Background: This comparative study simulates bone healing outcomes around tibial diaphyseal fractures under unilateral uniplanar external fixators and compares mono-cortical pins and bi-cortical ones for fixation.Methods: Eight finite element models of the fractured tibia-fixator constructs with 1 to 4 mono- or bi-cortical pins per bone segment were designed. A proven mechano-regulation algorithm was applied to the callus at the early stages of healing. Tissue differentiation was predicted, and axial stiffness was obtained to evaluate the healing process. To validate the simulation, finite element analysis of the models was compared with in-vitro biomechanical study results, and the error was less than 5%.Results: The overall axial stiffness of the bone-fixator structure reached 885, 913, and 925 N/mm for the 4, 6, and 8 bi-cortical pins, respectively, which was very close to the results of mono-cortical pins (882, 893, and 916 N/mm). The average Young's modulus of callus elements for structures with both types of pins was about 4.4 MPa, which at the initial stage of healing resulted in all structures of fibrous callus. This result was consistent with all previous studies.Conclusions: The healing simulation outcome in this study suggested that fixtures with mono-cortical pins resulted in fewer devastating complications and can be used as an alternative to the ones with bi-cortical pins.
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