Clavicle biomechanics

I am a trainee orthopaedic surgeon in Perth in Western Australia in the final stages of my training currently undertaking a research period. I want to look at the biomechanics of clavicle fracture plating (locked versus non locked, anterior versus superior plating). Whilst some of this has been done before in the literature, I don't think the the constructs have been tested very well -- usually by three or four point bending which I do not think is a good in-vivo mimic. What I'm hoping to do is to be able to quantify the forces that the in-vivo clavicle undergoes along with their vectors (in an assumed typical perioperative range( where we think patients will be likely to move in first 6 weeks post plating, say neutral rotn- 80deg IR, 0 - 90 deg abduction) so we can design a testing scenario that is more appropriate to the in-vivo situation - prob fatigue testing rather than load to failure. I cannot find however anything in the literature directly on point. Could anyone at least point me in the right direction or give me the contact of any other researchers in the field who you think might be able to help? I would be VERY grateful indeed. Paul

Analysis of clavicular fractures

Dear Paul
We recently asked ourselves the same question in order to build a finite element model of the clavicle. After reviewing the literature, no data on in vivo loading of the clavicle were found. We eventually used the following paper, which deals with clavicular fractures, and tested the bone in a worst case scenario (during a fall):

- Stanley, D., Trowbridge, E. A., and Norris, S. H. The mechanism of clavicular fracture: A clinical and biomechanical analysis. J. Bone Joint Surg. (Br.) 70: 461, 1988.

Even if this paper is not quantitative, it provides an interesting analysis of clavicular loading.

Also, the reference for our article is:
Werner CM, Favre P, van Lenthe HG, Dumont CE. Pedicled vascularized rib transfer for reconstruction of clavicle nonunions with bony defects: anatomical and biomechanical considerations. Plast Reconstr Surg. 2007 Jul;120(1):173-80.

Hope this helps as a start…
Philippe Favre