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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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Palierne S, Blondel M, Swider P, Autefage A. Biomechanical Comparison of Use of Two Screws versus Three Screws Per Fragment with Locking Plate Constructs under Cyclic Loading in Compression in a Fracture Gap Model. Vet Comp Orthop Traumatol 2022; 35:166-174. [PMID: 35272366 DOI: 10.1055/s-0042-1744175] [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
OBJECTIVES The aim of this study was to measure and compare the stiffness and cyclic fatigue of two plate-bone model constructs, with either two or three locking screws per fragment, under cyclic compression. METHODS A 10-hole 3.5 mm stainless steel locking compression plate (LCP) was fixed 1 mm from a synthetic bone model in which the fracture gap was 47 mm. Two groups of 10 constructs, prepared with either two or three bicortical locking screws placed at the extremities of each fragment, were tested in a load-controlled compression test until failure. RESULTS The three-screw constructs were stiffer than the two-screw constructs (196.75 ± 50.48 N/mm and 102.43 ± 22.93 N/mm, respectively) and the actuator displacements of the two-screw constructs were higher (18.02 ± 1.07 mm) than those of the three-screw constructs (14.48 ± 2.25 mm). The number of cycles to failure of the two-screw constructs was significantly lower (38,337.50 ± 2,196.98) than the that of the three-screw constructs (44,224.00 ± 1,515.24). Load at irreversible deformation was significantly lower in the two-screw constructs (140.93 ± 13.39 N) than in the three-screw constructs (184.27 ± 13.17 N). All constructs failed by plate bending at the gap between the two cylinders. CLINICAL SIGNIFICANCE Omission of the third innermost locking screw during bridging osteosynthesis subjected to compression forces led to a 13.3% reduction in the number of cycles to failure and a 23.5% reduction of the load withstood by the plate before plastic deformation occurred.
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Affiliation(s)
| | | | - Pascal Swider
- Université de Toulouse, IMFT UMR 5502, Toulouse, France
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Is Bridge Plating of Comminuted Humeral Shaft Fractures Advantageous When Using Compression Plates with Three versus Two Screws per Fragment? A Biomechanical Cadaveric Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6649712. [PMID: 33748273 PMCID: PMC7960035 DOI: 10.1155/2021/6649712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 11/21/2022]
Abstract
Background Minimally invasive plate osteosynthesis (MIPO) is one of the generally accepted surgical techniques for the treatment of humeral shaft fractures. However, despite the high bone union rate, a variety of complications are still prevailing. Moreover, the current literature lacks data comparing the anterolateral MIPO approach using dynamic compression plates accommodating different numbers of screws. The aim of this study was to analyze the biomechanical performance of comminuted humeral shaft fractures fixed with dynamic compression plates using either two or three screws per fragment. Methods Six pairs of fresh-frozen human cadaveric humeri from donors aged 66.8 ± 5.2 years were randomized to two paired study groups for simulation of bridge-plated comminuted shaft fracture type AO/OTA 12-C1/2/3 without interfragmentary bony support, using a dynamic compression plate positioned on the anterolateral surface and fixed with two (group 1) or three (group 2) screws per fragment. All specimens underwent nondestructive quasistatic biomechanical testing under lateral bending, anterior bending, axial bending, and torsion in internal rotation, followed by progressively increasing cyclic torsional loading in internal rotation until failure. Results Initial stiffness of the plated specimens in lateral bending, anterior bending, axial bending, and torsion was not significantly different between the groups (P ≥ 0.22). However, cycles to 10°, 15°, and 20° torsional deformation and cycles to construct failure were significantly higher in group 2 compared with group 1 (P ≤ 0.03). Conclusions From a biomechanical perspective, no significant superiority is identified in terms of primary stability when using two or three screws per fragment for bridge compression plating of comminuted humeral shaft fractures. However, three-screw configurations provide better secondary stability and maintain it with a higher resistance towards loss of reduction under dynamic loading. Therefore, the use of a third screw may be justified when such better secondary stability is required.
