Finite element modeling of clavicle fracture fixations: a systematic scoping review

Finite element analysis has become indispensable for biomechanical research on clavicle fractures. This review summarized evidence regarding configurations and applications of finite element analysis in clavicle fracture fixation. Seventeen articles involving 22 clavicles were synthesized from CINAHL, Embase, IEEE Xplore, PubMed, Scopus, and Web of Science databases. Most studies investigated midshaft transverse closed fractures by reconstructing intact models from CT scans and simulating fractures through gap creation. Common loading schemes included axial compression, distal torsion, and inferior bending. The primary objective was comparing different implant designs/placements on construct stiffness, von Mises stress, and fracture site micro-motion. Our review suggested a preference for plate fixation, particularly with anterior placement, for midshaft transverse fractures. However, limited fracture types studied constrain comprehensive recommendations. Additionally, the review highlighted discrepancies between finite element and clinical studies, emphasizing the need for improved modeling of physiological conditions. Future research should focus on developing a comprehensive database of finite element models to test various implant options and placements under common loading schemes, bridging the gap between biomechanical simulations and clinical outcomes.