Chancharoen Wares, Nwe Theingi, Seehanam Saran, Taradolpisut Napawan, Berkband Thewarid, Chobpenthai Thanapon, Jongwannasiri Chavin, Yurasakpong Laphatrada
Laboratory of Artificial Intelligence and Innovation in Medicine (AIIM), Princess Srisavangavadhana Faculty of Medicine, Chulabhorn Royal Academy, 906 Kamphaeng Phet 6 Road, Talat Bang Khen, Lak Si, Bangkok 10210, Thailand.
Department of Anatomy, Faculty of Science, Mahidol University, 272 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand.
APL Bioeng. 2025 Jun 11;9(2):026123. doi: 10.1063/5.0248553. eCollection 2025 Jun.
Fractures of the distal radius often require surgical intervention, with plate fixation being a standard stabilization method. Screw loosening and pull-out propose significant complications, necessitating comprehensive understanding of fixation stability factors. This study introduces a novel approach by the combination of finite element analysis (FEA) and experimental investigations on Thiel cadavers to evaluate screw pull-out behavior from plate fixation in en bloc distal radius resection with ulnar reconstruction. In comparison with previous investigations that used computational modeling or fresh-frozen cadaveric specimens, in the present research, FEA predictions specifically experimentally confirm the usage of Thiel cadavers, which better preserve soft tissue elasticity and hydration, thus more closely reflect conditions. Experimental set-up consisted of bending tests on cadavers and screw pull-out tests in Thiel-cadaveric radius specimens mimicking physiological conditions that induce the effects of screw pull-out. Finite element analysis and simulation were conducted using realistic clinical cases. Biomechanical test results indicated locking-plate deformation and screw loosening, particularly at locations closest to the ulnar bone gap. Torque measurements established various degrees of screw loosening, with the screws closest to the bone gap indicating maximum loosening. FEA demonstrated critical distributions of stresses in screws and locking plates, with good correlations to experimental findings. Screw pull-out force analysis showed vulnerability to loosening, particularly in the area of bone gaps, with findings consistent between biomechanical testing and FEA. This study offers valuable information on the surgical implications and biomechanical considerations of plate fixation for en bloc distal radius resection with ulnar reconstruction.
桡骨远端骨折通常需要手术干预,钢板固定是一种标准的稳定方法。螺钉松动和拔出会引发严重并发症,因此有必要全面了解固定稳定性因素。本研究引入了一种新方法,将有限元分析(FEA)与对蒂尔尸体的实验研究相结合,以评估在尺骨重建的整块桡骨远端切除术中钢板固定时螺钉的拔出行为。与以往使用计算模型或新鲜冷冻尸体标本的研究相比,在本研究中,FEA预测特别通过实验证实了蒂尔尸体的使用,其能更好地保留软组织弹性和水合作用,从而更接近真实情况。实验设置包括对尸体进行弯曲试验以及在模拟诱导螺钉拔出效果的生理条件的蒂尔尸体桡骨标本上进行螺钉拔出试验。使用实际临床病例进行有限元分析和模拟。生物力学测试结果表明锁定钢板变形和螺钉松动,尤其是在最靠近尺骨间隙的位置。扭矩测量确定了不同程度的螺钉松动,最靠近骨间隙的螺钉松动程度最大。FEA显示了螺钉和锁定钢板中的关键应力分布,与实验结果具有良好的相关性。螺钉拔出力分析表明在骨间隙区域易发生松动,生物力学测试和FEA的结果一致。本研究为尺骨重建的整块桡骨远端切除术中钢板固定的手术意义和生物力学考虑提供了有价值的信息。
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