Biomechanical analysis of combi-hole locking compression plate during fracture healing: A numerical study of screw configuration

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.

The effect of the degradation pattern of biodegradable bone plates on the healing process using a biphasic mechano-regulation theory

Bone plates are used to treat bone fractures by stabilizing the fracture site and allowing treatments to take place. Mechanical properties of the applied bone plate determine the stability of the fracture site and affect the endochondral ossification process and the healing performance. In recent years, biodegradable bone plates have been used in demand for the elimination of a second surgery to remove the plate. The degradation of these plates into the body environment is commonly accompanied by alterations in the mechanical properties of the bone plate and a shift in the healing performance of the bone. In the present study, the effects of using biodegradable plates with various elastic moduli and degradation patterns, including linear and nonlinear, on the healing process are investigated. A three-dimensional finite element model of the radius bone along with a mechano-regulation theory was used to study the healing performance. Two mechanical stimuli of octahedral shear strain and interstitial fluid flow are considered as the propelling factors of healing. The results of this study indicated that increasing the bone plate's initial elastic modulus accelerates the healing process. However, by increasing the initial Young's modulus of the plate more than 100 GPa, no noticeable alteration is observed. The degradation time period of the plate was seen to be directly related to the speed of the healing process. It is shown, however, that by increasing the degradation time period to more than 8 weeks, the healing performance remains almost unchanged. The results of this work showed that the application of plates with a high enough initial elastic modulus and degradation period can prevent the healing process from decelerating.

A simplified application (APP) for the parametric design of screw-plate fixation of bone fractures

Screw and plate fixation is commonly used to treat bone fractures. A prototype application (APP) for presurgical simulation was developed and validated by comparing it with current analytical approach and other models. In this APP, alternative plate designs and materials to limit the effects of stress shielding could be tested. In addition, the number and position of screws and the gap between bone and plate that achieved acceptable stability were predicted. The fixation stability providing a situation of interfragmentary strain between 2% and 10% is necessary for callus formation. However, improving the fixation stability leads to a stress shielding effect. The simultaneous alleviation of stress shielding and maintenance of stability are important in fracture healing. In this study, the feasibility of creating a specialized APP to evaluate different screw-plate configurations for diaphyseal femoral fractures was investigated. The ultimate goal is to extend this technique to computer-assisted preoperative planning for orthopedic surgery.