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The Effects of Bone Screw Configurations on the Interfragmentary Movement in a Long Bone Fixed by a Limited Contact Locking Compression Plate

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DOI: 10.4236/jbise.2015.89055    2,904 Downloads   3,587 Views   Citations


The locking compression plates (LCP) are efficient tools in open reduction and internal fixation (ORIF), especially in osteoporotic bones. Two important factors of screw density and screw position can affect the functionality of the bone plate. Several studies have assessed the influence of the screw configurations on the bone-plate stiffness, but the effects of screw positions on the interfragmentary strain, εIF of LCP construct have not been investigated yet. In this study, finite element method was used to investigate the influence of screws number and position on the interfragmentary strain of LCP-femur system for a mid-shaft fracture. Results of this study showed that by insertion of screws closer to the fracture site, εIF decreases by 2nd degree polynomial function versus screw position, but by adding the screws from the ends of the plate, or by moving and placing the screws towards the fracture site, the reduction of εIF will be linear. Results of this study were compared and are in agreement with some studies in the literature, even though their scope was mostly stability of the bone-implant system, whereas our scope was focused on the interfragmentary strain.

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The authors declare no conflicts of interest.

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Nourisa, J. , Baseri, A. , Sudak, L. and Rouhi, G. (2015) The Effects of Bone Screw Configurations on the Interfragmentary Movement in a Long Bone Fixed by a Limited Contact Locking Compression Plate. Journal of Biomedical Science and Engineering, 8, 590-600. doi: 10.4236/jbise.2015.89055.


