Biomechanical analysis of four augmented fixations of plate osteosynthesis for comminuted mid‑shaft clavicle fracture: A finite element approach

Abstract

Sufficient stabilization of comminuted mid-shaft clavicle fractures via plate fixation is difficult to achieve. Various augmentations, including interfragmentary screws and cerclage wiring, have been adopted to reinforce fixation stability. The present study aimed to assess the biomechanical stability of augmented plate fixations using the finite element method. First, a clavicle fracture model was created from CT data. Fixation was then induced using a locking compressive plate (LCP) with the following four augmentations: i) Double inner cerclage wirings (DICW), ii) double outer cerclage wirings (DOCW), iii) a single interfragmentary screw (SIS) and iv) double interfragmentary screws (DIS). Compressive and bending forces of 100 N were subsequently applied at the acromial region of the clavicle. The stress distribution, displacement and fracture micro-motions of the model were assessed and compared. The DOCW resulted in the highest stress exerted on the LCP, followed by SIS, DICW and DIS. For the clavicle fracture, DICW, DOCW and SIS resulted in high stress levels. However, DIS fixation alone resulted in levels of stress that were below the yield strength of cortical bone. Displacement analysis revealed that DOCW fixation resulted in the greatest degree of displacement and fracture micro-motions, followed by SIS, DICW and DIS. The results indicated that SIS, DIS and DOCW may be used as augmentations of LCP fixation for comminuted mid-shaft clavicle fractures. However, DIS was the recommended augmentation due to it exerting the lowest stress and the highest stability compared with the other fixations. The DICW may be used to aid fracture reduction and plate placement in surgery but should be avoided for permanent fixation.

Subcostal wire migration from the left clavicle internal fixation: A case report

“…The precise process of K-wire migration remains uncertain, however, in our case, we believe that it to occur at a very gradual pace. Several theories have been suggested to clarify the cause of this migration, such as muscular activity, joint mobility, respiratory movements, negative pressure within the chest, and localized bone reabsorption without bending or threading of the pin [ 8 , 9 , 11 , 12 ]. Possible causes of K-wire subcostal migration in our instance may be attributed to movements of the gravity, and thoracoclavicular joint, subsequently influenced by respiratory movements.…”

Screw Stress Distribution in a Clavicle Fracture with Plate Fixation: A Finite Element Analysis

“…This indicates that screw positioning close to the fracture can have a significant effect on the stress pattern in the plate fixation system [66]. These changes in stress patterns can potentially affect the healing process, long-term fracture stability, rehabilitation program, and clinical outcomes [67].…”