Effects of dynamic loading on fracture healing under different locking compression plate configurations: A finite element study

The design of patient specific weight-bearing exercises after the surgical implementation of internal fixations is of critical importance for bone fracture healing. The purpose of this study is to theoretically investigate the effects of physiologically relevant dynamic loading on early stage of fracture healing under different locking compression plate (LCP) configurations. The finite element results show that dynamic loading enhanced transport of bone cells and growth factors in the fracture callus is much dependent on the flexibility of LCP. In comparison to free diffusion, a relatively flexible LCP together with dynamic loading could significantly enhance solute transport in callus. For example, a flexible LCP achieved by increasing WL (Working Length) and BPD (Bone Plate Distance) (e.g. WL = 100 mm and BPD = 2 mm) together with a 5-h 150 N@1 Hz dynamic loading could increase the uptake of chondrocytes by around 280% compared to free diffusion, osteoblasts by around 180%, osteogenic growth factors by around 120% and chondrogenic growth factors by around 220%. In addition, dynamic loading enhanced transport of cells and growth factors under LCP is spatially dependent with a relatively higher enhancement in far cortex zone than that in near cortex zone. The outcomes from present study could potentially assist orthopaedic surgeons to determine optimal loading regimes with consideration of patient specific LCP configurations.