Klavikula Kırıklarında Plak Uygulamasının Yerleşim Konumuna Göre Yorulma Davranışının Sonlu Elemanlar Yöntemi ile İncelenmesi

Yıl 2019, , 69 - 74, 01.03.2019

Levent Uğur , Selami Karadeniz Arif Özkan Alper Gültekin

https://doi.org/10.2339/politeknik.466176

Öz

Amaç; Klavikula, omuz ve kolun
hareketlerinde önemli bir göreve sahip olan anatomik bir yapıdır. Klavikula
kırıkları iskelet sistemi yaralanmaları içerisinde sık karşılaşılan bir
problemlerdendir. Klavikula kırıklarında, kırığın türüne göre çeşitli
implantlar kullanarak omuzun ağrısız ve fonksiyonlarını en uygun düzeye
getirmek asıl amaçtır. Bu çalışmada klavikula kırıklarında
kullanılan anatomik plak uygulamasının biyomekanik açıdan incelenmesi
amaçlanmıştır.

Yöntem; Bu çalışmada, DICOM
formatında bilgisayarlı tomografi görüntüleri kullanılarak normal anatomiye
sahip klavikula modellenmiş ve klavikula üzerinde kırık hattı oluşturularak
superior ve anteriora plak yerleştirilmiştir. Plaklarda meydana gelen
gerilmeler, oluşturulan modeller üzerine eksenel kompresyon ve konsol bükme
yüklemeleri uygulanarak non-lineer sonlu elemanlar yöntemi ile incelenmiştir.
Analizler, ANSYS (surum 18) sonlu elemanlar programında yapılmış ve
tüm modellerde aynı sınır şartları uygulanmıştır.

Bulgular; Analizlerde plaklar
üzerinde meydana gelen maksimum eşdeğer gerilmelere (MES) bakılmış ve özellikle
anteriora yerleştirilen plakta gerilmenin azaldığı tespit edilmiştir. Klavikula
üzerine yerleştirilen plakların konumlarına göre yorulma davranışları
karşılaştırılmıştır.

Sonuçlar; Bu çalışmada,
klavikulanın anteriorüne yerleştirilen plaklarda gerilmenin daha az olduğu
sonlu elemanlar yöntemi ile gösterilmiştir. Ayrıca, anterior bölgeye
yerleştirilen plakların en uzun ömre sahip olmasından dolayı kırılma kararlığı
açısından daha güvenli olduğu belirlenmiştir.

Anahtar Kelimeler

Omuz, klavikula, plak, Sonlu Elemanlar Analizi

Investigation of Fatigue Behaviour Of Plate Applications In Clavicle Fractures By Finite Element Method According to The Plate Replacement Position

Öz

Background:
The clavicle is an anatomical structure whıch has an important role on the
movements of the shoulder and arm. Clavicular fractures are a common problem in
skeletal system injuries. The main purpose is to achieve a painless shoulder
joint and to optimise its function ıin clavicle fractures.n this study, it was
aimed to investigate biomechanically the application of anatomic plaque used in
clavicle fractures.Methods: In this study, a normal anatomical clavicle was
modeled using computed tomography images in DICOM format, a fracture line was
created on the clavicle and the plate was placed superiorly and anteriorly.The
stresses on the plates under axial compression and console bending were
investigated on the formed models by using finite element method. Analyzes were
made non-linear using ANSYS (v.18) and same limit conditions were applied in
all models. Findings: The maximum equivalent stresses (MES) on the plaques were
observed in the analyzes and it was found that the tension on the plaque,
especially placed anteriorly, decreased.Fatigue behaviours were compared
according to the positions  of the plates
placed on the clavicle. Results: In this study, the finite element method was
used which showed less tension on the plates placed on the anterior of the
clavicle.It was also found that the plates placed in the anterior region were
safer in terms of fatigue fracture stability due to longest longevity of the
plates.

