Finite element analysis of dual small plate fixation and single plate fixation for treatment of midshaft clavicle fractures

Fangxue Zhang, Fancheng Chen, Yuhan Qi, Zhi Qian, Shuo Ni, Zeyuan Zhong, Xu Zhang, Dejian Li, Baoqing Yu, Fangxue Zhang, Fancheng Chen, Yuhan Qi, Zhi Qian, Shuo Ni, Zeyuan Zhong, Xu Zhang, Dejian Li, Baoqing Yu

Abstract

Background: Midshaft clavicle fractures are one of the most familiar fractures. And, dual small plate fixation has been reported as can minimize hardware-related complications. However, the biomechanical properties of the dual small plate fixation have not yet been thoroughly evaluated. Here, we report the results of a finite element analysis of the biomechanical properties of midshaft clavicle fractures treated with dual small plating and superior and anteroinferior single plate fixation.

Methods: A three-dimensional (3D) finite element model of the midshaft clavicle fractures was created, whose 4-mm transverse fracture gap, having an angle < 30 degree and devoid of overlapping triangles, was simulated between the fractured segments of the middle-shaft of the clavicle. The equivalent von Mises stress and displacement of the model was used as the output measures for analysis.

Results: No significant differences were found between dual plating, superior or anteroinferior single plating in cantilever bending, axial compression, and axial torsion. Dual plating with a smaller plate-screw construct is biomechanically eligible to compare with superior and anteroinferior single plate fixation using larger plate-screw constructs.

Conclusions: This study demonstrated that larger plate-screw constructs for the treatment of simple are placed clavicular fractures; however, weight-bearing and exorbitant shoulder activity should be avoided after the operation. Therefore, dual plating may provide a viable option for fixing midshaft clavicle fractures and, thus, may be preferred for patients who need early activity.

Keywords: Biomechanics; Clavicle fracture; Dual small plating; Finite element analysis; Larger single plate constructs.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Finite element model of mid-shaft clavicle fractures fixed by the superior plate (a), anteroinferior plate (b), and dual plate (c)
Fig. 2
Fig. 2
Boundary and loading conditions
Fig. 3
Fig. 3
Construct rigidity of three fixation under bending condition compared with the published experimental data. The values obtained for the intact clavicle were set to 100% and served as a reference
Fig. 4
Fig. 4
Von Mises stress distribution in the bone of the 3 FE models under 3 loading conditions. Cantilever bending (a), axial compression (b), and axial torsion (c)
Fig. 5
Fig. 5
Normalized stiffness of three fixation of the superior (a), anteroinferior (b), and dual plate (c) in 3 loading cases. The values obtained for the spiral plate in axial compression were set to 100% and served as a reference

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