Ideal plate screw configuration in femoral shaft fractures: 3D finite element analysis

Authors

Keywords:

Femoral fractures, Plate fixation, Screw configuration, Finite element study

Abstract

Background/Aim: Plate screw fixation is an important method in femoral shaft fractures. Although there are many studies on plate screw fixation, the ideal plate screw configuration has not yet been determined. In our study, we investigated the optimal plate-screw configuration in femoral shaft fractures using the 3D finite element analysis method. Methods: A fracture model was created by removing the segment from the femur model obtained from 3D computed tomography scanning. Five different fixation models were designed using a 4.5 mm diameter steel locked femoral shaft plate and different screw configurations. Screws with double cortex locks of 4.5 mm in width were used in different configurations. To evaluate the effect of screw diameter, a 5.5 mm diameter screw with a double cortex lock was used in one model. Static linear analyses of these prepared Finite Element models were performed using Ansys Workbench 2020 R2 Finite Elements software. Results: The maximum stresses on the plate at the fracture sites were 156 MPa at 200 N, and 546 MPa at 700 N in model 1, 274 MPa at 200 N, and 784 MPa at 700 N in Model 2, 274 MPa at 200 N, and 959 MPa at 700 N in Model 3, 389 MPa at 200 N, and 1118 MPa at 700 N in Model 4, and 200 N is 274 MPa, and 961 MPa at 700 N in Model 5. Conclusion: The stress on the plate in the fracture area increases in parallel with the increase in screw diameter, plate length and plate working distance. Filling all screw holes does not alter the stress on the plate at the fracture line level.

Downloads

Download data is not yet available.

References

Gösling T, Krettek C. Femoral shaft fractures. Der Unfallchirurg. 2019;122:59–75.

Weiss RJ, Montgomery SM, Al Dabbagh Z, Jansson KA. National data of 6409 Swedish inpatients with femoral shaft fractures: Stable incidence between 1998 and 2004. Injury. 2009;40:304–8.

Li AB, Zhang WJ, Guo WJ, Wang XH, Jin HM, Zhao YM. Reamed versus unreamed intramedullary nailing for the treatment of femoral fractures. Medicine. 2016;95:e4248

Scannell BP, Waldrop NE, Sasser HC, Sing RF, Bosse MJ. Skeletal traction versus external fixation in the initial temporization of femoral shaft fractures in severely injured patients. Journal of Trauma. 2010;68:633–40.

Zlowodzki M, Vogt D, Cole PA, Kregor PJ. Plating of Femoral Shaft Fractures: Open Reduction and Internal Fixation Versus Submuscular Fixation. Journal of Trauma. 2007; 63:1061–5.

Crist BD, Wolinsky PR. Reaming does not add significant time to intramedullary nailing of diaphyseal fractures of the tibia and femur. Journal of Trauma.2009;67:727–34.

Köseoğlu E, Durak K, Bilgen MS, Küçükalp A, Bayyurt S. Comparison of two biological internal fixation techniques in the treatment of adult femur shaft fractures (plate-screws and locked intramedullary nail). Turkısh Journal of Trauma.2011;17:159-65.

Apivatthakakul T, Chiewcharntanakit S. Minimally invasive plate osteosynthesis (MIPO) in the treatment of the femoral shaft fracture where intramedullary nailing is not indicated. Int Orthop. 2009;33:1119–26.

Thapa S, Thapa SK, Dhakal S, Marasini R, Hamal B, Rai RK, et al. A comparative study of fracture shaft of femur in adults treated with broad dynamic compression plate versus intramedullary interlocking nail. J Coll Med Sci. 2016;12:66–9.

Adam P, Bonnomet F, Ehlinger M. Advantage and limitations of a minimally-invasive approach and early weight bearing in the treatment of tibial shaft fractures with locking plates. Orthop Traumatol Surg Res. 2012;98:564–9.

