Department of Infrastructure Engineering, The University of Melbourne, Parkville, VIC, Australia.
Centre for Limb Lengthening & Reconstruction, Epworth Hospital Richmond, Richmond, VIC, Australia.
Ann Biomed Eng. 2021 Sep;49(9):2533-2553. doi: 10.1007/s10439-021-02815-x. Epub 2021 Jun 29.
The application of volar locking plate (VLP) is promising in the treatment of dorsally comminuted and displaced fracture. However, the optimal balance between the mechanical stability of VLP and the mechanobiology at the fracture site is still unclear. The purpose of this study is to develop numerical models in conjunction with experimental studies to identify the favourable mechanical microenvironment for indirect healing, by optimizing VLP configuration and post-operative loadings for different fracture geometries. The simulation results show that the mechanical behaviour of VLP is mainly governed by the axial compression. In addition, the model shows that, under relatively large gap size (i.e., 3-5 mm), the increase of FWL could enhance chondrocyte differentiation while a large BPD could compromise the mechanical stability of VLP. Importantly, bending moment produced by wrist flexion/extension and torsion moment produced from forearm rotation could potentially hinder endochondral ossification at early stage of healing. The developed model could potentially assist orthopaedic surgeons in surgical pre-planning and designing post-operation physical therapy for treatment of distal radius fractures.
掌侧锁定板（VLP）在治疗背侧粉碎性和移位性骨折方面具有广阔的应用前景。然而，VLP 的机械稳定性与骨折部位的力学生物学之间的最佳平衡仍不清楚。本研究旨在通过优化 VLP 配置和不同骨折几何形状的术后负荷，结合实验研究，建立数值模型，确定有利于间接愈合的有利力学微环境。模拟结果表明，VLP 的力学行为主要由轴向压缩决定。此外，该模型表明，在较大的间隙尺寸（即 3-5 毫米）下，增加 FWL 可以增强软骨细胞分化，而较大的 BPD 可能会影响 VLP 的机械稳定性。重要的是，来自腕关节屈伸的弯矩和来自前臂旋转的扭转力矩可能会在愈合的早期阶段阻碍软骨内骨化。该模型可以帮助骨科医生进行手术前规划和设计术后物理治疗，以治疗桡骨远端骨折。
