Abstract
Objective
The purpose of this study is to compare 3 fixation methods for shoulder arthrodesis using finite element analysis.
Methods
Three dogs from different breeds, previously evaluated for shoulder joint arthrodesis, were selected, and their scapula and humerus were extracted from 2019 CT data to create computer models of shoulder arthrodesis. They were fixed with transarticular pins, a plate and screws, or a combination of all 3. The stress distribution of the implants and the dislocation at the osteotomy site were compared under a compression load of 35 N, an internal rotation of 1 Nm, and an external rotation of 1 Nm.
Results
The stress distribution on the implants was reduced when all 3 implants were used. The relative dislocation at the osteotomy site is the greatest when fixed solely with the transarticular pins and least when all the implants are used under any loads. The impact of adding transarticular pins was more prominent under the rotational load than under the compression load.
Conclusions
The plate and screws are the primary load-bearing components under the compression and rotational loads. However, adding the pins decreases the stress distribution on other implants and prevents motion at the osteotomy site, particularly under rotational load.
Clinical Relevance
This study indicated that using transarticular pins in conjunction with a plate and screws for shoulder arthrodesis has the potential to reduce the risk of implant failure and may be advantageous for minimizing the risk of malunion or nonunion.
Shoulder arthrodesis in dogs is a salvage surgery for end-stage diseases such as congenital dysplasia, severe comminuted fractures, and bone tumors.1–5 A limited number of reports exist regarding the surgical outcomes of shoulder arthrodesis.2,4,6 Typically, postsurgical lameness following shoulder arthrodesis is minimal,2,4,6–8 and the overall outcome is satisfactory for pet owners. However, postsurgical implant failure can happen.5,6 Several different fixation techniques are described in the literature.2–8 Plates and screws are frequently used as fixation implants, similar to arthrodesis in other joints.9–11 Most literature2–6,8 on shoulder arthrodesis in dogs employs plates and screws alongside transarticular pins or screws. This is also described as mandatory in many orthopedic textbooks,12,13 although the benefits of a transarticular implant in shoulder arthrodesis have not been established.
Recently, as animal rights have received more attention worldwide, animal experiments have become less common, prompting researchers to seek alternative methods. Finite element analysis has attracted considerable interest among researchers as a substitute for animal testing in the orthopedic field.14–20 Although there are several limitations in creating a model implementing the actual situation of each case, finite element analysis has proven to be a reliable method for comparing differences, such as implant structures or osteotomy lines.19,21,22 Finite element analysis enables the evaluation of the stress distribution on implants or bones, which is not easy to measure through biomechanical testing using animal specimens. Evaluating stress on materials under a specific load is fundamental since the concentration of stress may lead to potential implant failures or bone fractures.22–24 Previously, Rothstock et al20 examined pancarpal arthrodesis in dogs using finite element analysis and successfully compared the characteristics of plates with different designs. However, no finite element analysis has been conducted on shoulder arthrodesis in dogs.
This study employs finite element analysis to compare the various fixation methods for shoulder arthrodesis in dogs. We aim to explore the differences between these fixation methods under different loads.
Methods
Model construction
Clinical data of dogs considered for shoulder arthrodesis in 2019 who underwent CT at Nippon Veterinary and Life Science University were reviewed. Three dogs of different breeds were selected for this study, with their owners’ consent to use the data. A female Beagle (11 years old; body weight, 9.8 kg), a male Shetland Sheepdog (6 years old; body weight, 7.2 kg), and a castrated male Whippet (4 years old; body weight, 11.7 kg) were chosen regarding their size. The Shetland Sheepdog had a nerve sheath tumor at the eighth nerve root, while the others had unstable shoulders. Using finite element analysis software (Mechanical Finder, version 13.0; Research Centre of Computational Mechanics), the left scapula and humerus of each dog were extracted from the CT to create models. The bones were aligned so that the caudal angle was 110°, and the caudal cortices were aligned. The scapula glenoid cavity and humeral head were overlapped, and a surface was inserted between them as an osteotomy plane. The osteotomy plane was placed so that the bones had enough contact area after removing the subchondral bone. The proximal part of the scapula was secured to a square jig, and the distal part of the humeral condyles was fixed to a cross-shaped jig (Figure 1). The material property of resin was used for these jigs. The jigs were positioned with 2 faces perpendicular to the long axis of each model, which passed through the proximal edge of the scapular spine and the distal center of the humeral condyles.
