Finite Element- and Design of Experiment-Derived Optimization of Screw Configurations and a Locking Plate for Internal Fixation System

Objectives The optimization for the screw configurations and bone plate parameters was studied to improve the biomechanical performances such as reliable internal fixation and beneficial callus growth for the clinical treatment of femoral shaft fracture. Methods The finite element analysis (FEA) of internal fixation system under different screw configurations based on the orthogonal design was performed and so was for the different structural parameters of the locking plate based on the combination of uniform and orthogonal design. Moreover, orthogonal experiment weight matrixes for four evaluation indexes with FEA were analyzed. Results The analytical results showed the optimal scheme of screw configuration was that screws are omitted in the thread holes near the fracture site, and single cortical screws are used in the following holes to the distal end, while the double cortical screws are fixed in thread holes that are distal to the fracture; in the other words, the length of the screws showed an increasing trend from the fracture site to the distal end in the optimized configuration. The plate structure was optimized when thread holes gap reached 13 mm, with a width of 11 mm and 4.6 mm and 5 mm for thickness and diameter of the screw, respectively. The biomechanical performance of the internal fixation construct was further improved by about 10% based on the optimal strain range and lower stress in the internal fixation system. Conclusions The proposed orthogonal design and uniform design can be used in a more efficient way for the optimization of internal fixation system, which can reduce the simulation runs to about 10% compared with comprehensive test, and the methodology can be also used for other types of fractures to achieve better internal fixation stability and optimal healing efficiency, which may provide a method for an orthopedist in choosing the screw configurations and parameters for internal fixation system in a more efficient way.

[1]  M.S.J. Hashmi,et al.  Finite element simulation of the hip joint during stumbling: a comparison between static and dynamic loading , 2003 .

[2]  Ching-Hua Hung,et al.  Finite element comparison of retrograde intramedullary nailing and locking plate fixation with/without an intramedullary allograft for distal femur fracture following total knee arthroplasty. , 2014, The Knee.

[3]  G Sumner-Smith,et al.  The influence of screw omission on construction stiffness and bone surface strain in the application of bone plates to cadaveric bone. , 1999, Injury.

[4]  B. MacDonald,et al.  Computational modelling of long bone fractures fixed with locking plates - How can the risk of implant failure be reduced? , 2013, Journal of orthopaedics.

[5]  J. G. Bledsoe,et al.  Locked Plating of Comminuted Distal Femur Fractures: Does Unlocked Screw Placement Affect Stability and Failure? , 2014, Journal of orthopaedic trauma.

[6]  M. Fakoor,et al.  Different types of femoral shaft fracture; different types of treatment: their effects on postoperative lower llimb discrepancy. , 2011, Polski przeglad chirurgiczny.

[7]  L. Webb,et al.  Investigation of Kryptonite™ bone cement in hybrid screw configurations of locking plate humeral midshaft fixation: A study of surrogate bone model. , 2016, Journal of orthopaedics.

[8]  Zsolt J Balogh,et al.  Indications and limitations of locked plating. , 2009, Injury.

[9]  J Vander Sloten,et al.  Finite element study of trochanteric gamma nail for trochanteric fracture. , 2002, Medical engineering & physics.

[10]  Dae-Sung Son,et al.  Simulation of the bone healing process of fractured long bones applied with a composite bone plate with consideration of the blood vessel growth , 2014 .

[11]  Dae-Sung Son,et al.  The finite element analysis for endochondral ossification process of a fractured tibia applied with a composite IM-rod based on a mechano-regulation theory using a deviatoric strain , 2014 .

[12]  W. Marsden.  I and J , 2012 .

[13]  Chae-Youn Oh,et al.  Design optimization of a xenogeneic bone plate and screws using the Taguchi and finite element methods , 2011 .

[14]  D. Kohn,et al.  Primary Stability of Interference Screw Fixation , 1994, The American journal of sports medicine.

[15]  C. Hanhart,et al.  Investigation of a , 2008 .

[16]  Roy Sanders,et al.  Minimal Versus Maximal Plate Fixation Techniques of the Ulna: The Biomechanical Effect of Number of Screws and Plate Length , 2002, Journal of orthopaedic trauma.