[1] Moore, K.L., Dalley, A.F. and Agur, A.M. (2013) Clinically Oriented Anatomy. Wolters Kluwer Health.
[2] Bucholz, R.W. and Jones, A. (1991) Fractures of the Shaft of the Femur. The Journal of Bone and Joint Surgery American, 73, 1561-1566.
[3] Perren, S.M. (2002) Evolution of the Internal Fixation of Long Bone Fractures. The Scientific Basis of Biological Internal Fixation: Choosing a New Balance between Stability and Biology. The Journal of Bone & Joint Surgery (Br), 84, 1093-1110.
[4] Nork, S.E. (2006) Femural Shaft Fracture. Rockwood and Green’s Fractures in Adults. Lippincott Williams & Wilkins, Philadelphia, 14-15.
[5] Endo, H., Asaumi, K., Mitani, S., Noda, T., Minagawa, H., Tetsunaga, T., et al. (2008) The Minimally Invasive Plate Osteosynthesis (MIPO) Technique with a Locking Compression Plate for Femoral Lengthening. Acta Medica Okayama, 62, 333-339.
[6] Oh, C.-W., Kim, J.-J., Byun, Y.-S., Oh, J.-K., Kim, J.-W., Kim, S.-Y., et al. (2009) Minimally Invasive Plate Osteosynthesis of Subtrochanteric Femur Fractures with a Locking Plate: A Prospective Series of 20 Fractures. Archives of Orthopaedic and Trauma Surgery, 129, 1659-1665.
[7] Strohm, P., Reising, K., Hammer, T., Suedkamp, N., Jaeger, M. and Schmal, H. (2011) Humerus Shaft Fractures— Where Are We Today. Acta Chirurgiae Orthopaedicae et Traumatologiae Cechosl, 78, 185-189.
[8] Miller, D.L. and Goswami, T. (2007) A Review of Locking Compression Plate Biomechanics and Their Advantages as Internal Fixators in Fracture Healing. Clinical Biomechanics, 22, 1049-1062.
[9] Kanchanomai, C., Phiphobmongkol, V. and Muanjan, P. (2008) Fatigue Failure of an Orthopedic Implant—A Locking Compression Plate. Engineering Failure Analysis, 15, 521-530.
[10] Stoffel, K., Dieter, U., Stachowiak, G., Gachter, A. and Kuster, M.S. (2003) Biomechanical Testing of the LCP—How Can Stability in Locked Internal Fixators Be Controlled? Injury, 34, 11-19.
[11] Gautier, E. and Sommer, C. (2003) Guidelines for the Clinical Application of the LCP. Injury, 34, 63-76.
[12] Tan, S. and Balogh, Z.J. (2009) Indications and Limitations of Locked Plating. Injury, 40, 683-691.
[13] ElMaraghy, A., ElMaraghy, M., Nousiainen, M., Richards, R. and Schemitsch, E. (2001) Influence of the Number of Cortices on the Stiffness of Plate Fixation of Diaphyseal Fractures. Journal of Orthopaedic Trauma, 15, 186-191.
[14] Ellis, T., Bourgeault, C.A. and Kyle, R.F. (2001) Screw Position Affects Dynamic Compression Plate Strain in an in Vitro Fracture Model. Journal of Orthopaedic Trauma, 15, 333-337.
[15] Field, J.R., Tornkvist, H., Hearn, T.C., Sumner-Smith, G. and Woodside, T.D. (1999) The Influence of Screw Omission on Construction Stiffness and Bone Surface Strain in the Application of Bone Plates to Cadaveric Bone. Injury, 30, 591-598.
[16] Lindvall, E.M. and Sagi, H.C. (2006) Selective Screw Placement in Forearm Compression Plating: Results of 75 Consecutive Fractures Stabilized with 4 Cortices of Screw Fixation on Either Side of the Fracture. Journal of Orthopaedic Trauma, 20, 157-162.
[17] Sanders, R., Haidukewych, G.J., Milne, T., Dennis, J. and Latta, L.L. (2002) Minimal versus Maximal Plate Fixation Techniques of the Ulna: The Biomechanical Effect of Number of Screws and Plate Length. Journal of Orthopaedic Trauma, 16, 166-171.
[18] Tornkvist, H., Hearn, T. and Schatzker, J. (1996) The Strength of Plate Fixation in Relation to the Number and Spacing of Bone Screws. Journal of Orthopaedic Trauma, 10, 204-208.
[19] Freeman, A.L., Tornetta III, P., Schmidt, A., Bechtold, J., Ricci, W. and Fleming, M. (2010) How Much Do Locked Screws Add to the Fixation of “Hybrid” Plate Constructs in Osteoporotic Bone? Journal of Orthopaedic Trauma, 24, 163-169.
[20] Hak, D.J., Althausen, P. and Hazelwood, S.J. (2010) Locked Plate Fixation of Osteoporotic Humeral Shaft Fractures: Are Two Locking Screws per Segment Enough? Journal of Orthopaedic Trauma, 24, 207-211.
[21] Lee, C.H., Shih, K.S., Hsu, C.C. and Cho, T. (2014) Simulation-Based Particle Swarm Optimization and Mechanical Validation of Screw Position and Number for the Fixation Stability of a Femoral Locking Compression Plate. Medical Engineering & Physics, 36, 57-64.
[22] MacLeod, A., Pankaj, P. and Simpson, H. (2012) The Effect of Varying Screw Configuration on the Mechanical Response of Locking Plate Fixators. Journal of Biomechanics, 45, S218.
[24] Ahmad, M., Nanda, R., Bajwa, A., Candal-Couto, J., Green, S. and Hui, A. (2007) Biomechanical Testing of the Locking Compression Plate: When Does the Distance between Bone and Implant Significantly Reduce Construct Stability? Injury, 38, 358-364.
