Enhancing fixation stability in proximal humerus fractures: screw orientation optimization in PHILOS plates through finite element analysis and biomechanical testing
Abstract The optimal treatment strategy for proximal humerus fractures (PHFs) is debatable owing to the relatively high failure rate of locking plates. Optimizing implants may enhance the fixation stability of PHFs and reduce the rate of mechanical failures. We developed a finite element (FE) model...
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Nature Portfolio
2024-11-01
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| Series: | Scientific Reports |
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| Online Access: | https://doi.org/10.1038/s41598-024-78702-x |
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| author | Jichao Liu Ziyan Zhang Peng Li Chengdong Piao |
| author_facet | Jichao Liu Ziyan Zhang Peng Li Chengdong Piao |
| author_sort | Jichao Liu |
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| description | Abstract The optimal treatment strategy for proximal humerus fractures (PHFs) is debatable owing to the relatively high failure rate of locking plates. Optimizing implants may enhance the fixation stability of PHFs and reduce the rate of mechanical failures. We developed a finite element (FE) model to simulate the treatment of PHFs with Proximal Humerus Internal Locking System (PHILOS) plates. The model evaluated the average bone strain around the screw tips under vertical loading (as an alternative to the risk of cyclic screw cutout failure verified through biomechanical testing) to minimize this strain and maximize predicted fixation stability. After determining the optimal screw configuration, further FE analysis and in vitro biomechanical testing were conducted on both standard and optimized PHILOS screw orientation to assess whether the optimized plates have biomechanical advantages over the standard plates. The FE-based optimized configuration exhibited significantly lower bone strain around the implant than the standard PHILOS screw orientation (− 17.24%, p < 0.001). In both FE analysis and in vitro biomechanical testing, the optimized PHILOS plates achieved significantly lower average bone strain around the screws (p < 0.05), more uniform stress distribution, and greater structural stiffness (p < 0.05) than the standard PHILOS screw orientation. Our results show that biomechanical performance of the PHILOS plates can be improved by altering the orientation of the locking screws. This approach may be useful for future patient-specific design optimization of implants for other fractures. |
| format | Article |
| id | doaj-art-638833a95a2d49288ecc5d821399cb8a |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Nature Portfolio |
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| spelling | doaj-art-638833a95a2d49288ecc5d821399cb8a2024-11-10T12:26:01ZengNature PortfolioScientific Reports2045-23222024-11-0114111410.1038/s41598-024-78702-xEnhancing fixation stability in proximal humerus fractures: screw orientation optimization in PHILOS plates through finite element analysis and biomechanical testingJichao Liu0Ziyan Zhang1Peng Li2Chengdong Piao3Department of Orthopedics, The Second Hospital of Jilin UniversityDepartment of Orthopedics, The Second Hospital of Jilin UniversityDepartment of Engineering Mechanics, Jilin UniversityDepartment of Orthopedics, The Second Hospital of Jilin UniversityAbstract The optimal treatment strategy for proximal humerus fractures (PHFs) is debatable owing to the relatively high failure rate of locking plates. Optimizing implants may enhance the fixation stability of PHFs and reduce the rate of mechanical failures. We developed a finite element (FE) model to simulate the treatment of PHFs with Proximal Humerus Internal Locking System (PHILOS) plates. The model evaluated the average bone strain around the screw tips under vertical loading (as an alternative to the risk of cyclic screw cutout failure verified through biomechanical testing) to minimize this strain and maximize predicted fixation stability. After determining the optimal screw configuration, further FE analysis and in vitro biomechanical testing were conducted on both standard and optimized PHILOS screw orientation to assess whether the optimized plates have biomechanical advantages over the standard plates. The FE-based optimized configuration exhibited significantly lower bone strain around the implant than the standard PHILOS screw orientation (− 17.24%, p < 0.001). In both FE analysis and in vitro biomechanical testing, the optimized PHILOS plates achieved significantly lower average bone strain around the screws (p < 0.05), more uniform stress distribution, and greater structural stiffness (p < 0.05) than the standard PHILOS screw orientation. Our results show that biomechanical performance of the PHILOS plates can be improved by altering the orientation of the locking screws. This approach may be useful for future patient-specific design optimization of implants for other fractures.https://doi.org/10.1038/s41598-024-78702-xProximal humerus fracturesFinite element analysisPHILOSBiomechanicsParametric optimization |
| spellingShingle | Jichao Liu Ziyan Zhang Peng Li Chengdong Piao Enhancing fixation stability in proximal humerus fractures: screw orientation optimization in PHILOS plates through finite element analysis and biomechanical testing Scientific Reports Proximal humerus fractures Finite element analysis PHILOS Biomechanics Parametric optimization |
| title | Enhancing fixation stability in proximal humerus fractures: screw orientation optimization in PHILOS plates through finite element analysis and biomechanical testing |
| title_full | Enhancing fixation stability in proximal humerus fractures: screw orientation optimization in PHILOS plates through finite element analysis and biomechanical testing |
| title_fullStr | Enhancing fixation stability in proximal humerus fractures: screw orientation optimization in PHILOS plates through finite element analysis and biomechanical testing |
| title_full_unstemmed | Enhancing fixation stability in proximal humerus fractures: screw orientation optimization in PHILOS plates through finite element analysis and biomechanical testing |
| title_short | Enhancing fixation stability in proximal humerus fractures: screw orientation optimization in PHILOS plates through finite element analysis and biomechanical testing |
| title_sort | enhancing fixation stability in proximal humerus fractures screw orientation optimization in philos plates through finite element analysis and biomechanical testing |
| topic | Proximal humerus fractures Finite element analysis PHILOS Biomechanics Parametric optimization |
| url | https://doi.org/10.1038/s41598-024-78702-x |
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