Effect of fracture gap on stability of compression plate fixation: a finite element study.
In compression plating, anatomical reduction and compression across the fracture site are the basic principles necessary to achieve primary bone healing. However, varying amounts of gap at the fracture site frequently occur due to technical pitfalls, such as overbending of the plate and inaccurate reduction, and due to the fracture configuration itself. Little is known as to how fracture gap affects stability of the bone-plate construct. We analyzed the effects of fracture gap size (1 and 4 mm) and bone defect (25%, 50%, 75%, 100%) on the biomechanical stability of the compression plate-bone construct through validated finite element analysis. The stiffnesses of eight different models were compared with the stiffness of an ideally compressed model (0 mm/0%). Stress concentration in form of peak von Mises stress (PVMS) was also evaluated. The decrease in stiffness depended mainly on the depth of bone defect. The decrease in stiffness was similar in models with the same defect and different gap size. Considerably more stress was concentrated around the central hole of the plate in gap models with the depth of bone defects of 75% and 100% than with smaller defects. We concluded that even a thin fracture gap (1 mm) with no contact between the fracture after plating decreases stiffness exponentially; contact at the fracture surfaces of > or =50% was necessary to avoid undue stress concentration in the plate.
Department of Orthopaedic Surgery, Korea University Medical Center, 80 Guro-dong, Guro-ku, Seoul 152-703, Korea.
Jong-Keon
JK
Oh
Dipit
D
Sahu
Yoon-Ho
YH
Ahn
Sung-Jae
SJ
Lee
Sadami
S
Tsutsumi
Jin-Ho
JH
Hwang
Duk-Young
DY
Jung
Stephan M
SM
Perren
Chang-Wug
CW
Oh
D001860:Bone Plates; D004548:Elasticity; D019544:Equipment Failure Analysis; D020342:Finite Element Analysis; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology*; D050723:Fractures, Bone / Q000601:surgery*; D016268:Internal Fixators; D013314:Stress, Mechanical