Biomechanical evaluation of conventional locking compression plate and double locking compression plate combined with locking screw use to stabilize midshaft ulna fracture: A finite element study
Main Article Content
Abstract
This study explored the impact of midshaft ulna fractures on biomechanical performance of double locking compression (D-LCP) in comparison to conventional locking compression plates, utilizing finite element method. The study included transverse middle fractures stabilized with titanium implants, involving models of midshaft ulna and two fixation plates (D-LCP implant and C-LCP implant) created and aligned virtually using CAD. Four-node tetrahedral elements were employed in the finite element model, and regular daily activity loading conditions were applied to each model at axial compression, axial torsion, and lateral bending. EQV stress was observed around the distal screw contact in both C-LCP and D-LCP models, with D-LCP exhibiting lower EQV stress than C-LCP, particularly under axial compression. The D-LCP cases demonstrated less bone fracture displacement compared to C-LCP cases, providing valuable insights. Additionally, the bone stress in D-LCP revealed significantly lower levels compared to C-LCP.
Downloads
Article Details

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Altner, P. C., and Hartmann, J. T. (1972). Isolated fractures of the ulnar shaft in the adult. Surgical Clinics of North America, 52(1), 155–170.
Atkin, D. M., Bohay, D. R., Slabaugh, P., and Smith, B. W. (1995). Treatment of ulnar shaft fractures: A prospective, randomized study. Orthopedics, 18(6), 543–547.
Baratz, M. E. (2021). Disorders of the forearm. In Green's Operative Hand Surgery (Wolfe, S. W., Pederson, W. C., Kozin, S. H., and Cohen, M S., Eds.), 8th, pp. 950–976. Philadelphia, PA: Elsevier.
Bauccio, M. (1993). ASM Metals Reference Book, 3rd, Ohio: ASM International. p. 614.
Brakenbury, P. H., Corea, J. R., and Blakemore, M. E. (1981). Non-union of the isolated fracture of the ulnar shaft in adults. Injury, 12(5), 371–375.
Coates, C., Goeser, P., Coates-Clark, C., and Jenkins, M. (2012). Impact response and simulation of damaged ulna with internal fixation. Journal of Applied Biomechanics, 28(3), 324–334.
Collins, M., Hart, A., Hines, J., Steffen, T., Harvey, E. J., and Martineau, P. A. (2014). Distal ulna fractures: A biomechanical comparison of locking versus nonlocking plating constructs. Journal of Orthopaedic Trauma, 28(8), 470–475.
Corea, J. R., Brakenbury, P. H., and Blakemore, M. E. (1981). The treatment of isolated fractures of the ulnar shaft in adults. Injury, 12(5), 365–370.
Cronier, P., Pietu, G., Dujardin, C., Bigorre, N., Ducellier, F., and Gérard, R. (2010). The concept of locking plates. Orthopaedics & Traumatology: Surgery & Research, 96(4), S17–S36.
De Buren, N. (1962). Causes and treatment of non-union in fractures of the radius and ulna. The Journal of Bone and Joint Surgery British Volume, 44–B(3), 614–625.
Dymond, I. W. (1984). The treatment of isolated fractures of the distal ulna. The Journal of Bone and Joint Surgery British Volume, 66–B(3), 408–410.
Egol, K. A., Kubiak, E. N., Fulkerson, E., Kummer, F. J., and Koval, K. J. (2004). Biomechanics of locked plates and screws. Journal of Orthopaedic Trauma, 18(8), 488–493.
Fedorov, A., Beichel, R., Kalpathy-Cramer, J., Finet, J., Fillion-Robin, J.-C., Pujol, S., Bauer, C., Jennings, D., Fennessy, F., Sonka, M., Buatti, J., Aylward, S., Miller, J. V., Pieper, S., and Kikinis, R. (2012). 3D slicer as an image computing platform for the quantitative imaging network. Magnetic Resonance Imaging, 30(9), 1323–1341.
Gardner, M. J., Brophy, R. H., Campbell, D., Mahajan, A., Wright, T. M., Helfet, D. L., and Lorich, D. G. (2005). The mechanical behavior of locking compression plates compared with dynamic compression plates in a cadaver radius model. Journal of Orthopaedic Trauma, 19(9), 597–603.
Gebuhr, P., Hölmich, P., Orsnes, T., Soelberg, M., Krasheninnikoff, M., and Kjersgaard, A. G. (1992). Isolated ulnar shaft fractures. Comparison of treatment by a functional brace and long-arm cast. The Journal of Bone and Joint Surgery British Volume, 74–B(5), 757–759.
