture healing and mainly determined by the structural stiffness of bone plate. Currently, the materials commonly used in bone plates are stainless steel and titanium, which often lead to stress shielding effects because of their higher elastic modulus compared with the bone. This article suggests an optimal design method of lattice bone plate based on fracture healing theory. First, the mechanical regulation model with deviatoric strain is established to simulate the tissue differentiation process during fracture healing process. The ratio of the average elastic modulus of callus at the 120th day to the elastic modulus of mature bone is used to characterize the fracture healing rate. Second, the optimal elastic modulus of the design domain is obtained by the optimization mathematical model with the maximum fracture healing rate. Then, the design domain is filled with microstructures, the porosity of which is adjusted to make it possible that the equivalent elastic modulus is equal to the optimized value. And the finite element analysis of the bone plate with microstructure is executed. Finally, the designed lattice bone plates are manufactured through 3D printing, and the mechanical test is carried out. The simulation results indicate that the fracture healing rate is maximum when the elastic modulus of material in design domain is 38 GPa under the constraints of fixation stability. And both the finite element analysis and experiment results show that the designed lattice bone plate meet the strength requirements of fracture internal fixation implants.
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Affiliation(s)
- Shipeng Xu
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Xiaohong Ding
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Min Xiong
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Pengyun Duan
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Heng Zhang
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Zhuoyi Li
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, China
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Rosell-Pradas J, Redondo-Trasobares B, Sarasa-Roca M, Albareda-Albareda J, Puértolas-Broto S, Herrera-Rodríguez A, Gracia-Villa L. Influence of plate size and screw distribution on the biomechanical behaviour of osteosynthesis by means of lateral plates in femoral fractures. Injury 2023; 54:395-404. [PMID: 36528423 DOI: 10.1016/j.injury.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
Distal femoral fractures are fractures associated with high rates of morbidity and mortality, affecting to three different groups of individuals: younger people suffering high-energy trauma, elderly people with fragile bones and people with periprosthetic fractures around previous total knee arthroplasty. They have been classically treated with conventional plates and intramedullary nails and more recently with locked plates that have increased their indications to more types of fractures. The main objective of the present work is the biomechanical study, by means of finite element simulation, of the stability achieved in the osteosynthesis of femoral fractures in zones 4 and 5 of Wiss, by using locked plates with different plate lengths and different screw configurations, and analysing the effect of screw proximity to the fracture site. A three dimensional (3D) finite element model of the femur from 55-year-old male donor was developed, and then a stability analysis was performed for the fixation provided by Osteosynthesis System LOQTEC® Lateral Distal Femur Plate in two different fracture zones corresponding to the zones 4 and 5 according to the Wiss fracture classification. The study was focused on the immediately post-operative stage, without any biological healing process. The obtained results show that more stable osteosyntheses were obtained by using shorter plates. In the cases of longer plates, it results more convenient disposing screws in a way that the upper ones are closer to fracture site. The obtained results can support surgeons to understand the biomechanics of fracture stability, and then to guide them towards the more appropriate osteosynthesis depending on the fracture type and location.
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Affiliation(s)
- J Rosell-Pradas
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
| | - B Redondo-Trasobares
- Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Zaragoza, Spain; Aragón Health Research Institute, Zaragoza, Spain
| | - M Sarasa-Roca
- Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Zaragoza, Spain; Aragón Health Research Institute, Zaragoza, Spain
| | - J Albareda-Albareda
- Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Zaragoza, Spain; Aragón Health Research Institute, Zaragoza, Spain; Department of Surgery, University of Zaragoza, Zaragoza, Spain.
