Finite element analysis of intramedullary nailing and double locking plate for treating extra-articular proximal tibial fractures

Abstract

BackgroundProximal tibia fractures are one of the most familiar fractures. Surgical approaches are usually needed for anatomical reduction. However, no single treatment method has been widely established as the standard care. Our present study aims to compare the stress and stability of intramedullary nails (IMN) fixation and double locking plate (DLP) fixation in the treatment of extra-articular proximal tibial fractures.MethodsA three-dimensional (3D) finite element model of the extra-articular proximal tibial fracture, whose 2-cm bone gap began 7 cm from the tibial plateau articular surface, was created fixed by different fixation implants. The axial compressive load on an adult knee during single-limb stance was imitated by an axial force of 2500 N with a distribution of 60% to the medial compartment, while the distal end was fixed effectively. The equivalent von Mises stress and displacement of the model was used as the output measures for analysis.ResultsThe maximal equivalent von Mises stress value of the system in the IMN model was 293.23 MPa, which was higher comparing against that in the DLP fixation model (147.04 MPa). And the mean stress of the model in the IMN model (9.25 MPa) was higher than that of the DLP fixation system in terms of equivalent von Mises stress (EVMS) (P < 0.0001). The maximal value of displacement (sum) in the IMN system was 8.82 mm, which was lower than that in the DLP fixation system (9.48 mm).ConclusionsThis study demonstrated that the stability provided by the locking plate fixation system was superior to the intramedullary nails fixation system and served as an alternative fixation for the extra-articular proximal tibial fractures of young patients.

Static Study and Finite Element Analysis of a New Method of Fixation of a Medial Humerus Fracture by an Intramedullary Nailing System Analyzed by the ANSYS Workbench 16.2 Calculus Code

“…Humerus diaphysis fractures constitute 20% of humerus fractures and 3-5% of all fractures [1]. Conservative approaches (e.g.…”

“…functional bracing) achieved successful outcomes in nondisplaced or minimally displaced fractures owing to their high union potential [2,3]. Intramedullary nail, plate, and external fixators could be used for fixation in patients indicated for surgery [1]. Intramedullary nail fixation is a reliable fixation method in high-impact long bone fractures, advanced osteoporosis, and pathological fractures [4].…”

Influence of the Screw Positioning on the Stability of Locking Plate for Proximal Tibial Fractures: A Numerical Approach

“…The treatment goal is anatomic reduction and stable fixation leading to an early mobilization and a minimization of the surgical trauma [1,2]. So far, no single treatment method has been widely established as gold standard for all types of tibial fractures [4,5]. The most common surgical treatments include interlocking intramedullary nailing [4,6], locking compression plates [7,8] and external fixation systems [9].…”

“…So far, no single treatment method has been widely established as gold standard for all types of tibial fractures [4,5]. The most common surgical treatments include interlocking intramedullary nailing [4,6], locking compression plates [7,8] and external fixation systems [9]. Treatment failures are common and generally related to residual pain, stiffness, deformity, instability and a decrease in range of motion [1,8].…”

“…In recent years, many studies have examined the finite element method (FEM) analysis of locking plates in order to better understand which parameters can affect the performance of this type of fixation system. They typically investigate how number, length, type, or shape of the screws and the shape of the plates affect the implant stability [4,8,[17][18][19][20][21]. Some authors [22] have demonstrated the influence of the screw configuration on the stability of tibial tubercle osteotomy (without plates), but as far as we know, the influence of the screw configuration on the stability of tibial locking plates has not yet been adequately analysed.…”