Computer models of shoulder arthrodesis were created using 2019 CT data of 3 distinct dogs (a Beagle, a Shetland Sheepdog, and a Whippet), and each was subjected to 3 fixation methods: pin, plate, and pin-plate model. The compression load of 35 N (A), internal rotation of 1 Nm (B), and external rotation of 1 Nm (C) were applied during finite element analysis. The pin-plate model of a female Beagle (11 years old; body weight, 9.8 kg) is shown as a representative to illustrate the loading surface (red nodes), loading direction (red arrows), and boundary surface (green nodes).
Citation: American Journal of Veterinary Research 2025; 10.2460/ajvr.25.03.0084
Three fixation patterns were applied for each dog, respectively. The first pattern was fixed using only transarticular pins (pin model). The second pattern used a plate and screws without transarticular pins (plate model). The third pattern used transarticular pins, a plate, and screws (pin-plate model). Using micro-CT, stereolithographic data of a plate (2.7-mm straight locking compression plate with 10 holes; Johnson & Johnson) and a screw (2.7-mm locking head screw with 10 mm; Johnson & Johnson) were obtained. The length of the plate was extended by the addition of 5 holes and contoured to fit the bones, with the screw hole threads filled. Screws were extended and inserted into the 4 holes on each side of the plate so that all the screws penetrated both cortices. Subsequently, the plate and screws were combined as 1 element to eliminate discrepancies between models. A cylinder with a diameter of 1.6 mm and a length of 50 mm was made and employed as a transarticular pin. Throughout this study, 2 pins were fixed at the same angle to minimize discrepancies between models. Implants were modified and formed using 3-D modeling software (Metasequoia, version 4.8.6a; Tetraface). The contact conditions were defined on the interfaces of the scapula to the humerus and the pins to the bones. The friction coefficient on the contact surfaces between the bones was set to 0.46,25 and the friction coefficient on the contact surfaces between the bones and the pins was set to 0.3. The material properties of the components are shown in Table 1. The material properties of bones were converted using these equations from the hydroxyapatite-equivalent density obtained from the CT values.
Material properties of the components utilized in the finite element analysis of computer models for shoulder arthrodesis.
| Young modulus (MPa) | Yield stress (MPa) | Poisson ratio | |
|---|---|---|---|
| Bone | Keller equation | Keller equation | 0.4 |
| Implant | 196,133 | 209.8623 | 0.34 |
| Jig | 3,726.527 | 107.8713 | 0.4 |
The models were created using 2019 CT data from 3 distinct dog breeds (a Beagle, a Shetland Sheepdog, and a Whippet), and each was subjected to 3 fixation methods: pin, plate, and pin-plate models.
Mechanical tests
For compression tests, the proximal surface of the proximal jig was fixed, and a translational load of 35 N was applied to the distal surface of the distal jig along the long axis of the model. For rotational tests, the proximal surface of the proximal jig was fixed, and the load was applied to the 4 arms of the distal jig. Four translational loads of 10 N were applied to the edge surfaces of the distal jig, resulting in a total moment force of 1 Nm. The center node of the distal surface of the distal jig was fixed except for rotation around the long axis of the model, allowing rotation solely within the vertical plane of the long axis. Internal and external rotations were applied separately. Figure 1 illustrates the loading and boundary conditions.
Data analysis
For each test, the relative dislocation of the osteotomy surface and the distribution of stress on the implants were evaluated. The maximum value and the distribution of the relative dislocation across the osteotomy surface were collected. The equivalent, maximum principal, and minimum principal stresses were assessed, respectively. The von Mises stress equation was employed to calculate the equivalent stress. All data were acquired utilizing the finite element analysis software and were directly compared. No inferential statistical analysis was conducted.
