Canceling Notch Improves the Mechanical Safety of Clavicle Locking Plate: A 3D Finite Element Study

Abstract

ObjectiveImplant failure is a disastrous complication of the operative treatment of midshaft clavicle fractures, and improving the osteosynthesis plate is a strategy for preventing this. We aimed to investigate whether canceling the notch and adding screw‐hole inserts enhanced the mechanical properties of the plate.MethodsA clavicle model was generated based on the CT images of six adult volunteers (age range, 20–40 years; three males and three females; height range 160–175) using dedicated software, and a midshaft fracture model was created. The domestically made seven‐hole locking plate commonly used for midshaft clavicle fractures was simulated (Model I); modifications were made to the plate (Model II). Using 3D finite element analysis, we simulated the fracture construct under three different load conditions—downward cantilever bending, axial compression, and axial torsion—and compared the stress distribution.ResultsWe found that under axial compression, Model II experienced its maximum stress on the plate at 551.9MPa, which was less than that in Model I (790.4 MPa). Moreover, a greater stress concentration at the fracture site was observed under axial torsion, despite the maximum stress of both the models being similar.ConclusionCanceling the notch and filling the screw holes near the fracture can ameliorate stress concentration on the internal fixation construct and enhance its reliability under axial compression. This improvement has substantial effects on the mechanical properties of implants and potentially prevents implant failure. Modern osteosynthesis anatomical implants need to be improved.

Shoulder and Elbow Surgery Special Issue

“…This issue features 32 professional articles, including three review articles, 21 clinical articles, four research articles, two operative techniques, and two case reports, contributed by well-known orthopaedic experts from China, the United States, Korea, and Europe.The elbow section of this issue includes papers on arthroscopy, 1 open surgery in elbow stiffness, 2,3 fractures, 4 total elbow arthroplasty, 5 and conservative methods of treatment. 6 The shoulder section addresses a multitude of anatomic details as well as techniques, including clavicular shaft and distal fractures, acromioclavicular joint traumatic and degenerative conditions, [7][8][9][10][11] rotator cuff pathologies and fixation techniques, treatment of the post-surgical or post-traumatic glenohumeral stiffness, fractures of the proximal humerus, 5,[12][13][14][15][16][17][18][19][20][21] the safety of irrigation in the shoulder arthroscopy, management of the scapular and glenoid fractures, radiologic and 3D models. [22][23][24][25][26][27][28][29][30][31] Overall, this special issue contains plenty of meaningful readings for surgeons specializing in shoulder and elbow surgery and for general orthopaedic and trauma specialists, as well as for orthopaedic residents and young surgeons worldwide.…”

“…The elbow section of this issue includes papers on arthroscopy , 1 open surgery in elbow stiffness 2 , 3 fractures , 4 total elbow arthroplasty , 5 and conservative methods of treatment. 6 The shoulder section addresses a multitude of anatomic details as well as techniques, including clavicular shaft and distal fractures, acromioclavicular joint traumatic and degenerative conditions, 7 , 8 , 9 , 10 , 11 rotator cuff pathologies and fixation techniques, treatment of the post‐surgical or post‐traumatic glenohumeral stiffness, fractures of the proximal humerus, 5 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 the safety of irrigation in the shoulder arthroscopy, management of the scapular and glenoid fractures, radiologic and 3D models. 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 …”