Skip to main content
SpringerLink
Log in

Optimized Clavicle Hook Plate Geometry for Average Korean Clavicle–Acromion Dimensions: A Finite Element Analysis Study

  • Regular Paper
  • Published:
International Journal of Precision Engineering and Manufacturing Aims and scope Submit manuscript

Abstract

The acromioclavicular joint frequently experiences dislocations and fractures with ligament injuries during traumatic shoulder injuries, with clavicle hook plate fixation being a common treatment method. However, no studies have been conducted on the biomechanical analysis of plates and the average Korean clavicle–acromion dimensions. In this study, finite element analysis (FEA) was used to assess various parameters for biomechanical analysis. To assess the stress distribution in the acromion, clavicle, and plate, FEA models with the implantation of 36 clavicle hook plate models with different hook depths (12 mm, 15 mm, and 18 mm), hook lengths (15 mm, 17 mm, and 19 mm), and hook angles (90°, 95°, 100°, and 105°) were established. Moreover, three-dimensional chest computed tomography (CT) images and scanned CT image data were used for comparisons between the average Korean clavicle–acromion dimensions and the model dimensions. The study shows that the acromion experienced the least stress when the clavicle hook plate had dimensions of 12 mm depth, 19 mm length, and 105° angle. For the clavicle, the lowest stress occurred with a depth of 15 mm, length of 19 mm, and 105° angle. Additionally, the lowest stress on the clavicle hook plate was observed with dimensions of 18 mm depth, 19 mm length, and 100° angle. Based on the results, orthopedic surgeons can make an optimal selection for the plate geometry suitable for the bone length of each patient, which can reduce the incidence of adverse events, such as peri-plate fractures at the acromion or clavicle and postoperative pain due to the burrowing of the plate hook into the acromion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Chillemi, C., Franceschini, V., Dei Giudici, L., Alibardi, A., Salate Santone, F., Ramos Alday, L. J., & Osimani, M. (2013). Epidemiology of isolated acromioclavicular joint dislocation. Emergency Medicine International, 2013, 5. https://doi.org/10.1155/2013/171609

    Article  Google Scholar 

  2. Charity, R. M., Haidar, S. G., Ghosh, S., & Tillu, A. B. (2006). Fixation failure of the clavicular hook plate: A report of three cases. Journal of Orthopaedic Surgery, 14(3), 333–335. https://doi.org/10.1177/230949900601400320

    Article  Google Scholar 

  3. Arirachakaran, A., Boonard, M., Piyapittayanun, P., Phiphobmongkol, V., Chaijenkij, K., & Kongtharvonskul, J. (2016). Comparison of surgical outcomes between fixation with hook plate and loop suspensory fixation for acute unstable acromioclavicular joint dislocation: A systematic review and meta-analysis. European Journal of Orthopaedic Surgery & Traumatology: Orthopedie Traumatologie, 26(6), 565–574. https://doi.org/10.1007/s00590-016-1797-4

    Article  Google Scholar 

  4. Kim, M. H., Seo, J. B., & Moon, S. Y. (2010). Treatment of acromioclavicular joint injuries using clavicle hook plates. Journal of the Korean Shoulder & Elbow Society, 13(1), 92–98. https://doi.org/10.5397/CiSE.2010.13.1.092

    Article  Google Scholar 

  5. Di Francesco, A., Zoccali, C., Colafarina, O., Pizzoferrato, R., & Flamini, S. (2012). The use of hook plate in type III and V acromio-clavicular Rockwood dislocations: Clinical and radiological midterm results and MRI evaluation in 42 patients. Injury, 43(2), 147–152. https://doi.org/10.1016/j.injury.2011.04.002

    Article  Google Scholar 

  6. Feng, D., Yang, Y., Kang, X., Heng, L., Zhang, J., & Zhu, Y. (2023). Extra-articular locking plate and trans-articular clavicle hook plate for displaced medial clavicle fractures. Injury, 54(6), 1617–1624. https://doi.org/10.1016/j.injury.2023.03.023

    Article  Google Scholar 

  7. Huang, D., Hu, Z., Feng, W., et al. (2023). Dual plate has better biomechanical stability than hook plate or superior single plate for the fixation of unstable distal clavicle fractures: A finite element analysis. Archives of Orthopaedic and Trauma Surgery, 143, 4805–4812. https://doi.org/10.1007/s00402-023-04801-5

    Article  Google Scholar 

  8. ElMaraghy, A. W., Devereaux, M. W., Ravichandiran, K., & Agur, A. M. (2010). Subacromial morphometric assessment of the clavicle hook plate. Injury, 41(6), 613–619. https://doi.org/10.1016/j.injury.2009.12.012

    Article  Google Scholar 

  9. Chiang, C. L., Yang, S. W., Tsai, M. Y., & Chen, K. H. (2010). Acromion osteolysis and fracture after hook plate fixation for acromioclavicular joint dislocation: A case report. Journal of Shoulder & Elbow Surgery, 19(4), E13–E15. https://doi.org/10.1016/j.jse.2009.12.005