Mesh convergence test
The pin-plate model of the Beagle was utilized to investigate mesh convergence. The minimum mesh sizes were 3 mm for bones and jigs, with 0.75 mm for implants. These are the smallest sizes that can be analyzed within the limitations of the central processing unit on our computer. Four models were created by increasing the mesh sizes by 1 mm for bones and jigs, with 0.25 mm for implants. The largest mesh sizes used were 6 mm for bones and jigs, with 1.5 mm for implants. The same material properties and boundary conditions as the compression tests were applied to each model. Overall strain energy was calculated for every model after applying a 35-N translational load.
Results
Compared to the 3-mm mesh model, total strain energy was +1.06%, −5.66%, and −6.26% for the 4-, 5-, and 6-mm general mesh models, respectively. Based on these results, 4 mm was indicated as an acceptable mesh size for bones and 1 mm for implants.
The stress distribution on the implants and the relative dislocation at the osteotomy site displayed similar characteristics across the 3 dogs. Therefore, Figures 2–5 illustrate the results of the Whippet.
Distribution of the equivalent, maximum principal, and minimum principal stresses of the plate and screws on the castrated male Whippet (4 years old; body weight, 11.7 kg) obtained from finite element analysis described in Figure 1. The equivalent (A and D), maximum principal (B and E), and minimum principal (C and F) stresses of the plate model (A through C) versus the pin-plate model (D through F) are shown under compression, internal rotation (A’ through F’), and external rotation (A” through F”). The equivalent stress is shown from 0 (blue) to 100 MPa (red). The maximum principal stress is shown as 0 (blue) and extends to 50 MPa (red) to depict the area under tensile stress. The minimum principal stress is shown as 0 (blue) and extends downward to −50 MPa (red) to depict the area under compressive stress.
Citation: American Journal of Veterinary Research 2025; 10.2460/ajvr.25.03.0084
Distribution of the equivalent, maximum principal, and minimum principal stresses of the pins on the castrated male Whippet (4 years old, body weight 11.7 kg) obtained from finite element analysis described in Figure 1. The equivalent (A and D), maximum principal (B and E), and minimum principal (C and F) stresses of the pin model (A through C) versus the pin-plate model (C through F) are shown under compression, under internal rotation (A’ through F’), and under external rotation (A” through F”). The equivalent stress is shown from 0 (blue) to 200 MPa (red). The maximum principal stress is shown as 0 (blue) and extends to 100 MPa (red) to depict the area under tensile stress. The minimum principal stress is shown as 0 (blue) and extends downward to −50 MPa (red) to depict the area under compressive stress.
Citation: American Journal of Veterinary Research 2025; 10.2460/ajvr.25.03.0084
Relative dislocation of the osteotomy surfaces on the castrated male Whippet (4 years old; body weight, 11.7 kg) obtained from finite element analysis described in Figure 1. The osteotomy surface of the scapula for the pin model (A through C), plate model (D through F), and pin-plate model (G through I) under compression load (A, D, and G), internal rotation (B, E, and H), or external rotation (C, F, and I) are illustrated to show the dislocation from 0 (blue) to 0.1 mm (red).
Citation: American Journal of Veterinary Research 2025; 10.2460/ajvr.25.03.0084
The maximum relative dislocation value of the osteotomy site in each model under the compression (A), internal rotation (B), and external rotation (C) evaluated through finite element analysis described in Figure 1. The results are color-coded for each breed: blue for the female Beagle (11 years old; body weight, 9.8 kg), orange for the male Shetland Sheepdog (6 years old; body weight, 7.2 kg), and green for the male Whippet (4 years old; body weight, 11.7 kg).
Citation: American Journal of Veterinary Research 2025; 10.2460/ajvr.25.03.0084
The stress distribution on the plate and screws for the 2 fixation methods under the compression load of 35 N is shown in Figure 2. The screw-inserted holes closest to the osteotomy site, along with the 2 adjacent empty holes on the plate, exhibited the most significant equivalent stress around them. The tensile stress showed a similar pattern, whereas the compressive stress was high on the plate over the osteotomy site. The screws displayed the most notable equivalent stress near the screw heads. The stress distributions of the plates and screws are similar across the 2 fixation methods. The stress distribution on the pins of the 2 fixation methods under the compression load of 35 N is shown in Figure 3. The pins demonstrated apparent changes in the stress distribution compared to the plates and screws. The pins have less stress distribution when used with the plate and screws. Results for the other dogs can be found in Supplementary Figures S1–S6.
