Effective Treatment of Femur Diaphyseal Fracture with Compression Plate - A Finite Element and In Vivo Study Comparing the Healing Outcomes of Nailing and Plating.

Abstract

The rigidity in osteosynthesis causes primary healing, and it takes longer to heal. The flexibility provided to the fixation allows micromotion between fragments which accelerates secondary healing. In this study, the healing outcomes of nailing and plating in different fixation stabilities were investigated and compared by using a finite element tool. The clinical observational study was also performed to verify the results of the finite element analysis. The nonlinear contact analysis was performed on 5 different fixation configurations capturing nail and plate in immediate post-surgery. The finite element analysis results showed that flexibility instead of rigidity in interlock nail implantation increases the axial and shear micromotion near the fracture site by 47.4% (<i>P</i> < <i>0.05</i>) and 12.4% (<i>P</i> < <i>0.05</i>), respectively. For LCDCP implantation, the flexible fixation increases the axial and shear micromotion near fracture site by 75.7% (<i>P</i> < <i>0.05</i>) and 25.3% (<i>P</i> < <i>0.05</i>), respectively. Our findings suggest that flexible fixations of interlock nail and LCDCP provide a preferred mechanical environment for healing, and hence, the LCDCP in flexible mode can be an effective alternative to interlock nail for the femur diaphyseal fracture. The online version contains supplementary material available at 10.1007/s43465-022-00795-1.