Advertisement

Recovery of Forearm Bone Strength After Plate Removal: A Finite Element Analysis Study

Published:September 18, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.07.017

      Purpose

      The purpose of this study was to estimate the bone strength after plate removal over time and to investigate the progression of bone strength recovery.

      Methods

      A consecutive series of 31 patients was investigated to evaluate bone strength before and after forearm plate removal. Patients who were included underwent plate fixation for forearm diaphyseal fractures and were scheduled for plate removal. Computed tomography (CT) scans of the entire length of the bilateral forearms were taken before plate removal and at 1, 3, and 6 months after surgery. Patient-specific CT-based finite element analysis was used to predict the forearm bone fracture strength against an axial load (N), defined as the bone strength. Bone strength was estimated by patient-specific CT-based finite element analysis at each time point.

      Results

      The mean age of the patients was 40.4 years. The mean time between plate fixation and removal was 27.5 months. Bone strength before the removal was estimated as reduced to 47% of that of the uninjured side. This was constant regardless of age group, involvement of the radius or ulna, Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, open fracture, or type of plate. Bone strength at 1, 3, and 6 months after removal was estimated to be 66%, 85%, and 97%, respectively. The bone strength of the distal ulna was weaker than that at the other sites in the forearm and showed delayed recovery.

      Conclusions

      Bone strength after plate removal showed recovery within 3–6 months and was fully recovered by 6 months. The degree of recovery of bone atrophy varies from site to site, and patients should be careful about refracture after removal.

      Clinical relevance

      Clinicians should be aware that bone strength may not be sufficiently restored even 6 months after plate removal of forearm fractures.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hertel R.
        • Pisan M.
        • Lambert S.
        • Ballmer F.T.
        Plate osteosynthesis of diaphyseal fractures of the radius and ulna.
        Injury. 1996; 27: 545-548
        • Yao C.K.
        • Lin K.C.
        • Tarng Y.W.
        • Chang W.N.
        • Renn J.H.
        Removal of forearm plate leads to a high risk of refracture: decision regarding implant removal after fixation of the forearm and analysis of risk factors of refracture.
        Arch Orthop Trauma Surg. 2014; 134: 1691-1697
        • Leung F.
        • Chow S.P.
        Locking compression plate in the treatment of forearm fractures: a prospective study.
        J Orthop Surg (Hong Kong). 2006; 14: 291-294
        • Busam M.L.
        • Esther R.J.
        • Obremskey W.T.
        Hardware removal: indications and expectations.
        J Am Acad Orthop Surg. 2006; 14: 113-120
        • Matsuura Y.
        • Kuniyoshi K.
        • Suzuki T.
        • et al.
        Accuracy of specimen-specific nonlinear finite element analysis for evaluation of radial diaphysis strength in cadaver material.
        Comput Methods Biomech Biomed Eng. 2015; 18: 1811-1817
        • Matsuura Y.
        • Rokkaku T.
        • Suzuki T.
        • Thoreson A.R.
        • An K.N.
        • Kuniyoshi K.
        Evaluation of bone atrophy after treatment of forearm fracture using nonlinear finite element analysis: a comparative study of locking plates and conventional plates.
        J Hand Surg Am. 2017; 42 (e1–659.e9): 659
        • Rosson J.W.
        • Petley G.W.
        • Shearer J.R.
        Bone structure after removal of internal fixation plates.
        J Bone Joint Surg. 1991; 73: 65-67
        • Kettunen J.
        • Kröger H.
        • Bowditch M.
        • Joukainen J.
        • Suomalainen O.
        Bone mineral density after removal of rigid plates from forearm fractures: preliminary report.
        J Orthop Sci. 2003; 8: 772-776
        • Labosky D.A.
        • Cermak M.B.
        • Waggy C.A.
        Forearm fracture plates: to remove or not to remove.
        J Hand Surg Am. 1990; 15: 294-301
        • Miura M.
        • Nakamura J.
        • Matsuura Y.
        • et al.
        Prediction of fracture load and stiffness of the proximal femur by CT-based specimen specific finite element analysis: cadaveric validation study.
        BMC Musculoskelet Disord. 2017; 18: 536
        • Keyak J.H.
        Improved prediction of proximal femoral fracture load using nonlinear finite element models.
        Med Eng Phys. 2001; 23: 165-173
        • Wako Y.
        • Nakamura J.
        • Matsuura Y.
        • et al.
        Finite element analysis of the femoral diaphysis of fresh-frozen cadavers with computed tomography and mechanical testing.
        J Orthop Surg Res. 2018; 13: 192
        • Matsuura Y.
        • Giambini H.
        • Ogawa Y.
        • et al.
        Specimen-specific nonlinear finite element modeling to predict vertebrae strength after vertebroplasty.
        Spine (Phila Pa 1976). 2014; 39: E1291-E1296
        • Imai K.
        • Ohnishi I.
        • Bessho M.
        • Nakamura K.
        Nonlinear finite element model predicts vertebral bone strength and fracture site.
        Spine. 2006; 31: 1789-1794
        • Matsuura Y.
        • Kuniyoshi K.
        • Suzuki T.
        • et al.
        Accuracy of specimen-specific nonlinear finite element analysis for evaluation of distal radius strength in cadaver material.
        J Orthop Sci. 2014; 19: 1012-1018
        • Meinberg E.G.
        • Agel J.
        • Roberts C.S.
        • Karam M.D.
        • Kellam J.F.
        Fracture and Dislocation Compendium.
        J Orthop Trauma. 2018; 32: S24-S27
        • Gustilo R.B.
        • Mendoza R.M.
        • Williams D.N.
        Problems in the management of type III (severe) open fracture: a new classification of type III open fractures.
        J Trauma. 1984; 24: 742-746
        • Hirashima T.
        • Matsuura Y.
        • Suzuki T.
        • Akasaka T.
        • Kanazuka A.
        • Ohtori S.
        Long-term evaluation using finite element analysis of bone atrophy changes after locking plate fixation of forearm diaphyseal fracture.
        J Hand Surg Glob Online. 2021; 3: 240-244
        • Pfaeffle H.J.
        • Fischer K.J.
        • Manson T.T.
        • Tomaino M.M.
        • Woo S.L.
        • Herndon J.H.
        Role of the forearm interosseous ligament: is it more than just longitudinal load transfer?.
        J Hand Surg Am. 2000; 25: 683-688
        • Halls A.A.
        • Travill A.
        Transmission of pressures across the elbow joint.
        Anat Rec. 1964; 150: 243-248