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Investigating the biomechanical function of the plate-type external fixator in the treatment of tibial fractures: a biomechanical study. BMC Musculoskelet Disord 2020; 21:128. [PMID: 32106851 PMCID: PMC7047408 DOI: 10.1186/s12891-020-3144-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background The design of an external fixator with the optimal biomechanical function and the lowest profile has been highly pursued, as fracture healing is dependent on the stability and durability of fixation, and a low profile is more desired by patients. The plate-type external fixator, a novel prototype of an external tibial fixation device, is a low profile construct. However, its biomechanical properties remain unclear. The objective of this study was to investigate the stiffness and strength of the plate-type external fixator and the unilateral external fixator. We hypothesized that the plate-type external fixator could provide higher stiffness while retaining sufficient strength. Methods Fifty-four cadaver tibias underwent a standardized midshaft osteotomy to create a fracture gap model to simulate a comminuted diaphyseal fracture. All specimens were randomly divided into three groups of eighteen specimens each and stabilized with either a unilateral external fixator or two configurations of the plate-type external fixator. Six specimens of each configuration were tested to determine fixation stiffness in axial compression, four-point bending, and torsion, respectively. Afterwards, dynamic loading until failure was performed in each loading mode to determine the construct strength and failure mode. Results The plate-type external fixator provided higher stiffness and strength than the traditional unilateral external fixator. The highest biomechanics were observed for the classical plate-type external fixator, closely followed by the extended plate-type external fixator. Conclusions The plate-type external fixator is stiffer and stronger than the traditional unilateral external fixator under axial compression, four-point bending and torsion loading conditions.
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Ang BFH, Chen JY, Yew AKS, Chua SK, Chou SM, Chia SL, Koh JSB, Howe TS. Externalised locking compression plate as an alternative to the unilateral external fixator: a biomechanical comparative study of axial and torsional stiffness. Bone Joint Res 2017; 6:216-223. [PMID: 28420623 PMCID: PMC5415900 DOI: 10.1302/2046-3758.64.2000470] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives External fixators are the traditional fixation method of choice for contaminated open fractures. However, patient acceptance is low due to the high profile and therefore physical burden of the constructs. An externalised locking compression plate is a low profile alternative. However, the biomechanical differences have not been assessed. The objective of this study was to evaluate the axial and torsional stiffness of the externalised titanium locking compression plate (ET-LCP), the externalised stainless steel locking compression plate (ESS-LCP) and the unilateral external fixator (UEF). Methods A fracture gap model was created to simulate comminuted mid-shaft tibia fractures using synthetic composite bones. Fifteen constructs were stabilised with ET-LCP, ESS-LCP or UEF (five constructs each). The constructs were loaded under both axial and torsional directions to determine construct stiffness. Results The mean axial stiffness was very similar for UEF (528 N/mm) and ESS-LCP (525 N/mm), while it was slightly lower for ET-LCP (469 N/mm). One-way analysis of variance (ANOVA) testing in all three groups demonstrated no significant difference (F(2,12) = 2.057, p = 0.171). There was a significant difference in mean torsional stiffness between the UEF (0.512 Nm/degree), the ESS-LCP (0.686 Nm/degree) and the ET-LCP (0.639 Nm/degree), as determined by one-way ANOVA (F(2,12) = 6.204, p = 0.014). A Tukey post hoc test revealed that the torsional stiffness of the ESS-LCP was statistically higher than that of the UEF by 0.174 Nm/degree (p = 0.013). No catastrophic failures were observed. Conclusion Using the LCP as an external fixator may provide a viable and attractive alternative to the traditional UEF as its lower profile makes it more acceptable to patients, while not compromising on axial and torsional stiffness. Cite this article: B. F. H. Ang, J. Y. Chen, A. K. S. Yew, S. K. Chua, S. M. Chou, S. L. Chia, J. S. B. Koh, T. S. Howe. Externalised locking compression plate as an alternative to the unilateral external fixator: a biomechanical comparative study of axial and torsional stiffness. Bone Joint Res 2017;6:216–223. DOI: 10.1302/2046-3758.64.2000470.
