BIOMECHANICAL IMPACT OF OBLIQUE LOCKING PLATE ON FIXATION OF FEMORAL SHAFT FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DINGNing ^1,2 , ANGuojun ¹ , ZHANGChanghai ¹ , LIUJiabao ¹ , LIUBaotao ¹ , GENGXin ¹ ,  JIAJian ³

1. Department of Orthopedics, Tanggu Traditional Chinese Medicine Hospital of Tianjin Binhai New Area, Tianjin, 300451, P. R. China;
2. Graduate School of Tianjin Medical University;
3. Department of Traumatology, Tianjin Hospital;

Corresponding author：

JIAJian, Email: jiajian0612@126.com

Keywords：

Minimally invasive technique; Femoral shaft fracture; Plate fixation; Biomechanics

DOI：

10.7507/1002-1892.20150118

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Objective To investigate the biomechanical influence of the oblique locking plate on the fixation of femoral shaft fracture. Methods Forty imitation artificial femur model with mechanical properties similar to human femur were selected and randomly divided into groups A, B, C, and D, 10 in each group; the femur fracture model was made by transverse osteotomy at 15 cm and 17 cm below the lesser trochanter of the femur and fixed with locking plate with 12 holes and cortical bone screws. The plate was placed in the middle of the longitudinal axis of the femur in group A, and was placed at 5, 10, and 15° angle axis in groups B, C, and D respectively. The axial compression, three-point bending, torsion tests were carried out to measure the strain. Results With the compressive load and bending load increasing, the medial and lateral strains were significantly increased in each group (P<0.05); but no significant difference was found in strains under compressive load and bending load among 4 groups (P>0.05). With increasing torque, the strain was significantly increased in each group (P<0.05). At 10 N·m torque, there was no significant difference in the strain values among 4 groups (P>0.05); the strain value was significantly higher in groups C and D than groups A and B (P<0.05) and in group D than group C (P<0.05) at torque of 20 and 50 N·m, but no significant difference was found between groups A and B (P>0.05). Conclusion Under different stress, the strain will be significantly increased when the plate is placed at >10° angle axis.

Citation： DINGNing, ANGuojun, ZHANGChanghai, LIUJiabao, LIUBaotao, GENGXin, JIAJian. BIOMECHANICAL IMPACT OF OBLIQUE LOCKING PLATE ON FIXATION OF FEMORAL SHAFT FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(5): 542-547. doi: 10.7507/1002-1892.20150118 Copy

