Background

Using fewer distal screws in volar plate fixation of distal radius fractures could reduce treatment costs and complications. However, there is currently no consensus on the ideal screw configuration, likely due to experimental limitations and its subject-specific nature. In this study, finite element analysis was used to investigate (1) if reducing the number of screws is biomechanically feasible and (2) if an optimal screw configuration is subject-specific.

Methods

Validated subject-specific finite element models of 16 human radii with extra articular distal radius fractures and volar plate fixation with six distal screws were used as a baseline. 41 additional configurations with three to six distal screws were simulated for each subject. Axial stiffness and peri-implant strains around the distal screws were evaluated. Subject-specific optimum configurations were determined using a lower bound for the axial stiffness and minimizing peri-implant strains.

Findings

Even using three distal screws led to only minor deterioration of the biomechanical properties in the best configuration (axial stiffness: −11.2%, peri-implant strains: −35.0%), but a considerable deterioration in the worst configuration (axial stiffness: −46.2%, peri-implant strains: +112.4%). The optimization showed that the ideal screw configuration is subject-specific and on average 1.9 screws could be saved based on the herein used optimization criterion.

Interpretation

This study highlights that not only how many, but which screws are used in volar plate fixation of distal radius fractures is critical. Using a patient-specific selection of distal screws bears potential to save costs and reduce complications.

中文翻译：

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致力于优化radius骨远端骨折的掌侧钢板固定术：使用有限元分析来减少螺钉的数量

背景

在fewer骨远端骨折的掌侧钢板固定中使用较少的远端螺钉可以减少治疗费用和并发症。但是，由于实验的局限性及其特定主题的性质，目前对理想的螺钉配置尚无共识。在这项研究中，有限元分析用于研究（1）减少螺钉的数量在生物力学上是否可行，以及（2）最佳螺钉配置是否针对特定受试者。

方法

已验证的受试者特定的有限元模型（16个人的半径，关节外distal骨远端骨折和用六个远端螺钉固定掌侧钢板）被用作基线。针对每个受试者，模拟了41种具有三到六个远端螺钉的其他配置。评估了远端螺钉周围的轴向刚度和种植体周围的应变。使用轴向刚度的下限并最小化种植体周围的应变来确定特定于受试者的最佳配置。

发现

即使在最佳配置下（轴向刚度：-11.2％，植入物周围应变：-35.0％），即使使用三个远端螺钉也只会导致生物力学性能的轻微降低，而在最差配置下（轴向刚度：-46.2）只会导致相当大的劣化。 ％，植入物周围菌株：+ 112.4％）。优化表明理想的螺钉配置是特定于对象的，并且根据本文使用的优化标准平均可以节省1.9个螺钉。

解释

这项研究强调，在radius骨远端骨折的掌侧钢板固定中不仅使用多少螺钉，而且使用哪种螺钉也很关键。使用患者特定的远端螺钉选择具有节省成本和减少并发症的潜力。