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Affiliation(s)
- B F H Ang
- Singapore General Hospital, The Academia, 20 College Road, 169856 Singapore
| | - J Y Chen
- Singapore General Hospital, The Academia, 20 College Road, 169856 Singapore
| | - A K S Yew
- Singapore General Hospital, The Academia, 20 College Road, 169856 Singapore
| | - S K Chua
- Singapore General Hospital, The Academia, 20 College Road, 169856 Singapore
| | - S M Chou
- Nanyang Technological University, School of Mechanical and Aerospace Engineering, 50 Nanyang Avenue, Singapore 639798
| | - S L Chia
- Singapore General Hospital, The Academia, 20 College Road, 169856 Singapore
| | - J S B Koh
- Singapore General Hospital, The Academia, 20 College Road, 169856 Singapore
| | - T S Howe
- Singapore General Hospital, The Academia, 20 College Road, 169856 Singapore
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Garcés GL, Rodríguez O, Grau-Bassas ER, Roiz S, Yánez A, Cuadrado A. Use of screw locking elements improves radiological and biomechanical results of femoral osteotomies. BMC Musculoskelet Disord 2014; 15:387. [PMID: 25414116 PMCID: PMC4258045 DOI: 10.1186/1471-2474-15-387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 11/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dynamic compression plate (DCP) constructs provide inadequate fixation in cases of poor bone quality and early weight-bearing. Screw locking elements (SLE) are flat locking nuts placed at the end of the screw to prevent screw stripping from the bone, improving fixation stability. The purpose of this work was to compare biomechanical and radiological evaluations of femoral ovine osteotomies fixed using DCP constructs with and without SLE. METHOD A dyaphyseal femoral osteotomy was performed in sixteen adult sheep and fixed with a DCP and cortical screws. Half of the animals were operated on with a SLE on each side of the osteotomy and the rest without the addition of SLE. Four animals of each group were euthanized after 8 weeks, and the remaining after 16 weeks. Both femora of each animal were radiographed and mechanically tested in torsion. RESULTS Radiologically femoral malalignment or screw loosening was observed in six out of the eight animals operated on without SLE. In contrast, all animals subjected to the operation with SLE showed complete radiological consolidation of the osteotomy. Seven of these eight animals showed normal femoral alignment and no osteosynthesis failure. Stiffness of the bones fixed with SLE was among 145% and 177% the value of their contralateral non-operated femurs (all animals of this group showed greater stiffness on the operated bone than its contralateral non-operated femur). However, stiffness of the bones operated on without SLE was among 58% and 87% the value of the stiffness of their contralateral non-operated bone (all animals of this group showed greater stiffness on the non-operated bone than the osteotomized ones). CONCLUSIONS Use of SLE avoided loosening of the system and stimulated stronger osteotomy consolidation. Clinical application of this improved system may thus be a feasible and cost-effective alternative to other more rigid and expensive bone fixation techniques.
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Affiliation(s)
- Gerardo L Garcés
- Hospital Perpetuo Socorro and Department of Medical and Surgical Sciences, Las Palmas de Gran Canaria University, c/ León y Castillo 407, 35007 Las Palmas de Gran Canaria, Spain.