1.	Törnkvist H, Hearn TC, Sehatzker J. The strength of plate fixation in relation to the number and spacing of bone screws. J Orthop Trauma, 1996, 10(8):204-208.
2.	Sanders R, Haidukewych GJ, Milne T, et al. Minimal versus maximal plate fixation techniques of the ulna:the biomechanical effect of number of screws and plate length. J Orthop Trauma, 2002, 16(3):166-171.
3.	Stoffel K, Stachowiak G, Forster T, et al. Oblique screws at the plate ends increase the fixation strength in synthetic bone test medium. J Orthop Trauma, 2004, 18(9):611-616.
4.	Sanders R, Haidukewych GJ, Milnc T, et al. Minimal versus maximal plate fixation techniques of the ulna:the biomechanical effect of number of screws and plate length. J Orthop Trauma, 2012, 16(3):166-171.
5.	Stoffel K, Dieter U, Stachowiak G, et al. Biomechanical testing of theLCP-how can stability in locked intemal fixators be controlled? Injury, 2013, 34 Suppl 2:B11-19.
6.	EIMaraghy AW, EIMaraghy MW, Nousiainen M, et al. Influence of the number of cortices on the stiffness of plate fixation of diaphyseal fractures. J Orthop Trauma, 2011, 15(3):186-191.
7.	Lurence M, Freeman MA, Swanson SA. Engineering considerations in the intemal fixation of fractures of the tibial shaft. J Bone Joint Surg (Br), 1969, 51(4):754-768.
8.	Ellis T, Bourgeault CA, Kyle RF. Screw position affects dynamic compression plate strain in all in vitro fracture model. J Orthop Trauma, 2011, 15(5):333-337.
9.	王满宣, 杨庆铭, 曾炳芳, 等译. 骨折治疗的AO原则. 北京:华夏出版社, 2003:115-116.
10.	杨阳, 马信龙, 马剑雄, 等. 防腐与PMMA人工股骨近端标本的轴向生物力学差异. 生物医学工程与临床, 2010, 14(4):285-289.
11.	Bong MR, Patel V, lesaka K, et al. Comparison of a sliding hip screw with a trochanteric lateral support plate to an intramedullary hip screw for fixation of unstable intertrochanteric hip fractures:a cadaver study. J Trauma, 2004, 56(4):791-794.
12.	王杰, 马信龙, 马剑雄, 等. 生物力学分析四种内固定治疗股骨转子下骨折的差异. 中华骨科杂志, 2013, 33(11):1126-1134.
13.	Gerber C, Mast JW, Ganz R. Biological internal fixation of fractures. Arch Orthop Trauma Surg, 1990, 109(6):295-303.
14.	Ahmad M, Nanda R, Bajwa AS, et al. Biomechanical testing of the locking compression plate:when does the distance between bone and implant significantly reduce construct stability? Injury, 2007, 38(3):358-364.
15.	Claes LE, Heigele CA. Magnitudes of local stress and strain along bone surfaces predict the course and type of fracture healing. J Biomech, 2009, 32(3):255-266.
16.	McAllister TN, Frangos JA. Steady and transient fluid shear stress stimulate No release in ostcobJasts through distinct biochemical pathways. J Bone Miner Res, 1999, 14(6):930-936.
17.	Claes LE, Heigele CA, Neidlinger-Wilke C, et al. Effects of mechanical factors on the fracture healing process. Clin Orthop Relat Res, 2008, (355 Suppl):S132-147.
18.	Carretta R, Stüssi E, Müller R, et al. Prediction of local ultimate strain and toughness of trabecular bone tissue by Raman material composition analysis. Biomed Res Int, 2015, 2015:457371.
19.	Wilson CJ, Schuetz MA, Epari DR. Effects of strain artefacts arising from a pre-defined callus domain in models of bone healing mechanobiology. Biomech Model Mechanobiol, 2015.[Epub ahead of print].
20.	Buckley MJ, Banes AJ, Jordan RD. The effects of mechanical strain on osteoblasts in vitro. J Oral Maxillofac Surg, 1991, 48(3):276-283.
21.	Sato M, Ochi T, Nakase T, et al. Mechanical tension stress induces expression of bone morpbogenentic protein (BMP)-2 and BMP-4 hut not BMP-6, BMP-7, and GDF-5 mRNA, during distraction oslcogenesis. J Bone Miner Res, 1999, 14(7):1084-1095.
22.	Aspenberg P, Basic N, Tagil M, et al. Reduced expression of BMP-3 due to mechanical A link belween meehanical stimuli and tissue differentiation. Actaorthop Stand, 2000, 71(6):558-562.
23.	Perren SM. Physical and biological aspects of fracture healing with special reference to internal fixation. Clin Orthop Relat Res, 2006, (138):175-196.
24.	Märdian S, Schaser KD, Duda GN, et al. Working length of locking plates determines interfragmentary movement in distal femur fractures under physiological loading. Clin Biomech (Bristol, Avon), 2015, pii:S0268-0033(15)00044-3.
25.	Auston DA, Werner FW, Simpson RB. Orthogonal femoral plating:a biomechanical study with implications for interprosthetic fractures. Bone Joint Res, 2015, 4(2):23-38.
26.	Xu XX, Zhang X, Liu JG, et al. Stress analyses after femoral shaft Osteotomy fixed by various plates with different rigidities in simulation test. Chin Med J (Engl), 2003, 106(2):127-131.
27.	Tonino AJ, Davidson CL, Klopper PJ, et al. Protection from stress in bone and its effects. Experiments with stainless steel and plastic plates in dogs. J Bone Joint Surg (Br), 2006, 58(1):107-113.
28.	Sumitomo N, Noritak K, Hattori T, et al. Experiment study on fracture fixation with low rigidity titanium alloy:plate fixation of tibia fracture model in rabbit. J Mater Sci Mater Med, 2008, 19(4):1581-1604.
29.	Cheal EJ, Hayes WC, WhiteAA 3rd, et al. Three-dimensional Finite elemt analysis of a simplified compression plate fixation system. J Biomech Eng, 2004, 106(4):295-301.
30.	Laurence M, Freeman MA, Swanson SA. Engineering considerations in the internal fixation of fractures of the tibial shaft. J Bone Joint Surg (Br), 1969, 51(4):754-768.
31.	Jepsen KJ, Davy DT, Krzypow DJ. The role of the lamellar interface during torsional yielding ofhuman cortical bone. J Biomech, 1999, 32(3):303-310.