    Article  Google Scholar 

  10. Lin, H. Y., Wong, P. K., Ho, W. P., Chuang, T. Y., Liao, Y. S., & Wong, C. C. (2014). Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion-dynamic sonographic evaluation. Journal of Orthopaedic Surgery & Research, 9, 6. https://doi.org/10.1186/1749-799X-9-6

    Article  Google Scholar 

  11. Kim, Y. S., Yoo, Y. S., Jang, S. W., Nair, A. V., Jin, H., & Song, H. S. (2015). In vivo analysis of acromioclavicular joint motion after hook plate fixation using three-dimensional computed tomography. Journal of Shoulder & Elbow Surgery, 24(7), 1106–1111. https://doi.org/10.1016/j.jse.2014.12.012

    Article  Google Scholar 

  12. Wu, K., Su, X., Roche, S. J. L., Held, M. F. G., Yang, H., Dunn, R. N., & Guo, J. J. (2020). Relationship between the lateral acromion angle and postoperative persistent pain of distal clavicle fracture treated with clavicle hook plate. Journal of Orthopaedic Surgery & Research, 15(1), 217. https://doi.org/10.1186/s13018-020-01737-z

    Article  Google Scholar 

  13. Hoffler, C. E., & Karas, S. G. (2010). Transacromial erosion of a locked subacromial hook plate: Case report and review of literature. Journal of Shoulder & Elbow Surgery, 19(3), e12–e15. https://doi.org/10.1016/j.jse.2009.10.019

    Article  Google Scholar 

  14. Ding, M., Ni, J., Hu, J., & Song, D. (2011). Rare complication of clavicular hook plate: Clavicle fracture at the medial end of the plate. Journal of Shoulder & Elbow Surgery, 20(7), e18–e20. https://doi.org/10.1016/j.jse.2011.06.005

    Article  Google Scholar 

  15. Johansen, J. A., Grutter, P. W., McFarland, E. G., & Petersen, S. A. (2011). Acromioclavicular joint injuries: Indications for treatment and treatment options. Journal of Shoulder & Elbow Surgery, 20(2 Supplement), S70–S82. https://doi.org/10.1016/j.jse.2010.10.030

    Article  Google Scholar 

  16. Tiren, D., van Bemmel, A. J., Swank, D. J., & van der Linden, F. M. (2012). Hook plate fixation of acute displaced lateral clavicle fractures: Mid-term results and a brief literature overview. Journal of Orthopaedic Surgery & Research, 7, 2. https://doi.org/10.1186/1749-799X-7-2

    Article  Google Scholar 

  17. Allahabadi, S., Janghala, A., & Kandemir, U. (2023). Suture button placed beneath plate fixation for complex distal clavicle fractures and acromioclavicular joint injuries: A technical note. European Journal of Orthopaedic Surgery & Traumatology, 33, 3175–3180. https://doi.org/10.1007/s00590-023-03533-x

    Article  Google Scholar 

  18. Deng, Z., Cai, L., Ping, A., Ai, Q., & Wang, Y. (2014). Anatomical research on the subacromial interval following implantation of clavicle hook plates. International Journal of Sports Medicine, 35(10), 857–862. https://doi.org/10.1055/s-0034-1367050

    Article  Google Scholar 

  19. Hung, L. K., Su, K. C., Lu, W. H., & Lee, C. H. (2017). Biomechanical analysis of clavicle hook plate implantation with different hook angles in the acromioclavicular joint. International Orthopaedics, 41(8), 1663–1669. https://doi.org/10.1007/s00264-016-3384-z

    Article  Google Scholar 

  20. Hung, L. K., Lee, C. H., & Su, K. C. (2021). Biomechanical analysis of clavicle hook plates with a range of posterior hook offsets implanted at different acromion positions in the acromioclavicular joint: A finite element analysis study. Applied Sciences, 11(23), 11105. https://doi.org/10.3390/app112311105

    Article  Google Scholar 

  21. Lee, C. H., Shih, C. M., Huang, K. C., Chen, K. H., Hung, L. K., & Su, K. C. (2016). Biomechanical analysis of implanted clavicle hook plates with different implant depths and materials in the acromioclavicular joint: A finite element analysis study. Artificial Organs, 40(11), 1062–1070. https://doi.org/10.1111/aor.12679

    Article  Google Scholar 

  22. Shih, C. M., Huang, K. C., Pan, C. C., Lee, C. H., & Su, K. C. (2015). Biomechanical analysis of acromioclavicular joint dislocation treated with clavicle hook plates in different lengths. International Orthopaedics, 39(11), 2239–2244. https://doi.org/10.1007/s00264-015-2890-8

    Article  Google Scholar 

  23. Wang, C. C., Lee, C. H., Chen, K. H., Pan, C. C., Tsai, M. T., & Su, K. C. (2022). Biomechanical effects of different numbers and locations of screw-in clavicle hook plates. Frontiers in Bioengineering & Biotechnology, 10, 949802. https://doi.org/10.3389/fbioe.2022.949802

