Advertisement

Medical & Biological Engineering & Computing

, Volume 53, Issue 8, pp 759–769 | Cite as

Strength analysis of clavicle fracture fixation devices and fixation techniques using finite element analysis with musculoskeletal force input

  • Cronskär Marie
Original Article

Abstract

In the cases, when clavicle fractures are treated with a fixation plate, opinions are divided about the best position of the plate, type of plate and type of screw units. Results from biomechanical studies of clavicle fixation devices are contradictory, probably partly because of simplified and varying load cases used in different studies. The anatomy of the shoulder region is complex, which makes it difficult and expensive to perform realistic experimental tests; hence, reliable simulation is an important complement to experimental tests. In this study, a method for finite element simulations of stresses in the clavicle plate and bone is used, in which muscle and ligament force data are imported from a multibody musculoskeletal model. The stress distribution in two different commercial plates, superior and anterior plating position and fixation including using a lag screw in the fracture gap or not, was compared. Looking at the clavicle fixation from a mechanical point of view, the results indicate that it is a major benefit to use a lag screw to fixate the fracture. The anterior plating position resulted in lower stresses in the plate, and the anatomically shaped plate is more stress resistant and stable than a regular reconstruction plate.

Keywords

Clavicle Finite element analysis Multibody simulation Bone plates Fixation techniques 

Notes

Acknowledgments

This work was funded by the Swedish Agency for Economic and Regional Growth (Tillväxtverket) and the European Regional Development Fund. The author would also like to thank tutor Mats Tinnsten and assistant tutors Lars-Erik Rännar and Mikael Bäckström for their contribution to the study.