1. Törnkvist H, Hearn TC, Sehatzker J. The strength of plate fixation in relation to the number and spacing of bone screws. J Orthop Trauma, 1996, 10(8):204-208.
2. Sanders R, Haidukewych GJ, Milne T, et al. Minimal versus maximal plate fixation techniques of the ulna:the biomechanical effect of number of screws and plate length. J Orthop Trauma, 2002, 16(3):166-171.
3. Stoffel K, Stachowiak G, Forster T, et al. Oblique screws at the plate ends increase the fixation strength in synthetic bone test medium. J Orthop Trauma, 2004, 18(9):611-616.
4. Sanders R, Haidukewych GJ, Milnc T, et al. Minimal versus maximal plate fixation techniques of the ulna:the biomechanical effect of number of screws and plate length. J Orthop Trauma, 2012, 16(3):166-171.
5. Stoffel K, Dieter U, Stachowiak G, et al. Biomechanical testing of theLCP-how can stability in locked intemal fixators be controlled? Injury, 2013, 34 Suppl 2:B11-19.
6. EIMaraghy AW, EIMaraghy MW, Nousiainen M, et al. Influence of the number of cortices on the stiffness of plate fixation of diaphyseal fractures. J Orthop Trauma, 2011, 15(3):186-191.
7. Lurence M, Freeman MA, Swanson SA. Engineering considerations in the intemal fixation of fractures of the tibial shaft. J Bone Joint Surg (Br), 1969, 51(4):754-768.
8. Ellis T, Bourgeault CA, Kyle RF. Screw position affects dynamic compression plate strain in all in vitro fracture model. J Orthop Trauma, 2011, 15(5):333-337.
9. 王满宣, 杨庆铭, 曾炳芳, 等译. 骨折治疗的AO原则. 北京:华夏出版社, 2003:115-116.
10. 杨阳, 马信龙, 马剑雄, 等. 防腐与PMMA人工股骨近端标本的轴向生物力学差异. 生物医学工程与临床, 2010, 14(4):285-289.
11. Bong MR, Patel V, lesaka K, et al. Comparison of a sliding hip screw with a trochanteric lateral support plate to an intramedullary hip screw for fixation of unstable intertrochanteric hip fractures:a cadaver study. J Trauma, 2004, 56(4):791-794.
12. 王杰, 马信龙, 马剑雄, 等. 生物力学分析四种内固定治疗股骨转子下骨折的差异. 中华骨科杂志, 2013, 33(11):1126-1134.
13. Gerber C, Mast JW, Ganz R. Biological internal fixation of fractures. Arch Orthop Trauma Surg, 1990, 109(6):295-303.
14. Ahmad M, Nanda R, Bajwa AS, et al. Biomechanical testing of the locking compression plate:when does the distance between bone and implant significantly reduce construct stability? Injury, 2007, 38(3):358-364.
15. Claes LE, Heigele CA. Magnitudes of local stress and strain along bone surfaces predict the course and type of fracture healing. J Biomech, 2009, 32(3):255-266.
16. McAllister TN, Frangos JA. Steady and transient fluid shear stress stimulate No release in ostcobJasts through distinct biochemical pathways. J Bone Miner Res, 1999, 14(6):930-936.
17. Claes LE, Heigele CA, Neidlinger-Wilke C, et al. Effects of mechanical factors on the fracture healing process. Clin Orthop Relat Res, 2008, (355 Suppl):S132-147.
