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Strength analysis of clavicle fracture fixation devices and fixation techniques using finite element analysis with musculoskeletal force input
Mid Sweden University, Faculty of Science, Technology and Media, Department of Quality Technology and Management, Mechanical Engineering and Mathematics.
2015 (English)In: Medical and Biological Engineering and Computing, ISSN 0140-0118, E-ISSN 1741-0444, Vol. 53, no 8, p. 759-769Article in journal (Refereed) Published
Abstract [en]

In the cases, when clavicle fractures are treated with a fixation plate,opinions are divided about the best position of the plate, type of plateand type of screw units. Results from biomechanical studies of claviclefixation devices are contradictory, probably partly because ofsimplified and varying load cases used in different studies. The anatomyof the shoulder region is complex, which makes it difficult andexpensive to perform realistic experimental tests; hence, reliablesimulation is an important complement to experimental tests. In thisstudy, a method for finite element simulations of stresses in theclavicle plate and bone is used, in which muscle and ligament force dataare imported from a multibody musculoskeletal model. The stressdistribution in two different commercial plates, superior and anteriorplating position and fixation including using a lag screw in thefracture gap or not, was compared. Looking at the clavicle fixation froma mechanical point of view, the results indicate that it is a majorbenefit to use a lag screw to fixate the fracture. The anterior platingposition resulted in lower stresses in the plate, and the anatomicallyshaped plate is more stress resistant and stable than a regularreconstruction plate.

Place, publisher, year, edition, pages
2015. Vol. 53, no 8, p. 759-769
Keywords [en]
Clavicle, Finite element analysis, Multibody simulation, Bone plates, Fixation techniques
National Category
Medical Engineering
Identifiers
URN: urn:nbn:se:miun:diva-22982DOI: 10.1007/s11517-015-1288-5ISI: 000356371000008Scopus ID: 2-s2.0-84931576402OAI: oai:DiVA.org:miun-22982DiVA, id: diva2:746740
Available from: 2014-09-15 Created: 2014-09-15 Last updated: 2017-12-05Bibliographically approved
In thesis
1. On customization of orthopedic implants - from design and additive manufacturing to implementation
Open this publication in new window or tab >>On customization of orthopedic implants - from design and additive manufacturing to implementation
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This doctoral thesis is devoted to studying the possibilities of using additive manufacturing (AM) and design based on computed tomography (CT), for the production of patient-specific implants within orthopedic surgery, initially in a broad perspective and, in the second part of the thesis focusing on customized clavicle osteosynthesis plates. The main AM method used in the studies is the Electron Beam Melting (EBM) technology. Using AM, the parts are built up directly from 3D computer models, by melting or in other ways joining thin layers of material, layer by layer, to build up the part. Over the last 20 years, this fundamentally new way of manufacturing and the rapid development of software for digital 3D reconstruction of anatomical models from medical imaging, have opened up entirely new opportunities for the design and manufacturing of patient-specific implants. Based on the information in a computed tomography (CT) scan, both digital and physical models of the anatomy can be created and of implants that are customized based on the anatomical models.

 

The main method used is a number of case studies performed, focusing on different parts of the production chain, from CT-scan to final implant, and with several aims: learning about the details of the different steps in the procedure, finding suitable applications, developing the method and trying it out. The first study was on customized hip stems, focusing on the EBM method and its special preconditions and possibilities. It was followed by a study of bone plates, designed to follow the patient-specific bone contour, in this case a tibia fracture including the whole production chain. Further, four cases of patient-specific plates for clavicle fracture fixation were performed in order to develop and evaluate the method. The plates fit towards the patient’s bone were tested in cooperation with an orthopedic surgeon at Östersund hospital. In parallel with the case studies, a method for finite element (FE) analysis of fixation plates placed on a clavicle bone was developed and used for the comparative strength analysis of different plates and plating methods. The loading on the clavicle bone in the FE model was defined on a muscle and ligament level using multibody musculoskeletal simulation for more realistic loading than in earlier similar studies. 

 

The initial studies (papers I and II) showed that the EBM method has great potential, both for the application of customized hip stems and bone plates; in certain conditions EBM manufacturing can contribute to significant cost reductions compared to conventional manufacturing methods due to material savings and savings in file preparation time. However, further work was needed in both of the application areas before implementation. The studies on the fracture fixation using patient-specific clavicle plates indicated that the method can facilitate the work for the surgeon both in the planning and in the operating room, with the potential of a smoother plate with a better fit and screw positioning tailored to the specific fracture (paper VI). However, a large clinical trial is required to investigate the clinical benefit of using patient-specific plates. The FE simulations showed similar stress distributions and displacements in the patient-specific plates and the commercial plates (papers III to VI).

 

To summarize: the results of this thesis contribute to the area of digital design and AM in patient-specific implants with broad basis of knowledge regarding the technologies used and areas in which further work is needed for the implementation of the technology on a larger scale. Further, a method has been developed and initially evaluated for implementation in the area of clavicle fracture fixation, including an approach for comparing the strength of different clavicle plates.

Place, publisher, year, edition, pages
Sundsvall, Sweden: Kopieringen, Mid Sweden University, 2014. p. 60
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 191
Keywords
Patient-specific implants, Additive manufacturing, Electron beam melting, Multibody musculoskeletal analysis, Orthopedic implants, Clavicle, Finite element analysis, Computer aided design, Osteosynthesis plate, Hip stem implants
National Category
Mechanical Engineering
Identifiers
urn:nbn:se:miun:diva-22902 (URN)978-91-87557-63-7 (ISBN)
Supervisors
Available from: 2014-09-15 Created: 2014-09-11 Last updated: 2015-03-13Bibliographically approved

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Cronskär, Marie

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