Screw configuration in proximal humerus plating has a significant impact on fixation failure risk predicted by finite element models

Fletcher, James; Windolf, Markus; Richards, R. Geoff; Gueorguiev, Boyko; Варга, П.

doi:10.1016/j.jse.2019.02.013

Cited by 30 publications

(46 citation statements)

References 31 publications

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“…Perren stated that bone anisotropy is not significant in ORIF, so it can be ignored when treating bone as a material [55]. The literature corroborates this, showing that using isotropic material properties for the bone is sufficient for analysis under simple loads [3,5,[23][24][25][26]28,30,54,56].…”

Section: Simplification Of the Geometry Characteristics Of The Bonementioning

confidence: 83%

“…According to the recent literature, most proximal humerus fracture studies using FEA tend to investigate factors involving open reduction and internal fixation (ORIF) treatment with a locking plate [5,[28][29][30][31]33], due to the popularity of the treatment in the last few years, and also because of the high failure rate it has. Biomechanical studies turn around this treatment, investigating either the bone behavior or the effects of the locking plate configuration (Table 1); in any case, the interaction of both is relevant.…”

Section: Biomechanical Fea Studies For Proximal Humerus Fracturesmentioning

confidence: 99%

“…Fletcher et al [30] Investigate and quantify the effect of ORIF locking plate screw configuration on failure risk prediction of the fracture fixation.…”

Section: -Part Compressionmentioning

confidence: 99%

“…That is why almost all studies of this type are limited to a single fracture pattern. Today, the majority of researchers are investigating proximal humerus 3-part fractures [15,[29][30][31]33,46], because of the actual recurrence of the pattern in the clinical field [2,17,36,47,48]. The 3-part fracture (AO/OTA 11B1.1) mostly involves the surgical neck and greater tuberosity.…”

Section: -Part Compressionmentioning

confidence: 99%

“…The research papers also differ in their modeling technique. Some researchers consider the bone as a solid and "homogeneous" model, without distinguishing between the different bone tissue [25,26], while other studies use a threshold to separate cancellous and cortical bone in order to maintain real bone structure in their model [3,5,20,[29][30][31]. What is more, each researcher uses dissimilar meshing parameters for their FEA bone models-crucial parameters for the accuracy of outcomes, which vary from the type of element to the element's edge length.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Trends in the Characterization of the Proximal Humerus in Biomechanical Studies: A Review

Castro-Franco¹,

Mendoza-Muñoz²,

González-Ángeles³

et al. 2020

Applied Sciences

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Proximal humerus fractures are becoming more common due to the aging of the population, and more related scientific research is also emerging. Biomechanical studies attempt to optimize treatments, taking into consideration the factors involved, to obtain the best possible treatment scenario. To achieve this, the use of finite element analysis (FEA) is necessary, to experiment with situations that are difficult to replicate, and which are sometimes unethical. Furthermore, low costs and time requirements make FEA the perfect choice for biomechanical studies. Part of the complete process of an FEA involves three-dimensional (3D) bone modeling, mechanical properties assignment, and meshing the bone model to be analyzed. Due to the lack of standardization for bone modeling, properties assignment, and the meshing processes, this article aims to review the most widely used techniques to model the proximal humerus bone, according to its anatomy, for FEA. This study also seeks to understand the knowledge and bias behind mechanical properties assignment for bone, and the similarities/differences in mesh properties used in previous FEA studies of the proximal humerus. The best ways to achieve these processes, according to the evidence, will be analyzed and discussed, seeking to obtain the most accurate results for FEA simulations.

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Section: Simplification Of the Geometry Characteristics Of The Bonementioning

confidence: 83%

Section: Biomechanical Fea Studies For Proximal Humerus Fracturesmentioning

confidence: 99%

“…Fletcher et al [30] Investigate and quantify the effect of ORIF locking plate screw configuration on failure risk prediction of the fracture fixation.…”

Section: -Part Compressionmentioning

confidence: 99%

Section: -Part Compressionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Trends in the Characterization of the Proximal Humerus in Biomechanical Studies: A Review

Castro-Franco¹,

Mendoza-Muñoz²,

González-Ángeles³

et al. 2020

Applied Sciences

View full text Add to dashboard Cite

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Assessing screw length impact on bone strain in proximal humerus fracture fixation via surrogate modelling

Mini,

Reynolds,

Taylor

2024

Numer Methods Biomed Eng

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A high failure rate is associated with fracture plates in proximal humerus fractures. The causes of failure remain unclear due to the complexity of the problem including the number and position of the screws, their length and orientation in the space. Finite element (FE) analysis has been used for the analysis of plating of proximal humeral fractures, but due to computational costs is unable to fully explore all potential screw combinations. Surrogate modelling is a viable solution, having the potential to significantly reduce the computational cost whilst requiring a moderate number of training sets. This study aimed to develop adaptive neural network (ANN)‐based surrogate models to predict the strain in the humeral bone as a result of changing the length of the screws. The ANN models were trained using data from FE simulations of a single humerus, and after defining the best training sample size, multiple and single‐output models were developed. The best performing ANN model was used to predict all the possible screw length configurations. The ANN predictions were compared with the FE results of unseen data, showing a good correlation (R2 = 0.99) and low levels of error (RMSE = 0.51%–1.83% strain). The ANN predictions of all possible screw length configurations showed that the screw that provided the medial support was the most influential on the predicted strain. Overall, the ANN‐based surrogate model accurately captured bone strains and has the potential to be used for more complex problems with a larger number of variables.

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Biomechanical design of a new proximal humerus fracture plate using alternative materials

Islam,

Dembowski,

Schemitsch

et al. 2024

Numer Methods Biomed Eng

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Comminuted proximal humerus fractures are often repaired by metal plates, but potentially still experience bone refracture, bone “stress shielding,” screw perforation, delayed healing, and so forth. This “proof of principle” investigation is the initial step towards the design of a new plate using alternative materials to address some of these problems. Finite element modeling was used to create design graphs for bone stress, plate stress, screw stress, and interfragmentary motion via three different fixations (no, 1, or 2 “kickstand” [KS] screws across the fracture) using a wide range of plate elastic moduli (EP = 5–200 GPa). Well‐known design optimization criteria were used that could minimize bone, plate, and screw failure (i.e., peak stress < ultimate tensile strength), reduce bone “stress shielding” (i.e., bone stress under the new plate ≥ bone stress for an intact humerus, titanium plate, and/or steel plate “control”), and encourage callus growth leading to early healing (i.e., 0.2 mm ≤ axial interfragmentary motion ≤ 1 mm; shear/axial interfragmentary motion ratio <1.6). The findings suggest that a potentially optimal configuration involves the new plate being manufactured from a material with an EP of 5–41.5 GPa with 1 KS screw; but, using no KS screws would cause immediate bone fracture and 2 KS screws would almost certainly lead to delayed healing. A prototype plate might be fabricated using alternative materials suggested for orthopedics and other industries, like fiber‐metal laminates, fiber‐reinforced polymers, metal foams, pure polymers, shape memory alloys, or 3D‐printed porous metals.

show abstract

Screw configuration in proximal humerus plating has a significant impact on fixation failure risk predicted by finite element models

Cited by 30 publications

References 31 publications

Trends in the Characterization of the Proximal Humerus in Biomechanical Studies: A Review

Trends in the Characterization of the Proximal Humerus in Biomechanical Studies: A Review

Assessing screw length impact on bone strain in proximal humerus fracture fixation via surrogate modelling

Biomechanical design of a new proximal humerus fracture plate using alternative materials

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