1
|
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.
Collapse
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.)
| |
Collapse
|
2
|
Berger L, Eichler J, Ryll EJS, Fischerauer S, Raschke MJ, Kolbitsch A, Castellani C, Weinberg AM. Advanced interlocking systems to improve heavy-load-bearing characteristics of flexible intramedullary nailing. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 68:358-365. [PMID: 27524031 DOI: 10.1016/j.msec.2016.05.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/04/2016] [Accepted: 05/27/2016] [Indexed: 11/19/2022]
Abstract
Flexible intramedullary nailing (FIN) is a minimally invasive and widespread standard method for osteosynthesis of pediatric long bone fractures. In the case of unstable fractures of the lower extremity, interlocking systems need to be used to prevent axial shortening and subsequent perforation of the nail at its insertion site. In the present study, four different screw-fixed interlocking systems for FINs (Hofer TwinPlug with two 3-mm titanium interlocking screws, Hofer FixPlug with 3-mm titanium interlocking screw, Hofer Plug with 3.5-mm titanium interlocking screw, and Hofer Plug with 3-mm titanium interlocking screw) in comparison with the commonly used Ender stainless steel nails (locked with 3.5-mm screw) were experimentally investigated in cadaveric lamb tibiae, regarding their load characteristics and failure modes in the case of heavy loading. The specimens were subjected to sequential axial cyclic loading of 5000cycles with stepwise increase of the load amplitude until failure. Migration of locking screws and internal damage of bone tissue was quantified by micro-computed tomography (CT) imaging. Ender nails failed on average at a peak load of 800 N, TwinPlugs at 1367 N, FixPlugs at 1222 N, Plugs 3.5mm at 1225 N and Plugs 3.0mm at 971 N. TwinPlugs, FixPlugs, and Plugs 3.5mm failed in a slow manner over several hundred loading cycles, whereas Ender nails and Plugs 3.0mm exhibited abrupt failure without any prior indication. Our results confirm that axial stability of FIN can be further improved by screw-fixed plugs by simultaneously avoiding shortcomings of an eye-locked system, which the Ender nails are. Considering biomechanical results, plug interlocking systems with 3.5-mm screws should be favored over conventional Ender nails and plugs with 3-mm screws.
Collapse
Affiliation(s)
- Leopold Berger
- Institute of Building Construction and Technology, TU Wien, Karlsplatz 13/206-4, 1040 Vienna, Austria.
| | - Johannes Eichler
- Department of Orthopedics and Orthopedic Surgery, Medical University of Graz, Auenbruggerplatz 5/6, 8036 Graz, Austria
| | - E Jonathan S Ryll
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Westphalian-Wilhelms University, Muenster, Germany
| | - Stefan Fischerauer
- Department of Traumatology, Medical University of Graz, Auenbruggerplatz 5/6, 8036 Graz, Austria
| | - Michael J Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Westphalian-Wilhelms University, Muenster, Germany
| | - Andreas Kolbitsch
- Institute of Building Construction and Technology, TU Wien, Karlsplatz 13/206-4, 1040 Vienna, Austria
| | - Christoph Castellani
- Department of Pediatric and Adolescence Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria
| | - Annelie-Martina Weinberg
- Department of Orthopedics and Orthopedic Surgery, Medical University of Graz, Auenbruggerplatz 5/6, 8036 Graz, Austria
| |
Collapse
|
3
|
Abstract
The management of children's fractures has evolved as a result of better health education, changes in lifestyle, improved implant technology and the changing expectations of society. This review focuses on the changes seen in paediatric fractures, including epidemiology, the increasing problems of obesity, the mechanisms of injury, non-accidental injuries and litigation. We also examine the changes in the management of fractures at three specific sites: the supracondylar humerus, femoral shaft and forearm. There has been an increasing trend towards surgical stabilisation of these fractures. The reasons for this are multifactorial, including societal expectations of a perfect result and reduced hospital stay. Reduced hospital stay is beneficial to the social, educational and psychological needs of the child and beneficial to society as a whole, due to reduced costs.
Collapse
Affiliation(s)
- D Kosuge
- The Princess Alexandra Hospital NHS Trust, Harlow, Essex CM20 1QX, UK
| | - M Barry
- The Royal London Hospital, London E1 1BB, UK
| |
Collapse
|