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      Finite element method analysis of bone stress for variants of locking plate placement

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          Abstract

          This study investigates the optimal placement of locking plate screws for bone fracture stabilization in the humerus, a crucial factor for enhancing healing outcomes and patient comfort. Utilizing Finite Element Method (FEM) modeling, the research aimed to determine the most effective screw configuration for achieving optimal stress distribution in the humerus bone. A computer tomography (CT) scan of the humerus was performed, and the resulting images were used to create a detailed model in SOLIDWORKS 2012. This model was then analyzed using ANSYS Workbench V13 to develop a finite element model of the bone. Four different screw configurations were examined: 4 × 0°, 4 × 10°, 4 × 20°, 2 × 20°; 2 × 0°. These configurations were subjected to bending in the XZ and YZ planes, as well as tension and compression along the Z axis. The research identified the 2 × 20°+2 × 0° configuration as the most beneficial, with average stress values below 30 MPa and peak stress values below 50 MPa in 3-point bending at the first screw. This configuration consistently showed the lowest stress values across all loading scenarios. Specifically, stress levels ranged from 20 MPa to 50 MPa for bending in the XZ plane, 20 MPa–35 MPa for bending in the YZ plane, 20 MPa–30 MPa for extension in the Z-axis, and 18 MPa–25 MPa for compression in the Z-axis. The 4 × 10° and 4 × 20° configurations also produced satisfactory results, with stress levels not exceeding 70 MPa. However, the 4 × 0° configuration presented considerable stress during bending and compression in the Z-axis, with stress values exceeding 100 MPa, potentially leading to mechanical damage. In conclusion, the 2 × 20°; 2 × 0° screw configuration was identified as the most effective in minimizing stress on the treated bone. Future work will involve a more detailed analysis of this methodology and its potential integration into clinical practice, with a focus on enhancing patient outcomes in bone fracture treatment.

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          Most cited references47

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          Current concepts in locking plate fixation of proximal humerus fractures

          Despite numerous available treatment strategies, the management of complex proximal humeral fractures remains demanding. Impaired bone quality and considerable comorbidities pose special challenges in the growing aging population. Complications after operative treatment are frequent, in particular loss of reduction with varus malalignment and subsequent screw cutout. Locking plate fixation has become a standard in stabilizing these fractures, but surgical revision rates of up to 25% stagnate at high levels. Therefore, it seems of utmost importance to select the right treatment for the right patient. This article provides an overview of available classification systems, indications for operative treatment, important pathoanatomic principles, and latest surgical strategies in locking plate fixation. The importance of correct reduction of the medial cortices, the use of calcar screws, augmentation with bone cement, double-plate fixation, and auxiliary intramedullary bone graft stabilization are discussed in detail.
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            Modelling of bone fracture and strength at different length scales: a review.

            In this paper, we review analytical and computational models of bone fracture and strength. Bone fracture is a complex phenomenon due to the composite, inhomogeneous and hierarchical structure of bone. First, we briefly summarize the hierarchical structure of bone, spanning from the nanoscale, sub-microscale, microscale, mesoscale to the macroscale, and discuss experimental observations on failure mechanisms in bone at these scales. Then, we highlight representative analytical and computational models of bone fracture and strength at different length scales and discuss the main findings in the context of experiments. We conclude by summarizing the challenges in modelling of bone fracture and strength and list open topics for scientific exploration. Modelling of bone, accounting for different scales, provides new and needed insights into the fracture and strength of bone, which, in turn, can lead to improved diagnostic tools and treatments of bone diseases such as osteoporosis.
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              Effect of intramedullary nail and locking plate in the treatment of proximal humerus fracture: an update systematic review and meta-analysis

              Background To evaluate the effect of intramedullary nail and locking plate in the treatment of proximal humerus fracture (PHF). Methods China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wan-fang database, Chinese Biomedicine Database (CBM), PubMed, EMBASE, Web of Science, and Cochrane Library were searched until July 2018. The eligible references all show that the control group uses locking plates to treat PHF, while the experimental group uses intramedullary nails to do that. Two reviewers independently retrieved and extracted the data. Reviewer Manager 5.3 was used for statistical analysis. Results Thirty-eight retrospective studies were referred in this study which involves 2699 patients. Meta-analysis results show that the intramedullary nails in the treatment of proximal humeral fractures are superior to locking plates in terms of intraoperative blood loss, operative time, fracture healing time, postoperative complications, and postoperative infection. But there is no significance in constant, neck angle, VAS, external rotation, antexion, intorsion pronation, abduction, NEER, osteonecrosis, additional surgery, impingement syndrome, delayed union, screw penetration, and screw back-out. Conclusions The intramedullary nail is superior to locking plate in reducing the total complication, intraoperative blood loss, operative time, postoperative fracture healing time and postoperative humeral head necrosis rate of PHF. Due to the limitations in this meta-analysis, more large-scale, multicenter, and rigorous designed RCTs should be conducted to confirm our findings. Trial registration PROSPERO CRD42019120508
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                Author and article information

                Contributors
                Journal
                Heliyon
                Heliyon
                Heliyon
                Elsevier
                2405-8440
                24 February 2024
                30 April 2024
                24 February 2024
                : 10
                : 8
                : e26840
                Affiliations
                [a ]Institute of Aeronautics and Applied Mechanics, Warsaw University of Technology, Nowowiejska 24, 00-660, Warsaw, Poland
                [b ]Faculty of Medicine, Medical University of Warsaw, Żwirki i Wigury 61, 02-091, Warsaw, Poland
                [c ]Faculty of Applied Informatics and Mathematics, Warsaw University of Life Sciences, Nowoursynowska 159, 02-776, Warsaw, Poland
                Author notes
                []Corresponding author. rafal.perz@ 123456pw.edu.pl
                Article
                S2405-8440(24)02871-8 e26840
                10.1016/j.heliyon.2024.e26840
                11039970
                38660239
                75276e7b-aa4d-42d1-b6db-96b60a2e4a56
                © 2024 The Authors

                This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).

                History
                : 17 May 2023
                : 15 February 2024
                : 20 February 2024
                Categories
                Research Article

                finite element method,locking plate,long bone fracture,stabilization

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