| | - S Puértolas-Broto
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain; Aragón Institute for Engineering Research, Zaragoza, Spain
| | | | - L Gracia-Villa
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain; Aragón Institute for Engineering Research, Zaragoza, Spain
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He Z, Huang S, Ji T, Tang X, Yang R, Guo W. Plate configuration for biological reconstructions of femoral intercalary defect - a finite element evaluation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 224:107006. [PMID: 35816816 DOI: 10.1016/j.cmpb.2022.107006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/16/2022] [Accepted: 07/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Biological reconstruction was commonly used for femoral intercalary defect. The initial stability by plate fixation was believed to have an effect on bone union and implant failure. Our study was proposed to explore relationship of plate configuration and initial stability for femoral intercalary reconstruction using allo-/autograft. METHODS Femoral intercalary defect models were established with four different plate configurations: (1) Single lateral bridging plate, SLP (2) Lateral bridging plate + Orthogonal adjuvant plate, LP+OAP (3) Lateral bridging plate + Medial adjuvant plate, LP+MAP (4) Lateral bridging plate + Medial bridging plate, LP+MP. A diaphysis defect of 12 cm was simulated, and the removed native femoral bone was used as a structural allograft with the osteotomy gap of 2 mm. Models were analyzed by finite element simulations under an axial compression of 2000N and an axial moment of 10 Nm, respectively. RESULTS Axial load: (1) The peak von Mises stress of SLP, LP+OAP, LP+MAP, LP+MP were 993.50 MPa, 335.63 MPa, 240.03 MPa, 281.73 MPa, respectively and LP+MAP was the lowest (p < 0.01); (2) The mean displacement of SLP, LP+OAP, LP+MAP, LP+MP was 0.765, 0.130, 0.121, 0.235 mm, respectively. LP+MAP showed the best stability while SLP had a crash in the medial proximal gap; (3) The LP+MAP configuration had the most uniform stress distribution and the lowest maximum von Mises stress of 79.7 MPa within plates. Axial torsional load: (1) The peak von Mises stress of SLP, LP+OAP, LP+MAP, LP+MP were 431.66Mpa, 120.73 MPa, 72.31 MPa, 109.86 MPa, respectively; (2) The rotation angle of SLP, LP+OAP, LP+MAP, LP+MP was 4.30°, 1.35°, 1.20°, 1.57°, respectively. All of LP+OAP, LP+MAP and LP+MP showed an optimal torsional stability. CONCLUSIONS For femoral intercalary reconstruction using allo-/autograft fixed by plates, LP+MAP and LP+MP configurations showed superior stability in terms of axial compression and torsion load by FE simulation. A better stability was believed to be associated with higher union rate and lower hardware failure rate.
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Affiliation(s)
- Ziyang He
- Investigation performed at Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China
| | - Siyi Huang
- Investigation performed at Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China
| | - Tao Ji
- Investigation performed at Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China.
| | - Xiaodong Tang
- Investigation performed at Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China
| | - Rongli Yang
- Investigation performed at Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China
| | - Wei Guo
- Investigation performed at Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China.
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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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Siqueira RC, Rahal SC, Mesquita LR, Voorwald FA, Fernandes MF, Tosati M, Ribeiro CR, Scorsato PS. Influence of the Near-Cortical Over-Drilling Technique on the Mechanical Behaviour of Locking Plate Constructs Applied in Maned Wolf's Femur. Vet Comp Orthop Traumatol 2022; 35:246-254. [PMID: 35609873 DOI: 10.1055/s-0042-1748859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the influence of near-cortical over-drilling holes on the mechanical behaviour of locking plate constructs applied in maned wolf's femur by using mechanical testing and finite element method (FEM). STUDY DESIGN Seven pairs of adult maned wolves (Chrysocyon brachyurus) femur bones were randomly distributed into four groups. In all groups, a 3.5 mm locking compression plate, designed with 12 combi-holes and one locked, was applied to the lateral surface of the femur. G1 (n = 4) received bicortical locking screws placed in holes 1, 3, 5, 8, 10 and 12. In G2 (n = 5), the plate was applied as used in G1, but the application of the locked screws involved the near-cortical over-drilling technique. In G3 (n = 4), the plate was applied as used in G2, but the size of the near-cortical over-drilling was larger. The combi-holes 6 and 7 were maintained over a 10 mm fracture gap without screws. All constructs were tested for failure in the axial load. The axial load was applied eccentrically to the femoral head. RESULTS Statistical differences were observed in the maximum load with G3 > G1 and G3 > G2, and in the deflection with G2 > G1 and G2 > G3. The FEM showed the lowest total displacement of the bone-plate constructs as well as of the plate in G1 compared with G2 and G3. CONCLUSION The near-cortical over-drilling technique used in unstable fractures induced in the maned wolf's femur showed by static axial compression test that maximum load and deflection are dependent on drill hole size induced in the near-cortex. Based on FEM, the lowest total displacement of the bone-plate constructs was observed in Group 1.
