Effect of screw position on bone tissue differentiation within a fixed femoral fracture

Saghar Nasr, Stephen Hunt, Neil A. Duncan

McCaig Institute for Bone and Joint Health, Calgary, Canada Department of Mechanical & Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, Canada.
McCaig Institute for Bone and Joint Health, Calgary, Canada Department of Orthopedic Surgery, University of Calgary, Calgary, Canada.
McCaig Institute for Bone and Joint Health, Calgary, Canada Department of Orthopedic Surgery, University of Calgary, Calgary, Canada Department of Civil Engineering, Schulich School of Engineering, University of Calgary, Calgary, Canada.

DOI: 10.4236/jbise.2013.612A009                

Abstract

Plate and screw constructs are routinely used in the treatment of long bone fractures. Despite considerable advancements in technology and techniques, there can still be complications in the healing of long bone fractures. Non-unions, delayed unions, and hardware failures are common complications observed in clinical practice following open reduction and internal fixation of fractures [1]. Potential causes of these adverse clinical effects may be disruptive to the periosteal and endosteal blood supply, stress shielding effects, and inadequate mechanical stability. The goal of the present study was to explore the effect of screw position on the fracture healing and formation of new bone tissue with mechanoregulatory algorithms in a computational model. An idealized poroelastic 3D finite element (FE) model of a femur with a 5 mm fracture gap, including a plate-screw construct was developed. Nineteen different plate-screw combinations, created by varying the number and position of screws within the plate, were created to identify a construct with the most favourable attributes for fracture healing. The first phase of the study evaluated constructs through mechanical stress analyses to identify those constructs with high loadsupport capability. The second phase of the study evaluated healing and bone formation with a biphasic mechanoregulatory algorithm to simulate tissue differentiation for fixation within selected constructs. The results of our analysis demonstrated a 4-screw symmetrical construct with the largest distance between screws to provide the most favourable balance of stability and optimized conditions to promote fracture healing.

 

Keywords

Femoral Fracture; Internal Fixation; Screw Number; Screw Position; Tissue Differentiation; Finite Element Analysis

Conflicts of Interest

The authors declare no conflicts of interest.

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