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Purpose
The aim of this study was to compare several osteosynthesis techniques (intramedullary headless compression screws, T-plates, and Kirschner wires) for distal epiphyseal fractures of proximal phalanges in a human cadaveric model.
Methods
A total of 90 proximal phalanges from 30 specimens (index, ring, and middle fingers) were used for this study. After stripping off all soft tissue, a transverse distal epiphyseal fracture was simulated at the proximal phalanx. The 30 specimens were randomly assigned to 1 fixation technique (30 per technique), either a 3.0-mm intramedullary headless compression screw, locking plate fixation with a 2.0-mm T-plate, or 2 oblique 1.0-mm Kirschner wires. Displacement analysis (bending, distraction, and torsion) was performed using optical tracking of an applied random speckle pattern after osteosynthesis. Biomechanical testing was performed with increasing cyclic loading and with cyclic load to failure using a biaxial torsion-tension testing machine.
Results
Cannulated intramedullary compression screws showed significantly less displacement at the fracture site in torsional testing. Furthermore, screws were significantly more stable in bending testing. Kirschner wires were significantly less stable than plating or screw fixation in any cyclic load to failure test setup.
Conclusions
Intramedullary compression screws are a highly stable alternative in the treatment of transverse distal epiphyseal phalangeal fractures. Kirschner wires seem to be inferior regarding displacement properties and primary stability.
Clinical relevance
Fracture fixation of phalangeal fractures using plate osteosynthesis may have the advantage of a very rigid reduction, but disadvantages such as stiffness owing to the more invasive surgical approach and soft tissue irritation should be taken into account. Headless compression screws represent a minimally invasive choice for fixation with good biomechanical properties.
Limit loads can be calculated with the finite element method (FEM) for any component, defect geometry, and loading. FEM suggests that published long crack limit formulae for axial defects under-estimate the burst pressure for internal surface defects in thick pipes while limit loads are not conservative for deep cracks and for pressure loaded crack-faces. Very deep cracks have a residual strength, which is modelled by a global collapse load. These observations are combined to derive new analytical local and global collapse loads. The global collapse loads are close to FEM limit analyses for all crack dimensions.
A procedure for the evaluation of the failure probability of elastic-plastic thin shell structures is presented. The procedure involves a deterministic limit and shakedown analysis for each probabilistic iteration which is based on the kinematical approach and the use the exact Ilyushin yield surface. Based on a direct definition of the limit state function, the non-linear problems may be efficiently solved by using the First and Second Order Reliabiblity Methods (Form/SORM). This direct approach reduces considerably the necessary knowledge of uncertain technological input data, computing costs and the numerical error. In: Computational plasticity / ed. by Eugenio Onate. Dordrecht: Springer 2007. VII, 265 S. (Computational Methods in Applied Sciences ; 7) (COMPLAS IX. Part 1 . International Center for Numerical Methods in Engineering (CIMNE)). ISBN 978-1-402-06576-7 S. 186-189
Improved collapse loads of thick-walled, crack containing pipes and vessels are suggested. Very deep cracks have a residual strength which is better modelled by a global limit load. In all burst tests, the ductility of pressure vessel steels was sufficiently high whereby the burst pressure could be predicted by limit analysis with no need to apply fracture mechanics. The relative prognosis error increases however, for long and deep defects due to uncertainties of geometry and strength data.
This paper presents the direct route to Design by Analysis (DBA) of the new European pressure vessel standard in the language of limit and shakedown analysis (LISA). This approach leads to an optimization problem. Its solution with Finite Element Analysis is demonstrated for some examples from the DBA-Manual. One observation from the examples is, that the optimisation approach gives reliable and close lower bound solutions leading to simple and optimised design decision.