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Affiliation(s)
- Rafael C Siqueira
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine and Animal Science - São Paulo State University (UNESP), Rubião Júnior s/n, Botucatu, SP, Brazil
| | - Sheila C Rahal
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine and Animal Science - São Paulo State University (UNESP), Rubião Júnior s/n, Botucatu, SP, Brazil
| | - Luciana R Mesquita
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine and Animal Science - São Paulo State University (UNESP), Rubião Júnior s/n, Botucatu, SP, Brazil
| | - Fabiana A Voorwald
- Department of Veterinary Surgery, Federal University of Viçosa, MG, Brazil
| | - Martin F Fernandes
- Department of Materials and Technology, São Paulo State University (UNESP), Guaratinguetá, São Paulo, Brazil
| | - Marcos Tosati
- Solution Engineering Manager at SAMT - Structural Solutions for Finite Elements, Bauru, Brazil
| | - Celso R Ribeiro
- Mechanical and Metallography Testing Laboratory - LEMM, Jaú, SP, Rua Luiz Pengo 150, Brazil
| | - Paulo S Scorsato
- Department of Veterinary Surgery and Anesthesiology, School of Veterinary Medicine and Animal Science, University of Marília (UNIMAR), Marília, SP, Brazil
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Rafiei S, Nourani A, Chizari M. A multi-objective approach to optimize the weight and stress of the locking plates using finite element modeling. Proc Inst Mech Eng H 2021; 236:188-198. [PMID: 34696646 DOI: 10.1177/09544119211048286] [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: 11/17/2022]
Abstract
This paper aims to identify an optimum bone fracture stabilizer. For this purpose, three design variables including the ratio of the screw diameter to the plate width at three levels, the ratio of the plate thickness to the plate width at three levels, and the diameter of the bone at two levels were selected for analysis. Eighteen 3D verified finite element models were developed to examine the effects of these parameters on the weight, maximum displacement and maximum von Mises stress of the fixation structure. Considering the relations between the inputs and outputs using multivariate regression, a genetic algorithm was used to find the optimal choices. Results showed that the diameter of the bone and the amount of load applied on it did not have a significant effect on the normalized stresses on the structures. Furthermore, in all ratio of the plate thickness to the plate width, as the ratio of the screw diameter to the plate width increased, the amount of stress on the structure decreased. But, by further increasing the ratio of the screw diameter to the plate width, the amount of stress on the structure increased. On the other hand, by increasing the value of the ratio of the plate thickness to the plate width, the maximum amount of stress on the structure decreased. Finally, optimal solutions in terms of the weight and the maximum amount of stress on the structure were presented.
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Affiliation(s)
- Soroush Rafiei
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Amir Nourani
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Mahmoud Chizari
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield, UK
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Bird G, Glyde M, Hosgood G, Hayes A, Day R. Biomechanical Comparison of a Notched Head Locking T-Plate and a Straight Locking Compression Plate in a Juxta-Articular Fracture Model. Vet Comp Orthop Traumatol 2020; 34:161-170. [PMID: 33249549 DOI: 10.1055/s-0040-1719166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This investigation compared the biomechanical properties of a 2.0 mm locking compression notched head T-plate (NHTP) and 2.0 mm straight locking compression plate (LCP), in a simple transverse juxta-articular fracture model. STUDY DESIGN Two different screw configurations were compared for the NHTP and LCP, modelling short (configuration 1) and long working length (configuration 2). Constructs were tested in compression, perpendicular and tension non-destructive four point bending and torsion. Plate surface strain was measured at 12 regions of interest (ROI) using three-dimensional digital image correlation. Stiffness and strain were compared between screw configurations within and between each plate. RESULTS The LCP was stiffer than the NHTP in all three planes of bending and torsion (p < 0.05). The NHTP had greater strain than the LCP during compression bending and torsion at all ROI (p < 0.0005). The short working length was stiffer in all three planes of bending and in torsion (p < 0.05) than the longer working length for both plates. The long working length showed greater strain than the short working length at most ROI. CONCLUSION In this experimental model, a 2.0 mm LCP with two screws in the short fragment was significantly stiffer and had lower plate strain than a 2.0 mm NHTP with three screws in the short fragment. Extending the working length significantly reduced construct stiffness and increased plate strain. These findings may guide construct selection.