The stress distribution on the plate and screws for the 2 fixation methods under the rotational load of 1 Nm are shown in Figure 2. Under the rotational loads, the plates exhibit high areas of tensile and compressive stress situated between the screw holes, which appear as angled stripes. With the internal rotational load, the tensile stress on the plate is oriented from proximolateral to distalomedial. In contrast, the compressive stress is directed from proximomedial to distalolateral. These orientations are reversed under the external rotational load, with the tensile stress on the plate angled from proximomedial to distalolateral and the compressive stress angled from proximolateral to distalomedial. The difference in the stress distribution on the plate is evident, especially under the external rotation. The area of higher stress is more extensive with the plate model than with the pin-plate model. The screws exhibited a less pronounced difference between the models. The equivalent stress of the pins was lower when used with a plate (Figure 3). The equivalent stress of the plate and screws was reduced when used with pins. However, the difference was minor compared to the difference between the pins with and without the plate.
The peak dislocation at the osteotomy site was the greatest in the model without a plate under both compression and rotational loads (Figures 4 and 5). Although the difference between the plate and pin-plate models was less significant than that between the pin model and the other 2, the pin-plate model exhibited a smaller maximum dislocation among the 3 dogs. The impact of adding pins was more prominent under the rotational loads than under the compression load.
Discussion
This study employed finite element analysis to compare various fixation methods for shoulder arthrodesis in dogs. The pin-plate fixation demonstrated the greatest rigidity, while the pin fixation exhibited the least rigidity. Adding the transarticular pins reduces the stress on other implants, particularly under rotational loads, which may reduce the risk of implant failure. Relative dislocation at the osteotomy site was minimal for the pin-plate fixation under any load, which could be advantageous for decreasing the risk of malunion or nonunion.
Finite element analysis facilitates assessing stress distribution on implants or bones, a measurement difficult to obtain via biomechanical testing with animal specimens. Some studies showed that certain implants absorb stress, thereby decreasing the stress distribution on the bones24 or other implants.22 The stress concentration on implants is used to evaluate the weak area of the implants to improve their design22 or choose more appropriate implants.23,24 On the plate subjected to the compression load in the current study, the screw-inserted holes closest to the osteotomy site and the 2 adjacent empty holes had the most significant equivalent stress around them. This is consistent with previous studies.23,26 The pattern of the tensile stress mirrored that of the equivalent stress. Although the compressive stress is high on the plate over the osteotomy site, the equivalent stress is not the highest in that location. The area with the strongest equivalent stress corresponds to where we observe implant failure in clinical cases.
The screws had the most notable equivalent stress near the screw heads. This result is consistent with the other studies.23,26 Because this study employed the locking system, the plate and screws were treated as a single component. This arrangement eliminates any movement at the plate-screw interface and may increase the stress concentration on the screws and plates. Furthermore, in this study, the plate did not contact the bone cortex due to the difficulty of contouring the plate to fit the bone precisely. When a plate is fixed without contact with the near cortex of a bone, the bending movement is amplified as the distance between the plate and bone increases.27 Although the plate was placed as close to the bones as possible, maintaining a gap of less than 2 mm between the plate and bone, the remaining space in our model might have increased the bending load. The 2-mm limit was established based on previous studies28,29 indicating that the locking compression plate is less stiff when the gap exceeds 2 mm. However, those studies did not address the behavior of the screws. Stress on the screws could increase with the gap, even when it remains below 2 mm.
The pins demonstrate the most significant changes in fixation patterns under compression load. The region of equivalent stress exceeding 100 MPa appears noticeably smaller when using the plate and screws. In conjunction with the finding that the plates and screws exhibit minimal changes when additional pins are employed under the compression load, it is suggested that the plate and screws serve as the primary source of load bearing in this type of load.