Birringer RP, Ganot GS, James BA. Failure Analysis of Internal Fixation Medical Devices: Overview and Case Studies. Journal of Failure Analysis and Prevention. 2016;16:849–57.

Wang J, Zhang X, Li S, Yin B, Liu G, Cheng X, et al. Plating System Design Determines Mechanical Environment in Long Bone Mid-shaft Fractures: A Finite Element Analysis. J Invest Surg. 2020;33:699–708

Sheng W, Ji A, Fang R, He G, Chen C. Finite Element-and Design of Experiment-Derived Optimization of Screw Configurations and a Locking Plate for Internal Fixation System. Comput Math Methods Med. 2019;21:5636528.

Cronier P, Pietu G, Dujardin C, Bigorre N, Ducellier F, Gerard R. The concept of locking plates. Orthop Traumatol Surg Res. 2010;96:17–36.

Öner K, Paksoy AE, Özer A. Fixation of femoral neck fractures with three cannulated screws: biomechanical changes at critical fracture angles. J Surg Med. 2020;4:660-3.

Öner K, Durusoy S, Özer A. Is the fracture morphology in the sagittal plane important in determining the ideal placement of the lag screw in intertrochanteric femoral fractures?: Ideal lag screw placement in intertrochanteric fractures in the sagittal plane. Injury. 2021;52:562-8.

Öner K, Durusoy S, Özer A. A new proximal femoral nail antirotation design:Is it effective in preventing varus collapse and cut-out? Jt Dis Relat Surg.2020;31:426-31.

Mardian S, Schaser KD, Duda GN, Heyland M. Working length of locking plates determines interfragmentary movement in distal femur fractures under physiological loading. Clin Biomech. 2015;30:391–6.

Hoffmeier KL, Hofmann GO, Mückley T. Choosing a proper working length can improve the lifespan of locked plates: A biomechanical study. Clin Biomech. 2011;26:405–9.

Niemeyer P, Südkamp NP. Principles and clinical application of the locking compression plate (LCP). Acta Chir Orthop Traumatol Cech. 2006;73:221-8.

Injury M. General principles for the clinical use of the LCP. Injury.2003:34:31-42.

Kanchanomai C, Muanjan P, Phiphobmongkol V. Stiffness and Endurance of a Locking Compression Plate Fixed on Fractured Femur. J Appl Biomec.2010;26:10–6.

Ellis T, Bourgeault CA, Kyle RF. Screw position affects dynamic compression plate strain in an in vitro fracture model. J Orthop Trauma. 2001;15:333-7.

Chao P, Conrad BP, Lewis DD, Horodyski MB, Pozzi A. Effect of plate working length on plate stiffness and cyclic fatigue life in a cadaveric femoral fracture gap model stabilized with a 12-hole 2.4 mm locking compression plate. BMC Vet Res. 2013;9:1-7.

Smith WR, Ziran BH, Anglen JO, Stahel PF. Locking plates: tips and tricks. J Bone Joint Surg Am. 2007;89:2298-307.

Cheal EJ, Hayes WC, White AA, Perren SM. Three-dimensional finite element analysis of a simplified compression plate fixation system. J Biomech Eng. 1984;106:295–301.

Chatzistergos P, Magnissalis E, Kourkoulis S. A parametric study of cylindrical pedicle screw design implications on the pullout performance using an experimentally validated finite-element model. Med Eng Phys. 2010;32:145-54.

Kohn D, Rose C. Primary Stability of Interference Screw Fixation: Influence of Screw Diameter and Insertion Torque. Am J Sports Med. 1994;22:334–8.

Downloads

Published

2021-05-01

Issue

Section

Research Article

How to Cite

1.
Saraç Ünal, Karadeniz S, Özer A. Ideal plate screw configuration in femoral shaft fractures: 3D finite element analysis. J Surg Med [Internet]. 2021 May 1 [cited 2023 Feb. 6];5(5):540-3. Available from: https://jsurgmed.com/article/view/925624