Liu Mingrui, Luo Lincong, Lin Tao, Lv Xiaoyu, Vashisth Manoj Kumar, Li Jiaying, Shen Jianlin, Xu Lin, Huang Wenhua
School of Basic Medicine, Dali University, Dali, Yunnan, China.
Yue Bei People's Hospital Postdoctoral Innovation Practice Base, Southern Medical University, Guangzhou, China.
Front Bioeng Biotechnol. 2024 Sep 5;12:1457871. doi: 10.3389/fbioe.2024.1457871. eCollection 2024.
This study used finite element analysis to simulate four commonly used fixation methods for metacarpal shaft oblique fractures during finger motion and evaluate their biomechanical performance. The aim was to provide evidence for clinically selecting the optimal fixation method, guiding early rehabilitation treatment, and reducing the risk of complications.
Finite element analysis simulated dynamic proximal phalanx motion (60° flexion, 20° extension, 20° adduction, and 20° abduction). We analysed stress, displacement, and distributions for dorsal plates, intramedullary nails, Kirschner wire, and screw fixation methods.
At 60° of finger flexion and 20° of abduction, plate fixation demonstrated greater stability and minimal displacement, with a peak displacement of 0.19 mm; however, it showed higher stress levels in all motion states, increasing the risk of failure. The stability of the intramedullary nail was similar to that of the dorsal plate, with a maximum displacement difference of 0.04 mm, and it performed better than the dorsal plate during adduction of 20°. Kirschner wire showed the highest stress levels of 81.6 Mpa during finger flexion of 60°, indicating a greater risk of failure and unstable displacement. Screws had lower stress levels in all finger motion states, reducing the risk of failure, but had poorer stability. Stress and displacement distributions showed that the dorsal plate, intramedullary nail, and Kirschner wire mainly bore stress on the implants, concentrating near the fracture line and the proximal metacarpal. In contrast, the screws partially bore stress in the screw group. The anterior end of the metacarpal mainly hosted the maximum displacement.
This study demonstrates that under simulated finger motion states, the dorsal plate fixation method provides the best stability in most cases, especially during finger flexion and abduction. However, high stress levels also indicate a higher risk of failure. The intramedullary nail is similar to the dorsal plate in stability and performs better in certain motion states. Kirschner wire exhibits the highest risk of failure during flexion. Although screws have poorer stability in some motion states, they offer a lower risk of failure. These findings provide important reference and surgical selection strategies for treating metacarpal fractures.
本研究采用有限元分析方法，模拟掌骨干斜形骨折在手指运动时的四种常用固定方法，并评估其生物力学性能。目的是为临床选择最佳固定方法、指导早期康复治疗以及降低并发症风险提供依据。
有限元分析模拟近端指骨的动态运动（60°屈曲、20°伸展、20°内收和20°外展）。我们分析了背侧板、髓内钉、克氏针和螺钉固定方法的应力、位移及分布情况。
在手指屈曲60°和外展20°时，钢板固定显示出更高的稳定性和最小的位移，峰值位移为0.19毫米；然而，在所有运动状态下它都显示出较高的应力水平，增加了失败的风险。髓内钉的稳定性与背侧板相似，最大位移差异为0.04毫米，并且在20°内收时比背侧板表现更好。克氏针在手指屈曲60°时显示出最高应力水平，为81.6兆帕，表明失败风险更大且位移不稳定。螺钉在所有手指运动状态下应力水平较低，降低了失败风险，但稳定性较差。应力和位移分布表明，背侧板、髓内钉和克氏针主要在植入物上承受应力，集中在骨折线附近和掌骨近端。相比之下，螺钉组中螺钉部分承受应力。掌骨前端主要出现最大位移。
本研究表明，在模拟手指运动状态下，背侧板固定方法在大多数情况下提供了最佳稳定性，尤其是在手指屈曲和外展时。然而，高应力水平也表明失败风险更高。髓内钉在稳定性方面与背侧板相似，并且在某些运动状态下表现更好。克氏针在屈曲时表现出最高的失败风险。尽管螺钉在某些运动状态下稳定性较差，但它们提供了较低的失败风险。这些发现为治疗掌骨骨折提供了重要的参考和手术选择策略。