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Affiliation(s)
- Guy Bird
- College of Veterinary Medicine, Murdoch University, Perth, Australia
| | - Mark Glyde
- College of Veterinary Medicine, Murdoch University, Perth, Australia
| | - Giselle Hosgood
- College of Veterinary Medicine, Murdoch University, Perth, Australia
| | - Alex Hayes
- Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia
| | - Robert Day
- Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia
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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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12
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Şensoy AT, İspirli H, Dertli E. Determining the optimum model parameters for oligosaccharide production efficiency using response surface integrated particle swarm optimization method: an experimental validation study. Prep Biochem Biotechnol 2020; 50:820-826. [PMID: 32282271 DOI: 10.1080/10826068.2020.1753070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Glucansucrases (GTFs) catalyzes the synthesis of α-glucans from sucrose and oligosaccharides in the presence of an acceptor sugar by transferring glucosyl units to the acceptor molecule with different linkages. The acceptor reactions can be affected by several parameters and this study aimed to determine the optimal reaction parameters for the production of glucansucrase-based oligosaccharides using sucrose and maltose as the donor and acceptor sugars, respectively via a hybrid technique of Response Surface Method (RSM) and Particle Swarm Optimization (PSO). The experimental design was performed using Central Composite Design and the tested parameters were enzyme concentration, acceptor:donor ratio and the reaction period. The optimization studies showed that enzyme concentration was the most effective parameter for the final oligosaccharides yields. The optimal values of the significant parameters determined for enzyme concentration and acceptor:donor ratio were 3.45 U and 0.62, respectively. Even the response surface plots for input parameters verified the PSO results, an experimental validation study was performed for the reverification. The experimental verification results obtained were also consistent with the PSO results. These findings will help our understanding in the role of different parameters for the production of oligosaccharides in the acceptor reactions of GTFs.
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Affiliation(s)
- Abdullah Tahir Şensoy
- Department of Biomedical Engineering, Engineering Faculty, Samsun University, Samsun, Turkey
| | - Hümeyra İspirli
- Central Research Laboratory, Bayburt University, Bayburt, Turkey
| | - Enes Dertli
- Department of Food Engineering İstanbul, Chemical-Metallurgical Engineering Faculty, Yıldız Technical University, Istanbul, Turkey
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13
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Künzel LA, Leibfarth S, Dohm OS, Müller AC, Zips D, Thorwarth D. Automatic VMAT planning for post-operative prostate cancer cases using particle swarm optimization: A proof of concept study. Phys Med 2019; 69:101-109. [PMID: 31862575 DOI: 10.1016/j.ejmp.2019.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the potential of Particle Swarm Optimization (PSO) for fully automatic VMAT radiotherapy (RT) treatment planning. MATERIAL AND METHODS In PSO a solution space of planning constraints is searched for the best possible RT plan in an iterative, statistical method, optimizing a population of candidate solutions. To identify the best candidate solution and for final evaluation a plan quality score (PQS), based on dose volume histogram (DVH) parameters, was introduced. Automatic PSO-based RT planning was used for N = 10 postoperative prostate cancer cases, retrospectively taken from our clinical database, with a prescribed dose of EUD = 66 Gy in addition to two constraints for rectum and one for bladder. Resulting PSO-based plans were compared dosimetrically to manually generated VMAT plans. RESULTS PSO successfully proposed treatment plans comparable to manually optimized ones in 9/10 cases. The median (range) PTV EUD was 65.4 Gy (64.7-66.0) for manual and 65.3 Gy (62.5-65.5) for PSO plans, respectively. However PSO plans achieved significantly lower doses in rectum D2% 67.0 Gy (66.5-67.5) vs. 66.1 Gy (64.7-66.5, p = 0.016). All other evaluated parameters (PTV D98% and D2%, rectum V40Gy and V60Gy, bladder D2% and V60Gy) were comparable in both plans. Manual plans had lower PQS compared to PSO plans with -0.82 (-16.43-1.08) vs. 0.91 (-5.98-6.25). CONCLUSION PSO allows for fully automatic generation of VMAT plans with plan quality comparable to manually optimized plans. However, before clinical implementation further research is needed concerning further adaptation of PSO-specific parameters and the refinement of the PQS.
