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Çağlar C, Akçaalan S, Memiş K, Uğurlu M. Arthroscopic-assisted removal of broken distal hook fragment that migrated to the acromion in a patient who underwent hook plate fixation due to acromioclavicular joint dislocation: a case report and literature review. JSES Int 2024; 8:709-713. [PMID: 39035659 PMCID: PMC11258831 DOI: 10.1016/j.jseint.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Affiliation(s)
- Ceyhun Çağlar
- Department of Orthopaedics and Traumatology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Serhat Akçaalan
- Department of Orthopaedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Kemal Memiş
- Department of Orthopaedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Mahmut Uğurlu
- Department of Orthopaedics and Traumatology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Alito A, Fenga D, Tropeano G, Milardi D, Leonetti D, Migliorato A, Tisano A, D’Andrea D, Filardi V. Screw Stress Distribution in a Clavicle Fracture with Plate Fixation: A Finite Element Analysis. Bioengineering (Basel) 2023; 10:1402. [PMID: 38135993 PMCID: PMC10740883 DOI: 10.3390/bioengineering10121402] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Clavicle midshaft fractures are mostly treated surgically by open internal reduction with a superior or anteroinferior plate and screws or by intramedullary nailing. Screw positioning plays a critical role in determining the stress distribution. There is a lack of data on the screw position and the appropriate number of cortices required for plate fixation. The aim of this study is to evaluate the mechanical behavior of an anterior plate implanted in a fractured bone subjected to 120° of lateral elevation compared to a healthy clavicle using numerical simulations. Contact forces and moments used were obtained from literature data and applied to the healthy and fractured finite element models. Stresses of about 9 MPa were found on the healthy clavicle, while values of about 15 MPa were calculated on the plate of the fractured one; these stress peaks were reached at about 30° and 70° of elevation when the stress shielding on the clavicle sums all the three components of the solicitation: compression, flexion, and torsion. The stress distribution in a clavicle fracture stabilized with plates and screws is influenced by several factors, including the plate's position and design, the type of screw, and the biomechanical forces applied during movements.
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Affiliation(s)
- Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy; (A.A.); (G.T.); (D.M.); (D.L.); (A.M.)
| | - Domenico Fenga
- Department of Orthopaedics and Traumatology, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy;
| | - Giada Tropeano
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy; (A.A.); (G.T.); (D.M.); (D.L.); (A.M.)
| | - Demetrio Milardi
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy; (A.A.); (G.T.); (D.M.); (D.L.); (A.M.)
| | - Danilo Leonetti
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy; (A.A.); (G.T.); (D.M.); (D.L.); (A.M.)
| | - Alba Migliorato
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy; (A.A.); (G.T.); (D.M.); (D.L.); (A.M.)
| | - Adriana Tisano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy;
| | - Danilo D’Andrea
- Department of Engineering, University of Messina, 98158 Messina, Italy;
| | - Vincenzo Filardi
- D.A. Scientific Research and Internationalization, University of Messina, 98121 Messina, Italy
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Xue H, Deng J, Zhang Z, Knoedler S, Panayi AC, Knoedler L, Mi B, Liu M, Dai G, Liu G. Different internal fixation methods for Hoffa-like fractures of the tibial plateau: a finite element analysis. Front Med (Lausanne) 2023; 10:1172377. [PMID: 37465644 PMCID: PMC10351422 DOI: 10.3389/fmed.2023.1172377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/08/2023] [Indexed: 07/20/2023] Open
Abstract
Due to the low incidence of posteromedial tibial plateau fractures and limited clinical data available, the optimal treatment for this type of fracture remains to be established. This type of fracture, also known as Hoffa-like fracture of the tibial plateau, shares a similar mechanism of injury with the Hoffa fracture of the femoral condyle. In the field of orthopedics, finite element analysis is considered a valuable method to guide clinical decision-making. In this study, four methods used for internal fixation of Hoffa-like fractures of the tibial plateau were compared using computer simulation and applying a finite element method (FEM). The methods compared were lateral L-plate fixation alone (Model A); lateral L-plate combined with posterior anti-slip plate (reconstruction plate/T-plate) fixation (Model B); lateral L-plate combined with posterior hollow nail fixation of the fracture block (Model C); and lateral L-plate combined with anterior hollow nail fixation of the fracture (Model D). The maximum displacement of the model and the maximum stress of the internal fixation material were analyzed by applying an axial load of 2,500 N. The results showed that, in the normal bone model, the maximum displacement of the fracture in Model A was 0.60032 mm, with improved stability through the addition of posterior lateral plate fixation in Model B and reduction of the displacement to 0.38882 mm. The maximum displacement in Model C and Model D was comparable, amounting to 0.42345 mm and 0.42273 mm, respectively. Maximum stress was 1235.6 MPa for Model A, 84.724 MPa for Model B, 99.805 MPa for Model C, and 103.19 MPa for Model D. In the internal fixation analysis of the osteoporotic fracture model, we observed patterns similar to the results of the normal bone model. The results indicated that Model B yielded the overall best results in the treatment of Hoffa-like fractures of the tibial plateau. The orthopedic surgeon may wish to implement these insights into the perioperative algorithm, thereby refining and optimizing clinical patient care. In addition, our findings pave the way for future research efforts.
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Affiliation(s)
- Hang Xue
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Junrong Deng
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenhe Zhang
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Adriana C. Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Bobin Mi
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Mengfei Liu
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Guandong Dai
- Pingshan District People’s Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, China
| | - Guohui Liu
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
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