Abstract
INTRODUCTION: A spiral clavicle plate has been accepted for its superior multidirectional compatibility in the treatment of midshaft clavicle fractures from a biomechanical perspective. However, the influence of the sextant angle (spiral level) definition on biomechanical performance has not been clarified. A conceptual finite element analysis was conducted to identify the advantages and drawbacks of spiral clavicle plates with various sextant angle definitions. METHODS: Conventional superior and three different conceptual spiral plates with sextant angle definitions ranging from 45 to 135 degrees were constructed to restore an OTA 15-B1.3 midshaft clavicle fracture model. Three major loading scenarios (cantilever downward bending, axial compression, and axial torsion) were simulated to evaluate the reconstructed structural stiffness and the stress on the clavicle plate and bone screws. RESULTS: The spiral clavicle plate demonstrated greater capability in resisting cantilever downward bending with an increase in sextant angle and showed comparable structural stiffness and implant stress compared to the superior clavicle plate. However, weakened resistance to axial compression load was noted for the spiral clavicle plate, with lowered stiffness and increased stress on the clavicle plate and screws as the spiral level increased. CONCLUSION: The spiral clavicle plate has been reported to offer multidirectional compatibility for the treatment of midshaft clavicle fractures, as well as geometric advantages in anatomical matching and reduced skin prominence after surgery. The current study supports that remarkable cantilever bending strength can be achieved with this plate. However, users must consider the potential drawback of lowered axial compression resistance in safety considerations.