Although the internal and external rotational loads are exactly opposite, the stress distribution is not. The equivalent, tensile, and compressive stresses on the plate are all greater under the external rotation. The asymmetrical shape of the plate may contribute to this observation, as these features were consistent across all models using plates. Adding the transarticular pins decreases the equivalent stress on the plate, particularly under the rotational loads. While the plate and screws serve as the primary load-bearing components also under the rotational loads, adding the transarticular pins could potentially prevent plate failure. There is a lack of reports on the magnitude of rotational loads around the dog’s shoulder during walking or trotting; they are distinctly smaller than the compression loads.30 However, 1 Nm of rotational load generated an equivalent stress on the plate comparable to that of 40 N of compression load in the current study. Reducing the stress may be beneficial for the plate under rotational loads.
The maximum relative dislocation of the osteotomy site was the smallest for the pin-plate fixation under any load, which could be advantageous for reducing the risk of malunion or nonunion. Under the compression load, the plate and screws prevent the proximal osteotomy site from opening, while transarticular pins have no substantial effect. The difference between pin models and plate models is smaller under the rotational loads compared to the compression load. The transarticular pins effectively minimize dislocation around the center of rotation to the pin insertion sites. Although some micromotion can enhance callus formation and accelerate synostosis, excessive motion at the osteotomy site results in delayed union.31 Arthrodesis is typically performed to ensure that the 2 bones fit together at the osteotomy site. A small gap may arise from artifacts such as discrepancies in the osteotomy line. Consequently, it would be advantageous to minimize micromotion at the osteotomy site, as the appropriate interfragmentary strain is under 15% for endochondral ossification and under 5% for intramembranous bone formation.31
Three breeds of dogs were selected to generalize the results. Different dog breeds exhibit varying bone shapes.32 Discrepancies in cortical thickness, the ratio of length to diameter, or the curvature of the anatomical axis can lead to different mechanical behaviors. The variability in the stress distribution among the 3 dogs may arise from these diversities. Furthermore, these dogs had different diseases, and some were deemed unsuitable for shoulder arthrodesis during examinations, irrespective of the bone condition. However, the stress distribution patterns on the implants were similar, and the order of magnitude of the relative dislocation at the osteotomy site was consistent among the 3 dogs. Based on this study, similar results are expected across many breeds of dogs.
This study has several limitations. The models in this study did not replicate muscle tension. The loads were applied through the jigs, so the results may not fully reflect the actual case. Additionally, the models lacked soft tissues, resulting in their effects being neglected. The primary issue surrounding the finite element analysis is how detailed the models should be to replicate actual cases. Although cutting-edge studies in this area have yet to find an answer to this question, comparisons between osteotomy shapes or implant selections have been shown to be reasonably accurate.19,21,22 Another limitation is the orientation of the transarticular pins. The angles and distance between the 2 pins were fixed throughout this study to standardize the conditions between models. As a result, the relative position of the pins against the bones was slightly different among dogs. This could have affected the results.
This study demonstrated the potential benefit of using transarticular pins with a plate and screws in shoulder arthrodesis. The plate and screws serve as the leading part of fixation under compression and rotation. However, transarticular pins can provide additional rigidity to the fixation, particularly under rotational loads. This report is the first to investigate the mechanical behavior of shoulder arthrodesis. A future study on other fixation methods, such as a double plate technique, a tension band wire, or a lag screw, is anticipated.
Supplementary Materials
Supplementary materials are posted online at the journal website: avmajournals.avma.org.
Acknowledgments
The authors thank the Research Centre of Computational Mechanics for technical support.
Disclosures
Dr. Murakami is a member of the AJVR Scientific Review Board, but was not involved in the editorial evaluation of or decision to accept this article for publication.
Grammarly was used to proofread the drafts of this manuscript to improve grammar, punctuation, and sentence structure.
Funding
The authors have nothing to disclose.
ORCID
Sawako Murakami https://orcid.org/0000-0003-2558-595X
Masakazu Shimada https://orcid.org/0000-0002-9233-2496
References
- 1.↑
Kunkel KA, Rochat MC. A review of lameness attributable to the shoulder in the dog: part one. J Am Anim Hosp Assoc. 2008;44(4):156–162. doi:10.5326/0440156
- 2.↑
Edinger DT, Manley PA. Arthrodesis of the shoulder for synovial osteochondromatosis. J Small Anim Pract. 1998;39(8):397–400. doi:10.1111/j.1748-5827.1998.tb03740.x
- 3.
