{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T23:56:27Z","timestamp":1784937387232,"version":"3.55.0"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T00:00:00Z","timestamp":1734566400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003785","name":"Guangdong Medical Research Foundation","doi-asserted-by":"publisher","award":["A2023214"],"award-info":[{"award-number":["A2023214"]}],"id":[{"id":"10.13039\/501100003785","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82172523"],"award-info":[{"award-number":["82172523"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003453","name":"Natural Science Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2022A1515010488"],"award-info":[{"award-number":["2022A1515010488"]}],"id":[{"id":"10.13039\/501100003453","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The clivus is trapezoidal in shape with uneven bone structure, the optimal number and position of screws for clival fixation are not clear. Therefore, this study aims to explore the optimization clival screw fixation method for occipitocervical instability using finite element analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Seven finite element models were developed to evaluate biomechanical properties of clival screw fixation for treating occipitocervical stability, including (i) one clival screw fixation A1 and A2 models; (ii) two clival screws fixation B1 and B2 models; (iii) three clival screws fixation C1 and C2 models; (iv) four clival screws fixation D1 model. Loads of 1.5\u2009Nm were applied to the model fRoM different directions to induce flexion, extension, lateral bending, and axial rotation movements.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The regular triangle C1 type three clival screws fixation exhibited great stability, with RoM of 4.20\u00b0 in flexion, 5.80\u00b0 in extension, 0.85\u00b0 in lateral bending, and 1.60\u00b0 in axial rotation. The peak stress on the internal fixation devices were relatively low, with maximum screw stress of 194\u2009MPa in flexion, 276\u2009MPa in extension, 180\u2009MPa in lateral bending, and 213\u2009MPa in axial rotation; the maximum plate stress were 126, 554, 426, and 378\u2009MPa, respectively. The areas with higher stress were mainly concentrated at the robust neck section of the plate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The triangular configuration of three clival screws fixation represented the optimized anterior occipitocervical fixation method through the clivus, offering superior biomechanical stability, lower stress on the devices and dispersed stress distribution in the occipitocervical region.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.14314","type":"journal-article","created":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T04:39:54Z","timestamp":1734669594000},"page":"583-592","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Biomechanical Evaluation of Clival Screw Fixation for Occipitocervical Instablity: A Finite Element Analysis"],"prefix":"10.1111","volume":"17","author":[{"given":"Weipeng","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Orthopaedics Yunfu People's Hospital  Yunfu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianying","family":"Zheng","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery, Department of Orthopaedics, Nanfang Hospital Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meichao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anatomy Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6605-0233","authenticated-orcid":false,"given":"Panjie","family":"Xu","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery, Department of Orthopaedics, Nanfang Hospital Southern Medical University  Guangzhou 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