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Title: Finite element analysis of locking plate and two types of intramedullary nails for treating mid-shaft clavicle fractures
Authors: Ni, M 
Niu, W
Wong, DWC 
Zeng, W
Mei, J
Zhang, M 
Issue Date: Aug-2016
Source: Injury, Aug. 2016, v. 47, no. 8, p. 1618-1623
Abstract: Background: Both plate and intramedullary nail fixations, including straight and anatomic nails, have been clinically adopted for the treatment of displaced mid-shaft clavicle fractures. However, the biomechanical performances of these fixations and implants have not been well evaluated. This study aims to compare the construct stability, stress distribution and fracture micro-motion of three fixations based on finite element (FE) method. Methods: The FE model of clavicle was reconstructed from CT images of a male volunteer. A mid-shaft fracture gap was created in the intact clavicle. Three fixation styles were simulated including locking plate (LP), anatomic intramedullary nail (CRx), and straight intramedullary nail (RCP). Two loading scenarios (axial compression and inferior bending) were applied at the distal end of the clavicle to simulate arm abduction, while the sternal end was fixed. Results: Under both conditions, the LP was the stiffest, followed by the CRx, and the RCP was the weakest. LP also displayed a more evenly stress distribution for both implant and bone. RCP had a higher stress compared with CRx in both conditions. Moreover, all implants sustained higher stress level under the loading condition of bending than compression. Conclusions: The plate fixation significantly stabilizes the fracture gap, reduces the implant stress, and serves as the recommended fixation for the mid-shaft clavicle fracture. The CRx is an alternative device to treat clavicle shaft fracture, but the shoulder excessive activities should be avoided after operation.
Keywords: Biomechanics
Clavicle fracture
Internal fixation
Plate
Intramedullary nailing
Finite element
Publisher: Elsevier
Journal: Injury 
ISSN: 0020-1383
EISSN: 1879-0267
DOI: 10.1016/j.injury.2016.06.004
Rights: © 2016 Elsevier Ltd. All rights reserved.
© 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/
The following publication Ni, M., Niu, W., Wong, D. W. C., Zeng, W., Mei, J., & Zhang, M. (2016). Finite element analysis of locking plate and two types of intramedullary nails for treating mid-shaft clavicle fractures. Injury, 47(8), 1618-1623 is available at https://doi.org/10.1016/j.injury.2016.06.004
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