Finite element analysis and a pilot study of different fixation constructs for Danis-Weber A and B lateral malleolus fractures
Abstract Background Displaced lateral malleolus fractures are typically stabilised through open reduction and internal fixation. The biomechanically and clinically efficacy of locking plates and lag screws, particularly in Weber A and B distal fibular fractures remains a subject of contention. This...
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-023-07115-0 |
| _version_ | 1797377228112134144 |
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| author | Shuming Huang Junkun Zhu Hailin Xing Ruifeng Yang Jifei Ye Fang Ye Quanzhou Wu Shuhua Lan |
| author_facet | Shuming Huang Junkun Zhu Hailin Xing Ruifeng Yang Jifei Ye Fang Ye Quanzhou Wu Shuhua Lan |
| author_sort | Shuming Huang |
| collection | DOAJ |
| description | Abstract Background Displaced lateral malleolus fractures are typically stabilised through open reduction and internal fixation. The biomechanically and clinically efficacy of locking plates and lag screws, particularly in Weber A and B distal fibular fractures remains a subject of contention. This study examines two locking plate designs for lateral malleolus fractures, evaluating their performance with and without interfragmentary screws using finite element models. Methods Utilising CT images of a healthy adult male volunteer, a three-dimensional finite element model was constructed. The Fibula-specific Flank Multiaxial Locking Anatomic Plate (FMLP) and the Conventional Locking Plate (CLP) were subjected to stabilisation, both with and without an interfragmentary screw, mimicking the Danis-Weber A and B lateral malleolus oblique fracture fixation. Loads of 140 N and 70 N, equivalent to 20% of the body weight, were applied to simulate the single-leg and two-leg standing conditions in the axial direction. The von Mises stress (VMS) distributions and element displacements were subsequently analyzed. Results In the Danis-Weber A fracture model group, the FMLP with an interfragmentary screw fixation exhibited the lowest peak VMS values: 51.9 MPa in the fibula, 89.0 MPa in the plate, and 61.3 MPa in the screws for simulating single-leg conditions. Under two-leg standing conditions, these peak VMS values decreased to 25.9 MPa in the fibula, 44.5 MPa in the plate, and 30.6 MPa in the screws, respectively. Furthermore, the overall structural peak displacements during single-leg standing for both Weber-A and B fractures with different implants ranged from 1.61 to 2.54 mm. While standing on two feet, the ranged was from 0.80 to 1.27 mm. An interfragmentary screw at the oblique fracture site resulted in reduced the peak value of VMS in the fibula, plate, screws, consequently decreased the overall structural displacement for FMLP and CLP fixation in lateral malleolus fractures. Conclusions The current finite element analysis (FEA) demonstrates that FMLP exhibits superior mechanical characteristics in Danis-Weber A and B lateral malleolus fractures compared to CLP. The inclusion of an interfragmentary screw, combined with locking plate design, enhances stability for simple oblique distal fibular fractures. The FMLP presents itself as potential as an alternative for lateral malleolus fractures from a biomechanical perspective. Nevertheless, further verification of these results is imperative through subsequent clinical studies. |
| first_indexed | 2024-03-08T19:50:43Z |
| format | Article |
| id | doaj.art-d45ae122a2824d8ca46abf448be1c939 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-03-08T19:50:43Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-d45ae122a2824d8ca46abf448be1c9392023-12-24T12:07:40ZengBMCBMC Musculoskeletal Disorders1471-24742023-12-0124111310.1186/s12891-023-07115-0Finite element analysis and a pilot study of different fixation constructs for Danis-Weber A and B lateral malleolus fracturesShuming Huang0Junkun Zhu1Hailin Xing2Ruifeng Yang3Jifei Ye4Fang Ye5Quanzhou Wu6Shuhua Lan7Department of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central HospitalDepartment of Orthopedic Rehabilitation, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central HospitalDepartment of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central HospitalDepartment of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central HospitalDepartment of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central HospitalDepartment of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central HospitalDepartment of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central HospitalDepartment of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central HospitalAbstract Background Displaced lateral malleolus fractures are typically stabilised through open reduction and internal fixation. The biomechanically and clinically efficacy of locking plates and lag screws, particularly in Weber A and B distal fibular fractures remains a subject of contention. This study examines two locking plate designs for lateral malleolus fractures, evaluating their performance with and without interfragmentary screws using finite element models. Methods Utilising CT images of a healthy adult male volunteer, a three-dimensional finite element model was constructed. The Fibula-specific Flank Multiaxial Locking Anatomic Plate (FMLP) and the Conventional Locking Plate (CLP) were subjected to stabilisation, both with and without an interfragmentary screw, mimicking the Danis-Weber A and B lateral malleolus oblique fracture fixation. Loads of 140 N and 70 N, equivalent to 20% of the body weight, were applied to simulate the single-leg and two-leg standing conditions in the axial direction. The von Mises stress (VMS) distributions and element displacements were subsequently analyzed. Results In the Danis-Weber A fracture model group, the FMLP with an interfragmentary screw fixation exhibited the lowest peak VMS values: 51.9 MPa in the fibula, 89.0 MPa in the plate, and 61.3 MPa in the screws for simulating single-leg conditions. Under two-leg standing conditions, these peak VMS values decreased to 25.9 MPa in the fibula, 44.5 MPa in the plate, and 30.6 MPa in the screws, respectively. Furthermore, the overall structural peak displacements during single-leg standing for both Weber-A and B fractures with different implants ranged from 1.61 to 2.54 mm. While standing on two feet, the ranged was from 0.80 to 1.27 mm. An interfragmentary screw at the oblique fracture site resulted in reduced the peak value of VMS in the fibula, plate, screws, consequently decreased the overall structural displacement for FMLP and CLP fixation in lateral malleolus fractures. Conclusions The current finite element analysis (FEA) demonstrates that FMLP exhibits superior mechanical characteristics in Danis-Weber A and B lateral malleolus fractures compared to CLP. The inclusion of an interfragmentary screw, combined with locking plate design, enhances stability for simple oblique distal fibular fractures. The FMLP presents itself as potential as an alternative for lateral malleolus fractures from a biomechanical perspective. Nevertheless, further verification of these results is imperative through subsequent clinical studies.https://doi.org/10.1186/s12891-023-07115-0Finite elementAnkle fractureFibular fractureOsteosynthesisFracture fixation |
| spellingShingle | Shuming Huang Junkun Zhu Hailin Xing Ruifeng Yang Jifei Ye Fang Ye Quanzhou Wu Shuhua Lan Finite element analysis and a pilot study of different fixation constructs for Danis-Weber A and B lateral malleolus fractures BMC Musculoskeletal Disorders Finite element Ankle fracture Fibular fracture Osteosynthesis Fracture fixation |
| title | Finite element analysis and a pilot study of different fixation constructs for Danis-Weber A and B lateral malleolus fractures |
| title_full | Finite element analysis and a pilot study of different fixation constructs for Danis-Weber A and B lateral malleolus fractures |
| title_fullStr | Finite element analysis and a pilot study of different fixation constructs for Danis-Weber A and B lateral malleolus fractures |
| title_full_unstemmed | Finite element analysis and a pilot study of different fixation constructs for Danis-Weber A and B lateral malleolus fractures |
| title_short | Finite element analysis and a pilot study of different fixation constructs for Danis-Weber A and B lateral malleolus fractures |
| title_sort | finite element analysis and a pilot study of different fixation constructs for danis weber a and b lateral malleolus fractures |
| topic | Finite element Ankle fracture Fibular fracture Osteosynthesis Fracture fixation |
| url | https://doi.org/10.1186/s12891-023-07115-0 |
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