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Zamprogno H, Nelson N, Schaeffer DJ, Johnson AL. Three Dimensional Morphologic Analysis of the Lateral Surface of the Canine Femur. Vet Surg 2014; 44:494-500. [DOI: 10.1111/j.1532-950x.2014.12244.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 05/01/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Helia Zamprogno
- Department of Veterinary Clinical Medicine, Veterinary Teaching Hospital; University of Illinois; Urbana Illinois
| | - Nathan Nelson
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine, Michigan State; East Lansing Michigan
| | - David J. Schaeffer
- Department of Veterinary Clinical Medicine, Veterinary Teaching Hospital; University of Illinois; Urbana Illinois
| | - Ann L. Johnson
- Department of Veterinary Clinical Medicine, Veterinary Teaching Hospital; University of Illinois; Urbana Illinois
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Lai YC, Tarng YW, Hsu CJ, Chang WN, Yang SW, Renn JH. Comparison of dynamic and locked compression plates for treating midshaft clavicle fractures. Orthopedics 2012; 35:e697-702. [PMID: 22588412 DOI: 10.3928/01477447-20120426-24] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to compare the parameters of perioperative course and cost-effectiveness for patients with midshaft clavicle fractures treated by dynamic compression plates or locked compression plates.This retrospective, case-controlled study involved 54 patients with midshaft clavicle fractures who received dynamic compression plates (n=21) or locked compression plates (n=33) between January 2002 and December 2008. Indications for surgery included displacement or shortening >2 cm, comminuted fractures, and skin tenting. Patients with previous malunion, nonunion, multiple injuries of the shoulder girdle, or open fractures were excluded. Preoperative demographics showed no statistically significant differences between the 2 groups. Eighteen patients with dynamic compression plates and 28 patients with locked compression plates with postoperative follow-up >1 year were included for comparison. Statistical analyses for operative time, blood loss, complication rate, hospital stay, and union rate demonstrated no statistically significant difference between the 2 groups. The only statistically significant difference was a higher rate of plate removal requests in the dynamic compression plate group. Considering medical expenditure, locked compression plates cost 6 times more than dynamic compression plates in the authors' institution (US $600 vs $100, respectively).Other than more plate removal requests in the dynamic compression plate group and greater expense in the locked compression plate group, dynamic compression plates and locked compression plates achieved satisfactory operative outcomes in treating midshaft clavicle fractures, with no statistically significant difference between perioperative course and eventual fracture union observed between the 2 groups.
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Affiliation(s)
- Yu-Cheng Lai
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Göpfert B, Krol Z, Freslier M, Krieg AH. 3D video-based deformation measurement of the pelvis bone under dynamic cyclic loading. Biomed Eng Online 2011; 10:60. [PMID: 21762533 PMCID: PMC3155904 DOI: 10.1186/1475-925x-10-60] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 07/17/2011] [Indexed: 11/15/2022] Open
Abstract
Background Dynamic three-dimensional (3D) deformation of the pelvic bones is a crucial factor in the successful design and longevity of complex orthopaedic oncological implants. The current solutions are often not very promising for the patient; thus it would be interesting to measure the dynamic 3D-deformation of the whole pelvic bone in order to get a more realistic dataset for a better implant design. Therefore we hypothesis if it would be possible to combine a material testing machine with a 3D video motion capturing system, used in clinical gait analysis, to measure the sub millimetre deformation of a whole pelvis specimen. Method A pelvis specimen was placed in a standing position on a material testing machine. Passive reflective markers, traceable by the 3D video motion capturing system, were fixed to the bony surface of the pelvis specimen. While applying a dynamic sinusoidal load the 3D-movement of the markers was recorded by the cameras and afterwards the 3D-deformation of the pelvis specimen was computed. The accuracy of the 3D-movement of the markers was verified with 3D-displacement curve with a step function using a manual driven 3D micro-motion-stage. Results The resulting accuracy of the measurement system depended on the number of cameras tracking a marker. The noise level for a marker seen by two cameras was during the stationary phase of the calibration procedure ± 0.036 mm, and ± 0.022 mm if tracked by 6 cameras. The detectable 3D-movement performed by the 3D-micro-motion-stage was smaller than the noise level of the 3D-video motion capturing system. Therefore the limiting factor of the setup was the noise level, which resulted in a measurement accuracy for the dynamic test setup of ± 0.036 mm. Conclusion This 3D test setup opens new possibilities in dynamic testing of wide range materials, like anatomical specimens, biomaterials, and its combinations. The resulting 3D-deformation dataset can be used for a better estimation of material characteristics of the underlying structures. This is an important factor in a reliable biomechanical modelling and simulation as well as in a successful design of complex implants.
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