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Review
. 2021 Aug;19(4):403-416.
doi: 10.1007/s11914-021-00690-y. Epub 2021 Jun 29.

Finite Element Analysis of Fracture Fixation

Gregory S Lewis  1 , Dominic Mischler  2 , Hwabok Wee  3 , J Spence Reid  3 , Peter Varga  2
Affiliations
Review

Finite Element Analysis of Fracture Fixation

Gregory S Lewis et al. Curr Osteoporos Rep. 2021 Aug.

Abstract

Purpose of review: Fracture fixation aims to provide stability and promote healing, but remains challenging in unstable and osteoporotic fractures with increased risk of construct failure and nonunion. The first part of this article reviews the clinical motivation behind finite element analysis of fracture fixation, its strengths and weaknesses, how models are developed and validated, and how outputs are typically interpreted. The second part reviews recent modeling studies of the femur and proximal humerus, areas with particular relevance to fragility fractures.

Recent findings: There is some consensus in the literature around how certain modeling aspects are pragmatically formulated, including bone and implant geometries, meshing, material properties, interactions, and loads and boundary conditions. Studies most often focus on predicted implant stress, bone strain surrounding screws, or interfragmentary displacements. However, most models are not rigorously validated. With refined modeling methods, improved validation efforts, and large-scale systematic analyses, finite element analysis is poised to advance the understanding of fracture fixation failure, enable optimization of implant designs, and improve surgical guidance.

Keywords: Biomechanics; Finite element analysis; Fracture fixation; Nail; Plate; Screw.

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Figures

Figure 1.
Figure 1.
Radiographs from three patient cases (three rows of images). (A) A 72 y/o man sustained an intertrochanteric hip fracture that was stabilized with an intramedullary nail. After six months, the fracture did not heal and the nail sustained a fatigue fracture where the lag screw enters the neck of the femur (arrow). The patient was unable to walk without a walker. (B) He underwent revision surgery with placement of a different implant in compression (laterally based plate) which resulted in eventual healing of the fracture. (C) A 69 y/o man suffered a fracture above his revision knee replacement following a motorcycle accident. He was initially stabilized with a lateral plate. He was unable to restrict his weight bearing and sustained bending of his plate over three months. (D) Eventually, this plate fractured (arrow), requiring (E) complex reconstructive surgery with two plates and bone shortening, which eventually resulted in union. (F) 78 y/o woman sustained an osteoporotic proximal humerus fracture, initially stabilized with a blade plate and non-locking screws. (G) Early failure of the construct resulted, with pullout of the blade (arrow) and screws. (H) Revision surgery using an anatomic specific plate with locking screws resulted in successful union.
Figure 2.
Figure 2.
Overview of finite element analysis workflow (adapted from [24], with permission from Elsevier).
Figure 3.
Figure 3.
Example of finite element analysis comparing two fixation options for a challenging periprosthetic femur fracture.
See this image and copyright information in PMC

References

    1. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007;22:465–75. - PubMed
    1. Brinker MR, Hanus BD, Sen M, O’Connor DP. The devastating effects of tibial nonunion on health-related quality of life. J Bone Joint Surg Am. 2013;95:2170–6. - PubMed
    1. Brinker MR, Trivedi A, OʼConnor DP. Debilitating Effects of Femoral Nonunion on Health-Related Quality of Life. J Orthop Trauma. 2017;31:e37–42. - PubMed
    1. Hak DJ, Fitzpatrick D, Bishop JA, Marsh JL, Tilp S, Schnettler R, et al.Delayed union and nonunions: epidemiology, clinical issues, and financial aspects. Injury. 2014;45 Suppl 2:S3–7. - PubMed
    1. Rupp M, Biehl C, Budak M, Thormann U, Heiss C, Alt V. Diaphyseal long bone nonunions - types, aetiology, economics, and treatment recommendations. Int Orthop. 2018;42:247–58. - PubMed

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