Plate and Bone Stresses for Single- and

Double-Plated Femoral Fractures

D.R. Carter and R. Vasu

J. Biomech 14: 55-62, 1981

 Loading

Koch
Conditions
Intact

Trans-cortical
stress
Composite Beam
Representation
 Strain
Distribution
 Gap
Contact
Healed

Single Plate Stresses

 Contact Healed
Gap

Double Plate Stresses

Stress Fields in Unplated and Plated Canine
Femora, from In-Vivo Strain Measurements

D.R. Carter, R. Vasu, D. Spengler, R. Dueland

J. Biomech 14: 63-70, 1981

 In-Plane FEA
Gage Placements
 t*

Strains (Recorded)

Loads (Solved)
Intact Bone Stresses
 Composite Beam
Theory

Stresses for Plated Bone

Changes in Stress
16 Week Histology
 Discussion

• Site-specific agreement/disagreement

• Single loading instant

• Toward quantifying Wolff’s Law ?

 Role of Interfragmentary Strain in
Fracture Healing: Ovine Model of an
Healing Osteotomy

E.J. Cheal, K.A. Mansmann, A.M. DiGioia,

W.C. Hayes, S.M. Perren

J. Orthop. Res. 9: 131-142, 1991

 Hydraulic
Actuator

Experimental Preparation
FEA Zoning of Gap
 Osteogenic Index

I = (σs + k σd) / (1 + k)

k = 0.5, 2.0
 Strain
Evolution
Global Healing
Histology
1 wk ↑ 2 wk ↑

3 wk ↑ 4 wk ↑
 Gap
Deformations

Poisson Effect
193%

Gap Principal
Strains

144% ?
Gap Stress
Distributions
Osteogenic
Index
Distribution
Resorption vs. Octahedral Stress
Resorption vs. Hydrostatic Stress
 Examples of
Local Healing Histology
Local Healing Histology
Locations of Resorption
 Discussion
• Resorption for “tolerable” gage length ?

• Experimental apparatus failure:

– Strain control early
– Load control late

• FEA: nonuniform strain in gap

• No consistent numerical relation with histology

Mechanical and Morphological Properties of
Bone Beneath Internal Fixation Plates of
Differing Rigidity

Lutz Claes

J. Orthop. Res. 7: 170-177, 1989.

Post-Op
24 weeks
Specimen Harvest
Stress-strain
comparison
Cross-sectional Microradiographs
Elastic Modulus
Cross-sectional Morphology
Femoral Diameter
Porosity & Modulus
Distribution
 Discussion
• 7% net area decrease for steel vs. CFC

• Modulus differential: 27%

– More severe change under plates

• Newer osteons are less mineralized

– More new osteons where turnover is high

• Argued that CFC had “sufficient rigidity to

stabilize the fracture” and “minimized stress
protection.”
 Quantitative Measures for Fracture
Healing: An In Vitro Biomechanical Study

A. Foux, R.C. Black, H.K. Uhtoff

J. Biomech. Engr. 112: 401-413, 1990

Variable-Direction Flexure Set-up
 EI = k (P / y)

Idealized Model
 Rigidity
Contralateral Symmetry
Profiles
 Best-fit Ellipse Semi-Axes

Reproducibility
Healed

Rigidity Profiles
 Healed

Rigidity Profiles
 Healing
Efficiency
 A Retrospective Analysis of Plate
Contouring in Using Conventional 4.5
Narrow Dynamic Compression Plates

M.A. Frankel, J. Cordey, M.D. Frankle, F. Baumgart, S.

Perren

J. Orthop. Trauma 8: 59-63, 1994

Plate Length vs. Curvature Radius
Distribution of Plate Lengths
Distribution of Plate
Curvature Radii
Distribution of Plate
Bends
Strain, based on Flexural Elongation
 Screw-Hole
Influence on
Bending

LC-DCP DCP
 Strain (%)

Yield Behavior
Internal Fixation of the Distal Humerus: A
Biomechanical Comparison of Methods

D.L. Helfet, R.N. Hotchkiss

J. Orthop. Trauma 4: 260-264, 1990

Fracture Model
Crossed 4.5 mm
Malleolar Screws
3.5 mm “Y” Plate
3.5 mm Reconstruction
Plates at Right Angles
1/3 Tubular Plates at
Right Angles
1/3 Tubular Plate Medially
and 3.5 mm Reconstruction
Plate Posterio-Laterally
Fixation # of Specimens

Malleolar 3

Y-Plate 3

Reconstruction 3
Plate

Tubular Plate 3

Mixed Plates 2
Specimen Loading
Fatigue Cycling in Extension
 Results of fatigue and rigidity testing
Rigidity (N/mm) Fatigue failure(# cycles)a
Flexion Extension

Malleolar screws 113(+- 29.4) 111(+-16.3) 75.5 (+-15)

Y-plates 124(+-15.1) 167(+-13) 223 (+-124)
Reconstruction plate 313(+-18) 447(+-164) 4,148 (+-315)
1/3 tubular plate 206(+-63) 229(+-39) 3,559 (+-471)
Mixed plates b 215(+-71) 282(+-81) 3,471 (+-365)

aNumber of cycles before permanent deformation > 1mm

b
Two specimens
(+-) represents two SD’s

Construct Comparisons
 Ultimate Properties
of Intramedullary Nails

M. Martens, V.H. Frankel, A.H. Burstein

Injury 4: 18-24, 1973

IM Nail Loading

Complications:
Infection
Migration: 2-7%
Plastic Bending: 4-5%
Fatigue Fx: 1-2%
Fx Mal-Union: 4-5%
Nail Designs
 Femur
13 mm

A,D: Kuntscher
B,E: Schneider
C,F: Diamond

10-11 mm

Load-Deformation Comparisons
Permanent Deformation
Four-Point Bending
Deflection vs. Diameter
Deformation
Yield Points