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Mechanical performance and implications on bone healing of different screw configurations for plate fixation of diaphyseal tibia fractures: a computational study

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Abstract

Diaphyseal tibia fractures may require plate fixation for proper healing to occur. Currently, there is no consensus on the number of screws required for proper fixation or the optimal placement of the screws within the plate. Mechanical stability of the construct is a leading criterion for choosing plate and screws configuration. However, number and location of screws have implications on the mechanical environment at the fracture site and, consequently, on bone healing response: The interfragmentary motion attained with a specific plate and screw construct may elicit mechano-transduction signals influencing cell-type differentiation, which in turn affects how well the fracture heals. This study investigated how different screw configurations affect mechanical performance of a tibia plate fixation construct. Three configurations of an eight-hole plate were considered with the fracture in the center of the plate: eight screws—screws at first, fourth, fifth and eighth hole and screws at first, third, sixth and eighth hole. Constructs’ stiffness was compared through biomechanical tests on bone surrogates. A finite element model of tibia diaphyseal fracture was used to conduct a stress analysis on the implanted hardware. Finally, the potential for bone regeneration of each screw configuration was assessed via the computational model through the evaluation of the magnitude of mechano-transduction signals at the bone callus. The results of this study indicate that having screws at fourth and fifth holes represents a preferable configuration since it provides mechanical properties similar to those attained by the stiffest construct (eight screws), and elicits an ideal bone regenerative response.

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Funding

This study was partially supported by Miami CORE (Center for Orthopaedic Research and Education), University of Miami, Department of Orthopaedics (information that explains whether and by whom the research was supported).

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Authors and Affiliations

  1. Department of Mechanical and Aerospace Engineering, University of Miami, 1251 Memorial Drive, Mc Arthur Engineering Building #276, Coral Gables, FL, USA

    Francesco Travascio

  2. Department of Orthopaedic Surgery, University of Miami, Miami, FL, USA

    Francesco Travascio & Loren Latta

  3. Max Biedermann Institute for Biomechanics at Mount Sinai, Miami Beach, FL, USA

    Francesco Travascio, Edward Milne & Loren Latta

  4. Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Leonard T. Buller

Authors
  1. Francesco Travascio
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  2. Leonard T. Buller
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  3. Edward Milne
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  4. Loren Latta
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Contributions

FT, LTB, EM and LL conceived and designed the study, performed experiments, participated to data interpretation and drafted the manuscript. FT developed the computational model.

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Correspondence to Francesco Travascio.

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Travascio, F., Buller, L.T., Milne, E. et al. Mechanical performance and implications on bone healing of different screw configurations for plate fixation of diaphyseal tibia fractures: a computational study. Eur J Orthop Surg Traumatol 31, 121–130 (2021). https://doi.org/10.1007/s00590-020-02749-5

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  • DOI: https://doi.org/10.1007/s00590-020-02749-5

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