Pucheu B, Duhautois B. Surgical treatment of shoulder instability. A retrospective study on 76 cases (1993). Vet Comp Orthop Traumatol. 2008;21(4):368–374. doi:10.3415/VCOT-07-06-0058
- 4.↑
Phipps WB, Solano MA. Functional outcomes of dogs undergoing shoulder arthrodesis with 2 locking compression plates. Vet Surg. 2023;52(2):266–275. doi:10.1111/vsu.13900
- 5.↑
Yazawa D, Shimada M, Kanno N, et al. Three cases of dogs with osteosarcoma of the forelimb treated with liquid nitrogen for limb-sparing surgery using autologous bone. J Vet Med Sci. 2024;86(6):700–707. doi:10.1292/jvms.23-0390
- 6.↑
Fitzpatrick N, Yeadon R, Smith TJ, et al. Shoulder arthrodesis in 14 dogs. Vet Surg. 2012;41(6):745–754. doi:10.1111/j.1532-950X.2012.01004.x
- 7.
Oxley B. Bilateral shoulder arthrodesis in a Pekinese using three-dimensional printed patient-specific osteotomy and reduction guides. Vet Comp Orthop Traumatol. 2017;30(3):230–236. doi:10.3415/VCOT-16-10-0144
- 8.↑
Kalff S, Gemmill T. Proximal focal humeral deficiency in a large breed dog. Vet Comp Orthop Traumatol. 2012;25(6):532–536. doi:10.3415/VCOT-12-01-0006
- 9.↑
Garcia AR, Brincin C, Craig A. Outcome, complications, and follow-up in dogs treated with pancarpal arthrodesis stabilized with orthogonal plates. J Am Anim Hosp Assoc. 2024;60(6):252–264. doi:10.5326/JAAHA-MS-7421
- 10.
Dinwiddie EV, Rendahl A, Veytsman S, et al. Evaluation of post-operative complications, outcome, and long-term owner satisfaction of elbow arthrodesis (EA) in 22 dogs. PLoS One. 2021;16(7):e0255388. doi:10.1371/journal.pone.0255388
- 11.↑
Roch SP, Clements DN, Mitchell RA, et al. Complications following tarsal arthrodesis using bone plate fixation in dogs. J Small Anim Pract. 2008;49(3):117–126. doi:10.1111/j.1748-5827.2007.00468.x
- 12.↑
Permattei DL, Flo G, DeCamp C Arthrodesis of shoulder joint. In: Handbook of Small Animal Orthopedics and Fracture Repair. Saunders; 2006:276–278.
- 13.↑
Johnson AL, Houlton JEF. Arthrodesis of the shoulder In: Johnson AL, Houlton JEF, Vannini R, eds. AO Principles of Fracture Management in the Dog and Cat. Thieme; 2005;435–439.
- 14.↑
Kikuchi Y, Shimada M, Takahashi F, Yamaguchi S, Hara Y. Finite element analysis shows minimal stability difference between individualized mini-hemilaminectomy-corpectomy and partial lateral corpectomy in a dog model. Am J Vet Res. 2024;85(12):ajvr.24.08.0244. doi:10.2460/ajvr.24.08.0244
- 15.
Kikuchi Y, Shimada M, Yamaguchi S, Hara Y. Finite element analysis predictions in the canine lumbar spine are useful and correlate with ex vivo biomechanical studies. Am J Vet Res. 2023;84(11):ajvr.23.06.0125. doi:10.2460/ajvr.23.06.0125
- 16.
Polikeit A, Ferguson SJ, Schawalder P. [Elbow dysplasia in the dog: finite element analysis]. Biomed Tech (Berl). 2007;52(4):308–314. doi:10.1515/bmt.2007.052
- 17.
Anggoro D, Purba MS, Jiang F, et al. Elucidation of the radius and ulna fracture mechanisms in toy poodle dogs using finite element analysis. J Vet Med Sci. 2024;86(5):575–583. doi:10.1292/jvms.23-0520
- 18.
