Fracture location-type synergy impacts stability in surgical stabilization of rib fractures

Early chest wall stability following surgical stabilization of rib fractures (SSRF) is directly associated with respiratory complications. However, the influence of fracture location and type on rib fracture fixation stability and the underlying biomechanical mechanisms remain unclear. This study employs finite element analysis to quantify the impact of different fracture locations and types on rib fracture fixation stability, identify high-risk fracture patterns, and provide biomechanical rationale. Three-dimensional models of the fourth rib were constructed from computed tomography data of eight patients. Virtual fixation was simulated using MatrixRIB locking plates for fractures at different locations (anterior, lateral, posterior segments) and types (transverse, oblique, comminuted). Simulated loading included end-inspiratory rib forces and frontal-collision loads applied after SSRF. Entropy-based evaluation comprehensively assessed biomechanical parameters and fixation stability for fractures at different locations and types. Fracture location and type exerted significant main effects on all biomechanical parameters, with significant interactions (p < 0.01). Posterior comminuted fractures exhibited the highest maximum implant von Mises stress (167.1 ± 21.5 MPa), maximum rib displacement (0.44 ± 0.06 mm), and maximum interfragmentary gap (0.126 ± 0.039 mm), while demonstrating the lowest stiffness (4.1 ± 0.8 N/mm). Fracture location and type significantly influence postoperative SSRF stability through synergistic effects, with posterior comminuted fractures representing a high-risk subtype. These findings provide biomechanical evidence for optimizing personalized surgical strategies based on specific fracture morphologies.