Optimal screw configurations of broad and curved broad locking compression plates for femoral shaft fractures
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Abstract
The optimal configuration and number of screws used in a broad locking compression plate (B-LCP) and a curved broad locking compression plate (CB-LCP) to stabilize a femoral shaft fracture were determined using finite element (FE) analysis. A three-dimensional model of the femur and its transverse fracture at the mid-shaft region was created with widths of 10, 20 and 30 mm. The B-LCP and CB-LCP were attached to the femur model to retain the fracture using 3 to 5 screws placed equally and symmetrically for the proximal and distal segments. There were 16 screw fixation configurations for each B-LCP and CB-LCP, producing a total of 96 FE cases. The B-LCP screw configuration without secured screws at a position close to the fracture presented lower stress compared to the other configurations, while for CB-LCP, implant stress reduced when screws were secured close to the fracture. For both B-LCP and CB-LCP, elastic strain at the fracture site increased at greater working length. Bone stress using 6 screws in B-LCP was higher than when using 8 and 10 screws, with slight differences between bone stress values of 8 and 10 screws. Bone stresses in CB-LCP were in the same range, regardless of the number of screws. Three consecutive screws in CB-LCP at positions adjacent to the fracture produced lower bone stress than the other configurations. Fracture gap width had a slight influence on implant stress, elastic strain and bone stress. Results suggested that both LCPs should have four screws on each fragment, while screws on B-LCPs at positions close to the fracture without other adjacent screws should be avoided. Screws located close to the fracture gave best results for CB-LCP.
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