Gee, A., Bougherara, H., Schemitsch, E. H., and Zdero, R. (2021). Biomechanical design using in-vitro finite element modeling of distal femur fracture plates made from semi-rigid materials versus traditional metals for post-operative toe-touch weight-bearing. Medical Engineering & Physics, 87, 95–103.
Goel, S. C., Raj, K. B., and Srivastava, T. P. (1991). Isolated fractures of the ulnar shaft. Injury, 22(3), 212–214.
Hadden, W. A., Reschauer, R., and Seggl, W. (1983). Results of AO plate fixation of forearm shaft fractures in adults. Injury, 15(1), 44–52.
Ho, C. Y., Holt, J. M., and Mindlin, H. (1997). Structural Alloys Handbook, West Lafayette, IN: Cindas/Purdue University.
Hooper, G. (1974). Isolated fractures of the shaft of the ulna. Injury, 6(2), 180–184.
Hussain, A., Nema, S. K., Sharma, D., Akkilagunta, S., and Balaji, G. (2018). Does operative fixation of isolated fractures of ulna shaft results in different outcomes than non-operative management by long arm cast? Journal of Clinical Orthopaedics and Trauma, 9(Suppl. 1), S86–S91.
Jiang, D., Zhan, S., Wang, L., Shi, L. L., Ling, M., Hu, H., and Jia, W. (2021). Biomechanical comparison of five cannulated screw fixation strategies for young vertical femoral neck fractures. Journal of Orthopaedic Research, 39(8), 1669–1680.
Jitprapaikulsarn, S., Chantarapanich, N., Gromprasit, A., Mahaisavariya, C., and Patamamongkonchai, C. (2021). Single lag screw and reverse distal femur locking compression plate for concurrent cervicotrochanteric and shaft fractures of the femur: Biomechanical study validated with a clinical series. European Journal of Orthopaedic Surgery & Traumatology, 31(6), 1179–1192.
Kanjanamekanant, K. (2020). Titanium and titanium alloys in implant dentistry. Journal of the Dental Association of Thailand, 70(2), 83–93. [in Thai]
Kutz, M. (2003). Standard Handbook of Biomedical Engineering and Design. New York: McGraw-Hill.
Larson, A. N., and Rizzo, M. (2007). Locking plate technology and its applications in upper extremity fracture care. Hand Clinics, 23(2), 269–278.
Murphy, W., Black, J., and Hastings, G. (2016). Handbook of Biomaterial Properties, 2nd, New York: Springer.
Ostermann, P. A., Ekkernkamp, A., Henry, S. L., and Muhr, G. (1994). Bracing of stable shaft fractures of the ulna. Journal of Orthopaedic Trauma, 8(3), 245–248.
Santos, R. R., Rahal, S. C., Neto, C. M., Ribeiro, C. R., Sousa, E. A. C., Foschini, C. R., Agostinho, F. S., and Mesquita, L. R. (2016). Biomechanical analysis of locking reconstruction plate using mono- or bicortical screws. Materials Research, 19(3), 588–593.
Sarwar, A., Gee, A., Bougherara, H., Kuzyk, P. R. T., Schemitsch, E. H., and Zdero, R. (2021). Biomechanical optimization of the far cortical locking technique for early healing of distal femur fractures. Medical Engineering & Physics, 89, 63–72.
Snow, M., Thompson, G., and Turner, P. G. (2008). A mechanical comparison of the locking compression plate (LCP) and the low contact-dynamic compression plate (DCP) in an osteoporotic bone model. Journal of Orthopaedic Trauma, 22(2), 121–125.
Wagner, M. (2003). General principles for the clinical use of the LCP. Injury, 34(Suppl. 2), B31–B42.
Wang, H., Liu, J., Wen, G., and Xie, Y. M. (2020). The robust fail-safe topological designs based on the von Mises stress. Finite Elements in Analysis and Design, 171, 103376.
Xiong, Y., Zhao, Y., Wang, Z., Du, Q., Chen, W., and Wang, A. (2009). Comparison of a new minimum contact locking plate and the limited contact dynamic compression plate in an osteoporotic fracture model. International Orthopaedics, 33(5), 1415–1419.
Xue, R., Lai, Q., Xing, H., Zhong, C., Zhao, Y., Zhu, K., Deng, Y., and Liu, C. (2024). Finite element analysis and clinical application of 3D-printed Ti alloy implant for the reconstruction of mandibular defects. BMC Oral Health, 24(1), 95.
Zhang, Y., Shao, Q., Yang, C., Ai, C., Zhou, D., Yu, Y., and Sun, G. (2021). Finite element analysis of different locking plate fixation methods for the treatment of ulnar head fracture. Journal of Orthopaedic Surgery and Research, 16(1), 191.