Anahtar Kelimeler

Shoulder, clavicle, plate, finite element analysis

Kaynakça

• [1] Gustilo, R.B., R.M. Mendoza, and D.N. Williams, "Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. " Journal of Trauma and Acute Care Surgery, 24(8): 742-746,( 1984.)
• [2] Postacchini, F., et al., "Epidemiology of clavicle fractures." Journal of Shoulder and Elbow Surgery, 11(5): 452-456,( 2002).
• [3] Robinson, C.M., "Fractures of the clavicle in the adult: epidemiology and classification." The Journal of bone and joint surgery. British volume, 80(3): 476-484,( 1998).
• [4] Nordqvist, A. and C. Petersson, "The incidence of fractures of the clavicle." Clinical Orthopaedics and Related Research, 127-132,( 1994).
• [5] Canadian, O.T.S., "Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial". The Journal of bone and joint surgery. American 89(1): 1, (2007).
• [6] Eden, L., et al., "Biomechanical comparison of the locking compression superior anterior clavicle plate with seven and ten hole reconstruction plates in midshaft clavicle fracture stabilisation." International orthopaedics,. 36(12): 2537-2543,(2012).
• [7] Renfree, T., B. Conrad, and T. Wright, "Biomechanical comparison of contemporary clavicle fixation devices." The Journal of hand surgery, 35(4): 639-644,( 2010).
• [8] Nourian, A., et al., "Midshaft Fractures of the Clavicle: A Meta-analysis Comparing Surgical Fixation Using Anteroinferior Plating Versus Superior Plating." Journal of orthopaedic trauma, 31(9): 461-467,( 2017).
• [9] Marie, C., "Strength analysis of clavicle fracture fixation devices and fixation techniques using finite element analysis with musculoskeletal force input." Medical & biological engineering & computing, 53(8): 759-769,( 2015).
• [10] Uğur, L., "Pedikül vidasının yerleşim konumuna göre yorulma davranışının sonlu elemanlar yöntemiyle incelenmesi." Sakarya University Journal of Science, 20(2): 301-306,( 2016).
• [11] Favre, , et al., "Superior versus anteroinferior plating of the clavicle: a finite element study. Journal of orthopaedic trauma", 25(11): 661-665,( 2011).
• [12] Iannolo, M., et al., "Forces across the middle of the intact clavicle during shoulder motion." Journal of shoulder and elbow surgery, 19(7): 1013-1017(2010).
• [13] Scepi, M., et al., "A three-dimensional model of the shoulder girdle. Forces developed in deltoid and supraspinatus muscles during abduction." Surgical and Radiologic Anatomy, 26(4): 290-296,( 2004).
• [14] Altamimi, S.A. and M.D. McKee, "Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures:" Surgical technique. JBJS, 90(Supplement_2_Part_1): 1-8,( 2008).
• [15] Althausen, L., et al., "Clinical and financial comparison of operative and nonoperative treatment of displaced clavicle fractures." Journal of shoulder and elbow surgery, 22(5): 608-611,( 2013)
• [16] Xu, J., et al.,"Operative versus nonoperative treatment in the management of midshaft clavicular fractures: a meta-analysis of randomized controlled trials." Journal of shoulder and elbow surgery, 23(2): 173-181,( 2014).
• [17] Hill, J.M., M.H. Mcguire, and L.A. Crosby, "Closed treatment of displaced middle-third fractures of the clavicle gives poor results." The Journal of bone and joint surgery. British , 79(4): 537-538,( 1997).
• [18] Iannotti, M., et al., "Effects of plate location and selection on the stability of midshaft clavicle osteotomies: a biomechanical study. " Journal of shoulder and elbow surgery, 11(5): 457-462,( 2002).
• [19] Chen, C.-E., R.-J. Juhn, and J.-Y. Ko, "Anterior-inferior plating of middle-third fractures of the clavicle." Archives of orthopaedic and trauma surgery, 130(4): 507-511, (2010).
• [20] Kloen, , et al., "Anteroinferior plating of midshaft clavicular nonunions." Journal of orthopaedic trauma, 16(6): 425-430, (2002).