Alito Angelo, Fenga Domenico, Tropeano Giada, Milardi Demetrio, Leonetti Danilo, Migliorato Alba, Tisano Adriana, D'Andrea Danilo, Filardi Vincenzo
Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy.
Department of Orthopaedics and Traumatology, University Hospital A.O.U. "G. Martino", 98125 Messina, Italy.
Bioengineering (Basel). 2023 Dec 7;10(12):1402. doi: 10.3390/bioengineering10121402.
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.
锁骨中段骨折大多通过采用上方或前下方钢板及螺钉进行切开复位内固定手术治疗，或采用髓内钉固定。螺钉定位在确定应力分布方面起着关键作用。目前缺乏关于钢板固定所需螺钉位置及合适皮质骨数量的数据。本研究的目的是通过数值模拟评估与健康锁骨相比，植入骨折骨的前侧钢板在120°侧方抬高时的力学行为。所使用的接触力和力矩取自文献数据，并应用于健康和骨折的有限元模型。在健康锁骨上发现约9兆帕的应力，而在骨折锁骨的钢板上计算出约15兆帕的值；当锁骨上的应力屏蔽将所有三个载荷分量（压缩、弯曲和扭转）相加时，这些应力峰值在抬高约30°和70°时达到。用钢板和螺钉固定的锁骨骨折中的应力分布受多种因素影响，包括钢板的位置和设计、螺钉类型以及运动过程中施加的生物力学力。