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Affiliation(s)
- Luise A Künzel
- Section for Biomedical Physic, Department for Radiation Oncology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
| | - Sara Leibfarth
- Section for Biomedical Physic, Department for Radiation Oncology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Oliver S Dohm
- Department for Radiation Oncology, University Hospital Tübingen, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Arndt-Christian Müller
- Department for Radiation Oncology, University Hospital Tübingen, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Daniel Zips
- Department for Radiation Oncology, University Hospital Tübingen, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany; German Cancer Consortium (DKTK), Partner Site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniela Thorwarth
- Section for Biomedical Physic, Department for Radiation Oncology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany; German Cancer Consortium (DKTK), Partner Site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
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14
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Kiyono M, Noda T, Nagano H, Maehara T, Yamakawa Y, Mochizuki Y, Uchino T, Yokoo S, Demiya K, Saiga K, Shimamura Y, Ozaki T. Clinical outcomes of treatment with locking compression plates for distal femoral fractures in a retrospective cohort. J Orthop Surg Res 2019; 14:384. [PMID: 31771597 PMCID: PMC6880442 DOI: 10.1186/s13018-019-1401-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/04/2019] [Indexed: 11/24/2022] Open
Abstract
Background Plate fixation is one of the standard surgical treatments for distal femoral fractures. There are few reports on the relationship between the screw position and bone union when fixing by the bridging plate (relative stability) method. Methods This retrospective study included 71 distal femoral fractures of 70 patients who were treated with the locking compression plate for distal femur (DePuy Synthes Co., Ltd, New Brunswick, CA, USA). The following measurements were evaluated and analyzed: (1) bone union rate, (2) bridge span length (distance between screws across the fracture), (3) plate span ratio (plate length/bone fracture length), (4) number of empty holes (number of screw holes not inserted around the fracture), and (5) medial fracture distance (bone fracture distance on the medial side of the distal femur). Patient demographics (age), comorbidities (smoking, diabetes, chronic steroid use, dialysis), and injury characteristics (AO type, open fracture, infection) were obtained for all participants. Univariate analysis was performed on them. Results Of 71 fractures, 26 fractures were simple fractures, 45 fractures were comminuted fractures, and 7 fractures resulted in non-union. Non-union rate was significantly higher in comminuted fractures with bone medial fracture distance exceeding 5 mm. Non-union was founded in simple fractures with bone medial fracture distance exceeding 2 mm, but not significant (p = 0.06). In cases with simple fractures, one non-union case had one empty hole and one non-union case had four empty holes, whereas in cases with comminuted fractures, five non-union cases had two more empty holes. Conclusions We concluded that bone fragment distance between fracture fragments is more important than bridge span length of the fracture site and the number of empty holes. Smoking and medial fracture distance are prognostic risk factors of nonunion in distal femoral fractures treated with LCP as bridging plate.
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Affiliation(s)
- Masahiro Kiyono
- Department of Orthopedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kitaku, Okayama City, Okayama Prefecture, 700-8558, Japan
| | - Tomoyuki Noda
- Department of Musculoskeletal Traumatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Okayama City, Okayama, 700-8558, Japan.