    Article  Google Scholar 

  24. Wu, D. K., Chen, W. C., Lin, K. J., Tsai, C. L., Lin, K. P., & Wei, H. W. (2021). Advantage of multi-directional stability of spiral clavicle plate in treatment of middle one-third clavicle fracture: A finite element study. Journal of Medical & Biological Engineering, 41(4), 405–411. https://doi.org/10.1007/s40846-021-00635-x

    Article  Google Scholar 

  25. Yi, J. W., Kim, J. W., Kim, Y. A., Oh, B. H., Ahn, J. Y., & Tae, K. S. (2022). Evaluating the stability of locking screw on locking compression plate according to various screw insertion angles. International Journal of Precision Engineering and Manufacturing, 23, 789–796. https://doi.org/10.1007/s12541-022-00652-z

    Article  Google Scholar 

  26. Su, K. C., Chuang, S. F., Ng, E. Y. K., & Chang, C. H. (2014). Evaluation of dentinal fluid flow behaviours: A fluid–structure interaction simulation. Computer Methods in Biomechanics & Biomedical Engineering, 17(15), 1716–1726. https://doi.org/10.1080/10255842.2013.765410

    Article  Google Scholar 

  27. Yoon, J. P., Lee, Y. S., Song, G. S., & Oh, J. H. (2017). Morphological analysis of acromion and hook plate for the fixation of acromioclavicular joint dislocation. Knee Surgery, Sports Traumatology, Arthroscopy, 25(3), 980–986. https://doi.org/10.1007/s00167-016-3987-3

    Article  Google Scholar 

  28. Kim, H. J., Nam, K. M., Kang, D. Y., Oh, S. A., & Kho, D. H. (2013). Anatomical analysis of clavicles in Korean adults and compatibility of pre-contoured anatomical plates. Journal of the Korean Orthopaedic Association, 48(5), 350–358. https://doi.org/10.4055/jkoa.2013.48.5.350

    Article  Google Scholar 

  29. Gaillard, F., Lustosa, L., & Yap, J. Acromial types. In: Reference article. Radiopaedia.org. https://doi.org/10.53347/rID-842.

  30. Getz, J. D., Recht, M. P., Piraino, D. W., Schils, J. P., Latimer, B. M., Jellema, L. M., & Obuchowski, N. A. (1996). Acromial morphology: Relation to sex, age, symmetry, and subacromial enthesophytes. Radiology, 199(3), 737–742. https://doi.org/10.1148/radiology.199.3.8637998

    Article  Google Scholar 

  31. Mayntzhusen, T. W., Witten, A., Gramkow, J., Hansen, S. B., Chatterjee, S. A., & Barfod, K. W. (2023). Interrater and intrarater reliability of four different classification methods for evaluating acromial morphology on standardized radiographs. JSES International, 7, 445–449. https://doi.org/10.1016/j.jseint.2023.02.004

    Article  Google Scholar 

  32. Hahn, S. H., Yang, B. K., Yi, S. R., Jung, S. U., & Yoo, S. H. (1999). Radiologic assessment of normal acromial arch. Clinic in Shoulder and Elbow, 2(2), 106–109. https://doi.org/10.5397/CiSE.2009.12.2.173

    Article  Google Scholar 

  33. Cronskär, M., Rasmussen, J., & Tinnsten, M. (2015). Combined finite element and multibody musculoskeletal investigation of a fractured clavicle with reconstruction plate. Computer Methods in Biomechanics & Biomedical Engineering, 18(7), 740–748. https://doi.org/10.1080/10255842.2013.845175

    Article  Google Scholar 

  34. Aragão, J. A., Silva, L. P., Reis, F. P., & Dos Santos Menezes, C. S. (2014). Analysis on the acromial curvature and its relationships with the subacromial space and types of acromion. Revista Brasileira de Ortopedia, 49(6), 636–641. https://doi.org/10.1016/j.rboe.2013.10.005

    Article  Google Scholar 

Download references

Acknowledgements

This paper was supported by the Konyang University Research Fund in 2023.

Author information

Author notes

  1. Jong Ho Kim and Kyeong Rak Jeon have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea

    Jong Ho Kim

  2. Department of Biomedical Engineering, Konyang University, Daejeon, Republic of Korea

    Kyeong Rak Jeon, Hyeong Ju Jun, Gun Woo Son & Ki Sik Tae

  3. GS Medical Co., Ltd., O-song, Chungcheongbuk-do, Republic of Korea

    Young Su Ji & Je Hoon An

  4. Department of Physical Therapy, Konyang University, Daejeon, Republic of Korea

    Hyun Ju Lee

Authors
  1. Jong Ho Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyeong Rak Jeon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hyeong Ju Jun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gun Woo Son
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Young Su Ji
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Je Hoon An
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hyun Ju Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ki Sik Tae
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ki Sik Tae.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, J.H., Jeon, K.R., Jun, H.J. et al. Optimized Clavicle Hook Plate Geometry for Average Korean Clavicle–Acromion Dimensions: A Finite Element Analysis Study. Int. J. Precis. Eng. Manuf. (2024). https://doi.org/10.1007/s12541-024-01028-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12541-024-01028-1

Keywords

Search

Navigation