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J Orthop Surg (Hong Kong). 2019 Sep-Dec;27(3):2309499019876073. doi: 10.1177/2309499019876073.

Effect of the screw tightening sequence on the stress distribution of a dynamic compression plate: A pilot finite element study.

Author information

1
Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
2
Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong.
3
Institute of Manufacturing Technology, Guangdong University of Technology, Guangzhou, China.

Abstract

OBJECTIVE:

Although the optimal screw tightening sequence is a common question orthopaedists encounter during fractures fixation with a dynamic compression plate (DCP), the effect of the screw tightening sequence on the stability of the plate has never been explored. This study explores the effect of the screw tightening sequence on the stress distribution of a DCP using a finite element method.

METHODS:

Idealized finite element analysis models of the femoral diaphysis with six-hole or eight-hole DCPs were constructed. The screw tightening preload was simulated using 'bolt load' in ABAQUS. Two screw tightening sequences were studied for the six-hole plate and six sequences were studied for the eight-hole plate. U magnitude and Von Mises stress were used to evaluate the deformation and stress distribution of the plate, respectively. Deformation and stress distribution plots from different sequences were compared.

RESULTS:

The different screw tightening sequences showed different deformation processes, while all had the same final deformation after all the screws were tightened. Each screw tightening step of different tightening sequences showed different stress distributions in the plate, while all had the same stress distribution after all the screws were tightened.

CONCLUSION:

Using different screw tightening sequences to fix the same DCP can produce the same stability, which means in terms of fixation stability, after the two screws nearest to the fracture line are tightened, surgeons do not need to hesitate about the order in which the rest screws should be inserted during the surgery.

KEYWORDS:

dynamic compression plate; finite element analysis; screw tightening sequence; stress distribution

PMID:
31554466
DOI:
10.1177/2309499019876073

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