[17]  Mohamed Ahmed Alkhodary,et al.  The development of a composite bone model for training on placement of dental implants. , 2015, International journal of health sciences.

[18]  Georg N Duda,et al.  Semi-rigid screws provide an auxiliary option to plate working length to control interfragmentary movement in locking plate fixation at the distal femur. , 2015, Injury.

[19]  H. Lill,et al.  Influence of plate material and screw design on stiffness and ultimate load of locked plating in osteoporotic proximal humeral fractures. , 2016, Injury.

[20]  G. G. Stokes.  "J." , 1890, The New Yale Book of Quotations.

[21]  Gholamreza Rouhi,et al.  The Effects of Bone Screw Configurations on the Interfragmentary Movement in a Long Bone Fixed by a Limited Contact Locking Compression Plate , 2015 .

[22]  Stavros K Kourkoulis,et al.  A parametric study of cylindrical pedicle screw design implications on the pullout performance using an experimentally validated finite-element model. , 2010, Medical engineering & physics.

[23]  Zhou Yu-zhu.  A Matrix Analysis of Orthogonal Design , 2009 .

[24]  Till Vallée,et al.  Numerical investigations and capacity prediction of G-FRP rods glued into timber , 2017, Composite Structures.

[25]  W C Hayes,et al.  Three-dimensional finite element analysis of a simplified compression plate fixation system. , 1984, Journal of biomechanical engineering.

[26]  R. M. Greiwe,et al.  Locking Plate Technology – Current Concepts , 2010, The journal of knee surgery.

[27]  David L Helfet,et al.  First clinical results of the Locking Compression Plate (LCP). , 2003, Injury.

[28]  Philip F Stahel,et al.  Locking plates: tips and tricks. , 2007, The Journal of bone and joint surgery. American volume.

[29]  Shuichi Nomura,et al.  Influence of maxillary cortical bone thickness, implant design and implant diameter on stress around implants: a three-dimensional finite element analysis. , 2010, Journal of prosthodontic research.

[30]  John M. O’Byrne,et al.  Locking compression plate breakage and fracture non-union: a finite element study of three patient-specific cases , 2012, European Journal of Orthopaedic Surgery & Traumatology.

[31]  Wei Jiang,et al.  [Investigation on biomechanics behavior using three-dimensional finite element analysis for femur shaft fracture treated with locking compression plate]. , 2014, Sheng wu yi xue gong cheng xue za zhi = Journal of biomedical engineering = Shengwu yixue gongchengxue zazhi.

[32]  Zhou Li,et al.  A new experimental design for screening Chinese medicine formula. , 2004, Colloids and surfaces. B, Biointerfaces.

[33]  Seung-Hwan Chang,et al.  Optimal design of a functionally graded biodegradable composite bone plate by using the Taguchi method and finite element analysis , 2015 .

[34]  Shuichi Nomura,et al.  Influence of Maxillary Cortical Bone Thickness, Implant Design and Diameter on Stress around Implants : A 3-dimensional Finite Element Analysis , 2007 .

[35]  P. Cronier,et al.  The concept of locking plates. , 2010, Orthopaedics & traumatology, surgery & research : OTSR.

[36]  A. Saberi,et al.  Sciatic nerve injuries following femoral shaft fractures: Does the time interval from injury to surgery matter? , 2016, Clinical Neurology and Neurosurgery.

[37]  Cheng-Lun Tsai,et al.  Biomechanical effect of the configuration of screw hole style on locking plate fixation in proximal humerus fracture with a simulated gap: A finite element analysis. , 2016, Injury.

[38]  Seung-Hwan Chang,et al.  Effect of composite intramedullary nails (IM) on healing of long bone fractures by means of reamed and unreamed methods , 2017 .

[39]  Xiao Ling Wei,et al.  Application of Matrix Analysis in Multiple Index Orthogonal Test Design , 2012 .

[40]  Seung-Hwan Chang,et al.  Influence of initial biomechanical environment provided by fibrous composite intramedullary nails on bone fracture healing , 2017 .