A new anatomical locking plate for scapular neck fractures: a finite element analysis and retrospective clinical study.

BACKGROUND

Scapular neck fractures, typically caused by high-energy trauma, often require surgical fixation. Conventional reconstruction plates (RPs) are limited by poor anatomical conformity and extended operative times. We developed a novel scapular neck anatomical locking compression plate (SNALCP) and assessed its biomechanical stability and clinical performance.

METHODS

Finite element analysis (FEA) was used to compare the biomechanical behaviour of SNALCP and RP in Miller type IIA/B fractures, simulating forward flexion (FF), abduction (AB), internal rotation (IR), and external rotation (ER). Clinically, 40 patients treated between January 2021 and August 2023 were enrolled: RP group (n = 22) and SNALCP group (n = 18). Operative time, blood loss, Visual Analog Scale (VAS) pain scores, healing time, complications, and Constant-Murley scores were evaluated.

RESULTS

SNALCP demonstrated lower stress and displacement than RP across all loading conditions. For type IIA fractures, AB and FF stresses were 10.133 < 19.223 and 36.698 < 65.761 MPa; for type IIB, AB 63.089 < 97.578, FF 74.346 < 137.110, IR 379.290 < 540.640, and ER 1982.300 < 2253.100 MPa. Clinically, SNALCP yielded shorter surgical times (97.7 ± 19.3 min), less blood loss (152.6 ± 58.5 mL), faster healing (7.6 ± 1.4 weeks), and superior VAS and Constant-Murley scores (all p < 0.05). Only three cases of transient shoulder stiffness were observed.

CONCLUSION

SNALCP provides superior biomechanical stability and improved functional outcomes compared with RP. Larger, multicenter studies are warranted to validate these findings.