Computational Biomechanical Analysis of Postoperative Calcaneal Fractures with Different Placement of the Sustentaculum Screw

Abstract

Objective: To evaluate the computational biomechanical analysis of intra-articular calcaneal fractures with different fixation status of the sustentaculum plate screw, when the finite element modeling of calcaneal fractures were fixed by the lateral locking plate.

Methods: The normal right foot of a male (age: 36 years; height: 174 cm; body weight: 65 kg) was scanned by the CT scanner. As the computational biomechanical study, the three-dimensional finite element model of the simplified Sanders type-II calcaneal fracture was built. Fixation with the lateral calcaneal locking plate and screws was simulated using a finite element software package according to clinical operation. According to the different placement of the sustentaculum plate screw, the models were categorized as the accurate fixation group, marginal fixation group, and non-fixation group. The loading of 650 N with the vertical axial compression was applied to simulate the standing phase with single foot. The Von Mises stress distribution, maximal displacement, and contact area of the subtalar joint were analyzed among three groups.

Results: The pressure distribution of the subtalar joint facet was inhomogeneous. The stress concentration of the calcaneus was located at the medial zone of the posterior subtalar joint facet. The peak Von Mises stress distribution in three groups was similar at the subtalar joint facet of 4.9 MPa, 5.1 MPa, and 5.4 MPa. In the accurate fixation group, the contact area on the posterior articular facet was 277.1 mm² ; the maximal displacement was 0.18 mm. The contact area of the marginal fixation group was 265.3 mm² on the posterior facet, where the maximal displacement was 0.23 mm. In the non-fixation group, the contact area was 253.8 mm² ; the maximal displacement was 0.25 mm. There was a slight change in the contact area of the subtalar joint and no prominent displacement of the calcaneus could be detected among the three groups.

Conclusions: The biomechanical results, including the peak stress distribution, contact area, and maximal displacement of subtalar joint, were similar whether the screw is placed exactly within the sustentaculum tali or not, when the calcaneal fractures were fixed by the lateral locking plate. The sustentaculum plate screw had less effect on the biomechanical performance of the calcaneus.

Keywords: Calcaneus; Finite element analysis; Fracture fixation, Internal; Intra-articular fractures.

Figure 1

The flow diagram of rapid 3‐D segmentation of the hindfoot. The CT data (DICOM 3.0 format) was imported into software, SuperImage. The calcaneus and other bony structures were divided quickly by 3‐D interactive and automatic segmentation techniques, which saved a lot of time in the modeling process.

Figure 2

Reconstructed model of the intra‐articular calcaneal fracture. (A) The lateral calcaneal locking plate and screws were selected. (B) The Sanders type‐II calcaneal fracture was simulated. (C) The fracture model was fixed after the virtual surgery.

Figure 3

The contact of the articular surface and the rebuilding of ligaments. (A) The contact pairs of subtalar joint were stimulated by the automated surface‐to‐surface contact algorithm. (B) The 3‐D finite element model containing the ligaments was fixed with the lateral locking plate.

Figure 4

Results of FEA of the models. According to the placement of the sustentaculum plate screw, the stress distribution was measured in three groups: (A) the accurate fixation group; (B) marginal fixation group; and (C) non‐fixation group. And in every group, the stress concentration of the calcaneus was similarly located at the medial zone of the posterior facet.