| | - Hiroshi Nagano
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-Machi, Takamatsu City, Kagawa Prefecture, 760-8557, Japan
| | - Takashi Maehara
- Department of Orthopedic Surgery, Kagawa Rosai Hospital, Jotocho, Marugame, Kagawa Prefecture, 763-8502, Japan
| | - Yasuaki Yamakawa
- Department of Community and Emergency Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kitaku, Okayama City, Okayama Prefecture, 700-8558, Japan
| | - Yusuke Mochizuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kitaku, Okayama City, Okayama Prefecture, 700-8558, Japan
| | - Takahiko Uchino
- Department of Orthopedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kitaku, Okayama City, Okayama Prefecture, 700-8558, Japan
| | - Suguru Yokoo
- Department of Orthopedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kitaku, Okayama City, Okayama Prefecture, 700-8558, Japan
| | - Koji Demiya
- Department of Orthopedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kitaku, Okayama City, Okayama Prefecture, 700-8558, Japan
| | - Kenta Saiga
- Department of Orthopedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kitaku, Okayama City, Okayama Prefecture, 700-8558, Japan
| | - Yasunori Shimamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kitaku, Okayama City, Okayama Prefecture, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kitaku, Okayama City, Okayama Prefecture, 700-8558, Japan
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15
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Optimal Material Selection for Total Hip Implant: A Finite Element Case Study. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2019. [DOI: 10.1007/s13369-019-04088-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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16
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JHOU SHUYU, SHIH KAOSHANG, HUANG POSHENG, LIN FANGYU, HSU CHINGCHI. BIOMECHANICAL ANALYSIS OF DIFFERENT SURGICAL STRATEGIES FOR THE TREATMENT OF ROTATIONALLY UNSTABLE PELVIC FRACTURE USING FINITE ELEMENT METHOD. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419400153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A rotationally unstable pelvic fracture can lead to loss of function and limit moving ability. Immediate fracture fixation is needed for patients with the pelvic fractures. However, it may be difficult to evaluate different surgical strategies for the fracture treatments due to variations in patients’ anatomies and surgical techniques. Thus, the purpose of the present study was to analyze the biomechanical performances of the intact, injured, and treated pelvises based on different physiological movements of the spine using finite element method. Three-dimensional musculoskeletal finite element models of the spine-pelvis-femur complex were developed. The intact pelvis, the rotationally unstable pelvis, and six types of pelvic fixation techniques were analyzed. Additionally, seven types of physiological movements of the spine were also considered. The results showed that the posterior iliosacral screws combined with lower and anterior plate (PIS-LAP) had good fixation stability, lower plate stress, and lower pelvic stress. However, the PIS-LAP increased the stress of the posterior iliosacral screws. The right lateral bending, left lateral bending, and flexion significantly affect all the biomechanical performances compared to the other physiological movements of the spine. The present study can provide engineers and surgeons with the understanding of the biomechanics of various fixation techniques during different physiological movements for the treatment of rotationally unstable pelvic fractures.
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Affiliation(s)
- SHU-YU JHOU
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106, Taiwan, R.O.C
| | - KAO-SHANG SHIH
- Department of Orthopedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan, R.O.C
| | - PO-SHENG HUANG
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106, Taiwan, R.O.C
| | - FANG-YU LIN
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106, Taiwan, R.O.C
| | - CHING-CHI HSU
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106, Taiwan, R.O.C
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17
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Curtiss AL, Goodrich LR, Rossignol F, Richardson DW. Pancarpal and partial carpal arthrodesis with 3 locking compression plates in 6 horses. Vet Surg 2018; 47:692-704. [DOI: 10.1111/vsu.12916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/26/2018] [Accepted: 05/08/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Alexandra L. Curtiss
- Department of Clinical Studies, New Bolton Center; University of Pennsylvania; Kennett Square Pennsylvania
| | - Laurie R. Goodrich
- Orthopedic Research Center and Clinical Sciences; Colorado State University; Fort Collins Colorado
| | | | - Dean W. Richardson
- Department of Clinical Studies, New Bolton Center; University of Pennsylvania; Kennett Square Pennsylvania
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18
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Biomechanical Property of a Newly Designed Assembly Locking Compression Plate: Three-Dimensional Finite Element Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:8590251. [PMID: 29065654 PMCID: PMC5494084 DOI: 10.1155/2017/8590251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/03/2017] [Indexed: 11/17/2022]
Abstract
In this study, we developed and validated a refined three-dimensional finite element model of middle femoral comminuted fracture to compare the biomechanical stability after two kinds of plate fixation: a newly designed assembly locking compression plate (NALCP) and a locking compression plate (LCP). CT data of a male volunteer was converted to middle femoral comminuted fracture finite element analysis model. The fracture was fixated by NALCP and LCP. Stress distributions were observed. Under slow walking load and torsion load, the stress distribution tendency of the two plates was roughly uniform. The anterolateral femur was the tension stress area, and the bone block shifted toward the anterolateral femur. Maximum stress was found on the lateral border of the number 5 countersink of the plate. Under a slow walking load, the NALCP maximum stress was 2.160e+03 MPa and the LCP was 8.561e+02 MPa. Under torsion load, the NALCP maximum stress was 2.260e+03 MPa and the LCP was 6.813e+02 MPa. Based on those results of finite element analysis, the NALCP can provide adequate mechanical stability for comminuted fractures, which would help fixate the bone block and promote bone healing.