References

  1. 1.
    Dines D, Lorich D, Helfet D (2008) Solutions for complex upper extremity trauma, 1st edn. Thieme Medical Publishers, New YorkGoogle Scholar
  2. 2.
    Robinson CM (1998) Fractures of the clavicle in the adult: epidemiology and classification. J Bone Joint Surg (British) 80-B:476–484CrossRefGoogle Scholar
  3. 3.
    Eden L, Doht S, Frey S, Ziegler D, Stoyhe J, Fehske K, Blunk T, Meffert R (2012) Biomechanical comparison of the locking compression superior anterior clavicle plate with seven and ten hole reconstruction plates in midshaft clavicle fracture stabilisation. Int Orthop 36:2537–2543PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Favre P, Kloen P, Helfet DL, Werner CML (2011) Superior versus anteroinferior plating of the clavicle: a finite element study. J Orthop Trauma 25:661–665PubMedCrossRefGoogle Scholar
  5. 5.
    Renfree T, Conrad B, Wright T (2010) Biomechanical comparison of contemporary clavicle fixation devices. J Hand Surg Am 35:639–644PubMedCrossRefGoogle Scholar
  6. 6.
    Taylor PR, Day RE, Nicholls RL, Rasmussen J, Yates PJ, Stoffel KK (2011) The comminuted midshaft clavicle fracture: a biomechanical evaluation of plating methods. Clin Biomech 26:491–496CrossRefGoogle Scholar
  7. 7.
    Celestre P, Robertson C, Mahar A, Oka R, Meunier M, Schwarts A (2008) Biomechanical evaluation of clavicle fracture plating techniques: does a locking plate provide improved stability? J Orthop Trauma 22:241–247PubMedCrossRefGoogle Scholar
  8. 8.
    Iannotti MR, Crosby LA, Stafford P, Grayson G, Goulet R (2002) Effects of plate location and selection on the stability of midshaft clavicle osteotomies: a biomechanical study. J Shoulder Elbow Surg 11:457–462PubMedCrossRefGoogle Scholar
  9. 9.
    Robertson C, Celestre P, Mahar A, Schwartz A (2009) Reconstruction plates for stabilization of mid-shaft clavicle fractures: differences between nonlocked and locked plates in two different positions. J Shoulder Elbow Surg 18:204–209PubMedCrossRefGoogle Scholar
  10. 10.
    Partal G, Meyers KN, Sama N, Pagenkopf E, Lewis PB, Goldman A, Wright TM, Helfet DL (2010) Superior versus anteroinferior plating of the clavicle revisited: a mechanical study. J Orthop Trauma 24:420–425PubMedCrossRefGoogle Scholar
  11. 11.
    Little K, Riches P, Fazzi U (2012) Biomechanical analysis of locked and non-locked plate fixation of the clavicle. Injury 43:921–925PubMedCrossRefGoogle Scholar
  12. 12.
    Ataç MS, Erkmen E, Yücel E, Kurt A (2009) Comparison of biomechanical behaviour of maxilla following le fort i osteotomy with 2- versus 4-plate fixation using 3d-fea: part 2: impaction surgery. Int J Oral Maxillofac Surg 38:58–63PubMedCrossRefGoogle Scholar
  13. 13.
    Lin C-L, Lin Y-H, Chen A-Y (2006) Buttressing angle of the double-plating fixation of a distal radius fracture: a finite element study. Med Biol Eng Comput 44:665–673PubMedCrossRefGoogle Scholar
  14. 14.
    Peleg E, Mosheiff R, Liebergall M, Mattan Y (2006) A short plate compression screw with diagonal bolts—a biomechanical evaluation performed experimentally and by numerical computation. Clin Biomech 21:963–968CrossRefGoogle Scholar
  15. 15.
    Pérez MA, Prados-Frutos JC, Bea JA, Doblaré M (2011) Stress transfer properties of different commercial dental implants: a finite element study. Comput Methods Biomech Biomed Eng 15:263–273CrossRefGoogle Scholar
  16. 16.
    Raja Izaham RMA, Abdul Kadir MR, Abdul Rashid AH, Hossain MG, Kamarul T (2012) Finite element analysis of puddu and tomofix plate fixation for open wedge high tibial osteotomy. Injury 43:898–902PubMedCrossRefGoogle Scholar
  17. 17.
    Arregui-Dalmases C, Pozo ED, Duprey S, Lopez-Valdes FJ, Lau A, Subit D, Kent R (2010) A parametric study of hard tissue injury prediction using finite elements: consideration of geometric complexity, subfailure material properties, ct-thresholding, and element characteristics. Traffic Injury Prev 11:286–293CrossRefGoogle Scholar
  18. 18.
    Bolte JH, Hines MH (2000) Shoulder response characteristics and injury due to lateral glenohumeral joint impacts, SAE Technical PaperGoogle Scholar
  19. 19.
    Duprey S, Bruyere K, Verriest J-P (2008) Influence of geometrical personalization on the simulation of clavicle fractures. J Biomech 41:200–207PubMedCrossRefGoogle Scholar
  20. 20.
    Duprey S, Bruyere K, Verriest J-P (2010) Clavicle fracture prediction: simulation of shoulder lateral impacts with geometrically personalized finite elements models. J Trauma Acute Care Surg 68:177–182CrossRefGoogle Scholar
  21. 21.
    Untaroiu C, Duprey S, Kerrigan J, Li Z, Bose D, Crandall J (2008) Experimental and computational investigation of human clavicle response in anterior-posterior bending loading-biomed 2009. Biomed Sci Instrum 45:6–11Google Scholar
  22. 22.
    Kunze M, Schaller A, Steinke H, Scholz R, Voigt C (2012) Combined multi-body and finite element investigation of the effect of the seat height on acetabular implant stability during the activity of getting up. Comput Methods Programs Biomed 105:175–182PubMedCrossRefGoogle Scholar
  23. 23.