18. Carretta R, Stüssi E, Müller R, et al. Prediction of local ultimate strain and toughness of trabecular bone tissue by Raman material composition analysis. Biomed Res Int, 2015, 2015:457371.
19. Wilson CJ, Schuetz MA, Epari DR. Effects of strain artefacts arising from a pre-defined callus domain in models of bone healing mechanobiology. Biomech Model Mechanobiol, 2015.[Epub ahead of print].
20. Buckley MJ, Banes AJ, Jordan RD. The effects of mechanical strain on osteoblasts in vitro. J Oral Maxillofac Surg, 1991, 48(3):276-283.
21. Sato M, Ochi T, Nakase T, et al. Mechanical tension stress induces expression of bone morpbogenentic protein (BMP)-2 and BMP-4 hut not BMP-6, BMP-7, and GDF-5 mRNA, during distraction oslcogenesis. J Bone Miner Res, 1999, 14(7):1084-1095.
22. Aspenberg P, Basic N, Tagil M, et al. Reduced expression of BMP-3 due to mechanical A link belween meehanical stimuli and tissue differentiation. Actaorthop Stand, 2000, 71(6):558-562.
23. Perren SM. Physical and biological aspects of fracture healing with special reference to internal fixation. Clin Orthop Relat Res, 2006, (138):175-196.
24. Märdian S, Schaser KD, Duda GN, et al. Working length of locking plates determines interfragmentary movement in distal femur fractures under physiological loading. Clin Biomech (Bristol, Avon), 2015, pii:S0268-0033(15)00044-3.
25. Auston DA, Werner FW, Simpson RB. Orthogonal femoral plating:a biomechanical study with implications for interprosthetic fractures. Bone Joint Res, 2015, 4(2):23-38.
26. Xu XX, Zhang X, Liu JG, et al. Stress analyses after femoral shaft Osteotomy fixed by various plates with different rigidities in simulation test. Chin Med J (Engl), 2003, 106(2):127-131.
27. Tonino AJ, Davidson CL, Klopper PJ, et al. Protection from stress in bone and its effects. Experiments with stainless steel and plastic plates in dogs. J Bone Joint Surg (Br), 2006, 58(1):107-113.
28. Sumitomo N, Noritak K, Hattori T, et al. Experiment study on fracture fixation with low rigidity titanium alloy:plate fixation of tibia fracture model in rabbit. J Mater Sci Mater Med, 2008, 19(4):1581-1604.
29. Cheal EJ, Hayes WC, WhiteAA 3rd, et al. Three-dimensional Finite elemt analysis of a simplified compression plate fixation system. J Biomech Eng, 2004, 106(4):295-301.
30. Laurence M, Freeman MA, Swanson SA. Engineering considerations in the internal fixation of fractures of the tibial shaft. J Bone Joint Surg (Br), 1969, 51(4):754-768.
31. Jepsen KJ, Davy DT, Krzypow DJ. The role of the lamellar interface during torsional yielding ofhuman cortical bone. J Biomech, 1999, 32(3):303-310.

Chinese Journal of Reparative and Reconstructive Surgery

BIOMECHANICAL IMPACT OF OBLIQUE LOCKING PLATE ON FIXATION OF FEMORAL SHAFT FRACTURES

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