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19
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Tsai PI, Hsu CC, Chen SY, Wu TH, Huang CC. Biomechanical investigation into the structural design of porous additive manufactured cages using numerical and experimental approaches. Comput Biol Med 2016; 76:14-23. [DOI: 10.1016/j.compbiomed.2016.06.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
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Li H, Agarwal J, Coats B, Gale BK. Optimization and Evaluation of a Vascular Coupling Device for End-to-End Anastomosis: A Finite-Element Analysis. J Med Device 2015. [DOI: 10.1115/1.4031810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Currently, end-to-end anastomosis of blood vessels is performed using suturing, which is time consuming, expensive, and subject to large degrees of human error. One promising alternative is a ring–pin coupling device. This device has been shown to be useful for venous anastomosis, but lacks the versatility necessary for arterial applications. The purpose of this study was to optimize a vascular coupling design that could be used for arteries and veins of various sizes. To achieve this, finite-element (FE) analysis was used to simulate the vessel–device interaction during anastomosis. Parametric simulations were performed to optimize the number of pins, the wing pivot point, and the pin offset of the design. The interaction of the coupler with various blood vessel sizes was also evaluated. Maximum strain in the vessel wall increased with the number of pins. The positions of the wings and pins were also important in dictating maximum strain, and improper dimensions lead to failure of the installation process. Extra force applied to the distal end of the vessel, or a supplementary tool, will be required during the coupler installation process to prevent vessels less than 3 mm inner diameter (0.5 mm wall thickness) from slipping off the coupler.
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Affiliation(s)
- Huizhong Li
- Department of Mechanical Engineering, University of Utah, 50 S Central Campus Drive, Room 2110, Salt Lake City, UT 84112
- Department of Surgery, School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT 84132 e-mail:
| | - Jay Agarwal
- Department of Mechanical Engineering, University of Utah, 50 S Central Campus Drive, Room 2110, Salt Lake City, UT 84112
- Department of Surgery, School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT 84132
| | - Brittany Coats
- Department of Mechanical Engineering, University of Utah, 50 S Central Campus Drive, Room 2110, Salt Lake City, UT 84112
- Department of Surgery, School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT 84132
| | - Bruce K. Gale
- Department of Mechanical Engineering, University of Utah, 50 S Central Campus Drive, Room 2110, Salt Lake City, UT 84112
- Department of Surgery, School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT 84132 e-mail:
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Märdian S, Schaser KD, Duda GN, Heyland M. Working length of locking plates determines interfragmentary movement in distal femur fractures under physiological loading. Clin Biomech (Bristol, Avon) 2015; 30:391-6. [PMID: 25716162 DOI: 10.1016/j.clinbiomech.2015.02.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/05/2015] [Accepted: 02/05/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to investigate the influence of the screw location and plate working length of a locking plate construct at the distal femur on interfragmentary movement under physiological loading. METHODS To quantitatively analyse the influence of plate working length on interfragmentary movements in a locking plate construct bridging a distal femur fracture, a finite element model based on CT (computed tomography) data was physiologically loaded and fracture gap conditions were calculated. Four working lengths with eight screw variations each were systemically analysed. FINDINGS Interfragmentary movements for axial (12-19%, p<0.001) and shear movements (-7.4-545%, p<0.001) at all tested nodes increased significantly with longer plate working length, whereas screw variations within the groups revealed no significant influence. The working length (defined by screw location) dominates the biomechanical fracture gap conditions. INTERPRETATION The current finite element analysis demonstrates that plate working length significantly influences interfragmentary movements, thereby affecting the biomechanical consequences of fracture healing.
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Affiliation(s)
- Sven Märdian
- Centre for musculoskeletal surgery, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Klaus-Dieter Schaser
- Centre for musculoskeletal surgery, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Georg N Duda
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Mark Heyland
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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Nourisa J, Baseri A, Sudak L, Rouhi G. The Effects of Bone Screw Configurations on the Interfragmentary Movement in a Long Bone Fixed by a Limited Contact Locking Compression Plate. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/jbise.2015.89055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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