    Wong C, Rasmussen J, Simonssen E, Hansen L, De Zee M, Dendorfer S (2011) The influence of muscle forces on the stress distribution in the lumbar spine. Open Spine J 3:21–26CrossRefGoogle Scholar
  24. 24.
    Cronskär M, Rasmussen J, Tinnsten M (2013) Combined finite element and multibody musculoskeletal investigation of a fractured clavicle with reconstruction plate. Comput Methods Biomech Biomed Eng 18(7):740–748CrossRefGoogle Scholar
  25. 25.
    Ahmad M, Trewhella MJ, Bayliss NC (2006) Study to describe the morphology of a series of clavicles & the dimensions of its intramedullary canal. J Bone Joint Surg (British) 88(SUPPIII):401Google Scholar
  26. 26.
    Damsgaard M, Rasmussen J, Christensen ST, Surma E, De Zee M (2006) Analysis of musculoskeletal systems in the anybody modeling system. Simul Model Pract Theory 14:1100–1111CrossRefGoogle Scholar
  27. 27.
    Netter FH (2011) Atlas of human anatomy. Saunders/Elsevier, PhiladelphiaGoogle Scholar
  28. 28.
    Nowak J (2002) Clavicular fractures, epidemiology, union, malunion, nonunion. Faculty of Medicine, UppsalaGoogle Scholar
  29. 29.
    Disegi J (2009) Implant materials. Wrought 18 % chromium-14 % nickel-2.5 % molybdenum stainless steel, 3rd edn. Synthes (USA), West ChesterGoogle Scholar
  30. 30.
    Li Z, Kindig MW, Kerrigan JR, Kent RW, Crandall JR (2012) Development and validation of a subject-specific finite element model of a human clavicle. Comput Methods Biomech Biomed Eng 16:1–11CrossRefGoogle Scholar
  31. 31.
    Kim S-H, Chang S-H, Son D-S (2011) Finite element analysis of the effect of bending stiffness and contact condition of composite bone plates with simple rectangular cross-section on the bio-mechanical behaviour of fractured long bones. Compos B Eng 42:1731–1738CrossRefGoogle Scholar
  32. 32.
    Astier V, Thollon L, Arnoux PJ, Mouret F, Brunet C (2008) Development of a finite element model of the shoulder: application during a side impact. Int J Crashworthiness 13:301–312CrossRefGoogle Scholar
  33. 33.
    Zhao J, Narwani G (2005) Development of a human body finite element model for restraint system R&D applications. In: Proceedings of the 19th international technical conference on the enhanced safety of vehicles (ESV), Washington, DC, 6–9Google Scholar
  34. 34.
    Reilly DT, Burstein AH (1974) The mechanical properties of cortical bone. J Bone Joint Surg 56:1001–1022PubMedGoogle Scholar
  35. 35.
    Cronskär M, Bäckström M (2013) Modeling of fractured clavicles and reconstruction plates using cad, finite element analysis and real musculoskeletal forces input. In: 10th international conference on modelling and measurement in medicine and biology, Budapest, Hungary, 235–243Google Scholar
  36. 36.
    Vanbeek C, Boselli K, Cadet E, Ahmad C, Levine W (2011) Precontoured plating of clavicle fractures: decreased hardware-related complications? Clin Orthop Relat Res 469:3337–3343PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Bostman O, Manninen M, Pihljamaki H (1997) Complications of plate fixation in fresh displaced midclavicular fractures. J Trauma 45:778–783CrossRefGoogle Scholar
  38. 38.
    Ledger M, Leeks N, Ackland T, Wang A (2005) Short malunions of the clavicle: an anatomic and functional study. J Shoulder Elbow Surg 14:349–354PubMedCrossRefGoogle Scholar
  39. 39.
    Nowak J, Holgersson M, Larsson S (2005) Sequelae from clavicular fractures are common. Acta Orthop 76:496–502PubMedCrossRefGoogle Scholar
  40. 40.
    Harnroongroj T, Vanadurongwan V (1996) Biomechanical aspects of plating osteosynthesis of transverse clavicular fracture with and without inferior cortical defect. Clin Biomech 11:290–294CrossRefGoogle Scholar
  41. 41.
    Chen C-E, Juhn R-J, Ko J-Y (2010) Anterior-inferior plating of middle-third fractures of the clavicle. Arch Orthop Trauma Surg 130:507–511PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Collinge C, Devinney S, Herscovici D, Dipasquale T, Sanders R (2006) Anterior-inferior plate fixation of middle-third fractures and nonunions of the clavicle. J Orthop Trauma 20:680–686PubMedCrossRefGoogle Scholar
  43. 43.
    Kloen P, Werner CL, Stufkens SS, Helfet D (2009) Anteroinferior plating of midshaft clavicle nonunions and fractures. Oper Orthop Traumatol 21:170–179PubMedCrossRefGoogle Scholar
  44. 44.
    Cronskär M, Rännar L-E, Bäckström M (2012) Implementation of digital design and solid free-form fabrication for customization of implants in trauma orthopaedics. J Med Biol Eng 32:91–96CrossRefGoogle Scholar
  45. 45.
    Takahashi H, Shuto B, Katayama M, Nagashima H, Okumura M (2012) Design and application of tailor-made plates for treating fractures in small animals. In: 2012 4th international conference on awareness science and technology (iCAST), pp 243–247Google Scholar
  46. 46.
    Wieding J, Souffrant R, Fritsche A, Mittelmeier W, Bader R (2012) Finite element analysis of osteosynthesis screw fixation in the bone stock: an appropriate method for automatic screw modelling. PLoS ONE 7:e33776PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© International Federation for Medical and Biological Engineering 2015

Authors and Affiliations

  1. 1.Department of Quality, Mechanics and MathematicsMid Sweden UniversityÖstersundSweden

Personalised recommendations