[25] Kim, H.-J., Kim, S.-H. and Chang, S.-H. (2011) Finite Element Analysis Using Interfragmentary Strain Theory for the Fracture Healing Process to Which Composite Bone Plates Are Applied. Composite Structures, 93, 2953-2962.
[26] Wang, C., Yettram, A., Yao, M. and Procter, P. (1998) Finite Element Analysis of a Gamma Nail within a Fractured Femur. Medical Engineering & Physics, 20, 677-683.
[27] Benli, S., Aksoy, S., Havitcgolu, H. and Kucuk, M. (2008) Evaluation of Bone Plate with Low-Stiffness Material in Terms of Stress Distribution. Journal of Biomechanics, 41, 3229-3235.
[28] Lacroix, D. and Prendergast, P. (2002) A Mechano-Regulation Model for Tissue Differentiation during Fracture Healing: Analysis of Gap Size and Loading. Journal of Biomechanics, 35, 1163-1171.
[29] Lacroix, D., Prendergast, P., Li, G. and Marsh, D. (2002) Biomechanical Model to Simulate Tissue Differentiation and Bone Regeneration: Application to Fracture Healing. Medical & Biological Engineering & Computing, 40, 14-21.
[30] Nassiri, M., MacDonald, B. and O’Byrne, J.M. (2013) Computational Modelling of Long Bone Fractures Fixed with Locking Plates—How Can the Risk of Implant Failure Be Reduced? Journal of Orthopaedics, 10, 29-37.
[31] Oh, J.K., Sahu, D., Ahn, Y.H., Lee, S.J., Tsutsumi, S., Hwang, J.H., et al. (2010) Effect of Fracture Gap on Stability of Compression Plate Fixation: A Finite Element Study. Journal of Orthopaedic Research, 28, 462-467.
[32] Britton, J., Walsh, L. and Prendergast, P. (2003) Mechanical Simulation of Muscle Loading on the Proximal Femur: Analysis of Cemented Femoral Component Migration with and without Muscle Loading. Clinical Biomechanics, 18, 637-646.
[33] Tsai, A.G., Reich, M.S., Bensusan, J., Ashworth, T., Marcus, R.E. and Akkus, O. (2013) A Fatigue Loading Model for Investigation of Iatrogenic Subtrochanteric Fractures of the Femur. Clinical Biomechanics, 28, 981-987.
[34] Simoes, J., Vaz, M., Blatcher, S. and Taylor, M. (2000) Influence of Head Constraint and Muscle Forces on the Strain Distribution within the Intact Femur. Medical Engineering & Physics, 22, 453-459.
[35] Cheung, G., Zalzal, P., Bhandari, M., Spelt, J. and Papini, M. (2004) Finite Element Analysis of a Femoral Retrograde Intramedullary Nail Subject to Gait Loading. Medical Engineering & Physics, 26, 93-108.
[36] Wieding, J., Souffrant, R., Fritsche, A., Mittelmeier, W. and Bader, R. (2012) Finite Element Analysis of Osteosynthesis Screw Fixation in the Bone Stock: An Appropriate Method for Automatic Screw Modelling. PLoS ONE, 7, e33776.
[37] Heller, M., Bergmann, G., Kassi, J.-P., Claes, L., Haas, N. and Duda, G. (2005) Determination of Muscle Loading at the Hip Joint for Use in Pre-Clinical Testing. Journal of Biomechanics, 38, 1155-1163.
[38] Stolk, J., Verdonschot, N. and Huiskes, R. (2001) Hip-Joint and Abductor-Muscle Forces Adequately Represent in Vivo Loading of a Cemented Total Hip Reconstruction. Journal of Biomechanics, 34, 917-926.
[39] Campoli, G., Weinans, H. and Zadpoor, A.A. (2012) Computational Load Estimation of the Femur. Journal of the Mechanical Behavior of Biomedical Materials, 10, 108-119.
[40] Watson-Jones, R. and Wilson, J.N. (1982) Watson-Jones Fractures and Joint Injuries. Churchill Livingstone, Edinburg.
[41] Aro, H.T., Wahner, H.T. and Chao, E.Y. (1991) Healing Patterns of Transverse and Oblique Osteotomies in the Canine Tibia under External Fixation. Journal of Orthopaedic Trauma, 5, 351-364.
[42] Yamagishi, M. and Yoshimura, Y. (1955) The Biomechanics of Fracture Healing. The Journal of Bone & Joint Surgery, 37, 1035-1068.
[43] MacLeod, A.R., Pankaj, P. and Simpson, A. (2012) Does Screw-Bone Interface Modelling Matter in Finite Element Analyses? Journal of Biomechanics, 45, 1712-1716.
[44] Yang, J. and Xiang, H.-J. (2007) A Three-Dimensional Finite Element Study on the Biomechanical Behavior of an FGBM Dental Implant in Surrounding Bone. Journal of Biomechanics, 40, 2377-2385.
[45] Haase, K. and Rouhi, G. (2013) Prediction of Stress Shielding around an Orthopedic Screw: Using Stress and Strain Energy Density as Mechanical Stimuli. Computers in Biology and Medicine, 43, 1748-1757.
[46] Rouhi, G., Tahani, M., Haghighi, B. and Herzog, W. (2015) Prediction of Stress Shielding around Orthopedic Screws: Time-Dependent Bone Remodeling Analysis Using Finite Element Approach. Journal of Medical and Biological Engineering,35, 545-554.

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