Muroi N, Murakami S, Kanno N, Harada Y, Hara Y. Stress changes in the canine radius after locking plate fixation using finite element analysis. Vet Comp Orthop Traumatol. 2024;37(5):213–222. doi:10.1055/s-0044-1782194
- 19.↑
Zderic I, Varga P, Styger U, et al. Mechanical evaluation of two hybrid locking plate designs for canine pancarpal arthrodesis. Biomed Res Int. 2021;2021:2526879. doi:10.1155/2021/2526879
- 20.↑
Rothstock S, Kowaleski MP, Boudrieau RJ, et al. Biomechanical and computational evaluation of two loading transfer concepts for pancarpal arthrodesis in dogs. Am J Vet Res. 2012;73(11):1687–1695. doi:10.2460/ajvr.73.11.1687
- 21.↑
Chang CW, Chen YN, Li CT, Chung CR, Chang CH, Peng YT. Finite element study of the effects of fragment shape and screw configuration on the mechanical behavior of tibial tubercle osteotomy. J Orthop Surg (Hong Kong). 2019;27(3):2309499019861145. doi:10.1177/2309499019861145
- 22.↑
Wang SP, Lai WY, Lin YY, et al. Biomechanical comparisons of different diagonal screw designs in a novel embedded calcaneal slide plate. J Chin Med Assoc. 2021;84(11):1038–1047. doi:10.1097/JCMA.0000000000000625
- 23.↑
Muftuoglu G, Bayram B, Aydin P. Comparison of locking and non-locking reconstruction plate-screw system in lateral mandibular defects by finite element analysis. J Stomatol Oral Maxillofac Surg. 2021;122(4):e65–e69. doi:10.1016/j.jormas.2020.10.007
- 24.↑
Fang S, Zhang L, Yang Y, Wang Y, Guo J, Mi L. Finite element analysis comparison of type 42A2 fracture fixed with external titanium alloy locking plate and traditional external fixation frame. J Orthop Surg Res. 2023;18(1):815. doi:10.1186/s13018-023-04307-1
- 25.↑
Shirazi-Adl A, Dammak M, Paiement G. Experimental determination of friction characteristics at the trabecular bone/porous-coated metal interface in cementless implants. J Biomed Mater Res. 1993;27(2):167–175. doi:10.1002/jbm.820270205
- 26.↑
Nassiri M, Macdonald B, O’Byrne JM. Computational modelling of long bone fractures fixed with locking plates - how can the risk of implant failure be reduced? J Orthop. 2013;10(1):29–37. doi:10.1016/j.jor.2013.01.001
- 27.↑
Yang JC, Lin KP, Wei HW, et al. Importance of a moderate plate-to-bone distance for the functioning of the far cortical locking system. Med Eng Phys. 2018;56:48–53. doi:10.1016/j.medengphy.2018.04.006
- 28.↑
Stoffel K, Dieter U, Stachowiak G, Gachter A, Kuster MS. Biomechanical testing of the LCP–how can stability in locked internal fixators be controlled? Injury. 2003;34(suppl 2):B11–B19. doi:10.1016/j.injury.2003.09.021
- 29.↑
Ahmad M, Nanda R, Bajwa AS, Candal-Couto J, Green S, Hui AC. Biomechanical testing of the locking compression plate: when does the distance between bone and implant significantly reduce construct stability? Injury. 2007;38(3):358–364. doi:10.1016/j.injury.2006.08.058
- 30.↑
Andrada E, Reinhardt L, Lucas K, Fischer MS. Three-dimensional inverse dynamics of the forelimb of Beagles at a walk and trot. Am J Vet Res. 2017;78(7):804–817. doi:10.2460/ajvr.78.7.804
- 31.↑
Claes L. Biomechanical principles and mechanobiologic aspects of flexible and locked plating. J Orthop Trauma. 2011;25(suppl 1):S4–S7. doi:10.1097/BOT.0b013e318207093e
- 32.↑
Toryan E, Szara T, Gundemir O. Linear measurements and shape analysis in the calcaneus of selected dog breeds. Anat Histol Embryol. 2024;53(4):e13078. doi:10.1111/ahe.13078
