In-silico study of type 'B' condylar head fractures and evaluating the influence of two positional screw distance in two-screw osteosynthesis construct.

Abstract

Clinical fixation screws are common in clinical practices to fix mandibular condyle fractures. Evidence suggests significance of 'working length' that is, distance between proximal and distal fixation screws in proximity to the fracture in orthopaedic implant design. In pursuit of stable implant-bone construct, this study aims to investigate the biomechanical performance of each configuration considered in the study and provide an optimal working length between the screws for clinical reference. Finite element models of virtually designed broken condyle as type 'B' were simulated and analysed in ANSYS Workbench. Screws are implanted according to previous literature at five varied distances 'd' maintaining five different ratios with the fracture length 'D'. Based on a literature review, boundary conditions, muscle traction forces and non-linear contacts were assigned to obtain precise results. Each case is considered an individual configuration and von Mises distribution, microstrain in bone, screw-bone interface micromotion and fracture dislocation were evaluated for all these configurations. Stress-shielding phenomenon is observed for maximum von Mises stresses in bone. Microstrain concentration was significant in cancellous bone in the vicinity of the screw around the fracture line. Configurations were compared based on the stress-strain along with micromotion to support the required amount of osseointegration between implant and bone. Presented data from all five conditions supported the assumption that under physiological loading conditions, the D3 configuration provided stability for fracture healing. Further research on screw shapes, diameters and material properties, or investigating the direction of forces within the screws could provide further insight into this topic.