{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T11:40:54Z","timestamp":1761824454741,"version":"3.41.2"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T00:00:00Z","timestamp":1691366400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Posterior internal fixation is the main method used for the treatment of thoracolumbar fractures. Fractures often occur in the upper 1\/3 of the vertebral body. However, they can also occur in the middle or lower 1\/3 of the vertebral body. At present, there is no report discussing the potential effects of sagittal location on instrument biomechanics or surgical strategy. The object of this study was to investigate the effect of the sagittal location of the fracture region of the vertebral body on the biomechanics of the internal fixation system and surgical strategy.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> A finite element model of the T11-L3 thoracolumbar segment was established based on a healthy person\u2019s CT scan. Different sagittal fracture location finite element models were created by resection of the upper 1\/3, middle 1\/3, and lower 1\/3 of the L1 vertebral body. Three surgical strategies were utilized in this study, namely, proximal 1 level and distal 1 level (P1-D1), proximal 2 level and distal 1 level (P2-D1), and proximal 1 level and distal 2 levels (P1-D2). Nine fixation finite element models were created by combining fracture location and fixation strategies. Range of motion, von Mises stress, and stress distribution were analyzed to evaluate the effects on the instrument biomechanics and the selection of surgical strategy.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> In all three different fixation strategies, the maximum von Mises stress location on the screw did not change with the sagittal location of the fracture site; nevertheless, the maximum von Mises stress differed. The maximum rod stress was located at the fracture site, with its value and location changed slightly. In the same fixation strategy, a limited effect of sagittal location on the range of motion was observed. P2D1 resulted in a shorter range of motion and lower screw stress for all sagittal locations of the fracture compared with the other strategies; however, rod stress was similar between strategies.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> The sagittal location of a fracture may affect the intensity and distribution of stress on the fixation system but does not influence the selection of surgical strategy.<\/jats:p>","DOI":"10.3389\/fbioe.2023.1229218","type":"journal-article","created":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T16:15:35Z","timestamp":1691424935000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Finite element study of sagittal fracture location on thoracolumbar fracture treatment"],"prefix":"10.3389","volume":"11","author":[{"given":"Xilong","family":"Cui","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junjun","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wanmei","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuxiang","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiuling","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiumei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haiyang","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chengmin","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zikai","family":"Hua","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,8,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.1002\/jor.22376","article-title":"The use of X-shaped cross-link in posterior spinal constructs improves stability in thoracolumbar burst fracture: A finite element analysis","volume":"31","author":"Alizadeh","year":"2013","journal-title":"J. Orthop. Res."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e1109","DOI":"10.1016\/j.wneu.2019.05.077","article-title":"Finite element analysis of short-versus Long-Segment posterior fixation for thoracolumbar burst fracture","volume":"128","author":"Basaran","year":"2019","journal-title":"World Neurosurg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1016\/j.jor.2016.06.007","article-title":"Management of burst fractures in the thoracolumbar spine","volume":"13","author":"Cahueque","year":"2016","journal-title":"J. Orthop."},{"key":"B4","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1177\/0954411917719740","article-title":"Biomechanical analysis of the thoracolumbar spine under physiological loadings: Experimental motion data corridors for validation of finite element models","volume":"231","author":"Couvertier","year":"2017","journal-title":"Proc. Institution Mech. Eng. Part H J. Eng. Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1097\/BRS.0000000000002923","article-title":"Epidemiology of spinal fractures in a level one trauma center in The Netherlands","volume":"44","author":"den Ouden","year":"2019","journal-title":"Spine"},{"key":"B6","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1097\/00007632-198311000-00003","article-title":"The three column spine and its significance in the classification of acute thoracolumbar spinal injuries","volume":"8","author":"Denis","year":"1983","journal-title":"Spine (Phila Pa 1976)"},{"key":"B7","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1016\/j.clinbiomech.2007.07.010","article-title":"Three-dimensional stiffness in a thoracolumbar en-bloc spondylectomy model: A biomechanical in vitro study","volume":"22","author":"Disch","year":"2007","journal-title":"Clin. Biomech."},{"key":"B8","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1111\/os.12590","article-title":"Short-Segment fixation of thoracolumbar fractures with incorporated screws at the level of fracture","volume":"12","author":"El","year":"2020","journal-title":"Orthop. Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1016\/j.tranon.2018.03.002","article-title":"The role of the size and location of the tumors and of the vertebral anatomy in determining the structural stability of the metastatically involved spine: A finite element study","volume":"11","author":"Galbusera","year":"2018","journal-title":"Transl. Oncol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"424","DOI":"10.31616\/asj.2020.0033","article-title":"Long versus short segment instrumentation in osteoporotic thoracolumbar vertebral fracture","volume":"15","author":"Girardo","year":"2021","journal-title":"Asian Spine J."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2021\/8872514","article-title":"A finite element study on the treatment of thoracolumbar fracture with a new spinal fixation system","volume":"2021","author":"Guo","year":"2021","journal-title":"Biomed. Res. Int."},{"key":"B12","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.clinbiomech.2019.05.018","article-title":"A biomechanical investigation of thoracolumbar burst fracture under vertical impact loads using finite element method","volume":"68","author":"Guo","year":"2019","journal-title":"Clin. Biomech. (Bristol, Avon)"},{"key":"B13","doi-asserted-by":"publisher","first-page":"866","DOI":"10.1111\/j.1553-2712.2001.tb01146.x","article-title":"Epidemiology of thoracolumbar spine injury in blunt trauma","volume":"8","author":"Holmes","year":"2001","journal-title":"Acad. Emerg. Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1016\/j.jcot.2020.06.008","article-title":"Current status of short segment fixation in thoracolumbar spine injuries","volume":"11","author":"Jindal","year":"2020","journal-title":"J. Clin. Orthop. Trauma"},{"key":"B15","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/j.jor.2016.06.019","article-title":"The epidemiology of thoracolumbar trauma: A meta-analysis","volume":"13","author":"Katsuura","year":"2016","journal-title":"J. Orthop."},{"key":"B16","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.injury.2008.06.040","article-title":"Epidemiology of traumatic spine fractures","volume":"40","author":"Leucht","year":"2009","journal-title":"Injury"},{"key":"B17","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1007\/s11914-021-00690-y","article-title":"Finite element analysis of fracture fixation","volume":"19","author":"Lewis","year":"2021","journal-title":"Curr. Osteoporos. Rep."},{"key":"B18","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1080\/08941939.2018.1474301","article-title":"Clinical effects of posterior limited Long-Segment pedicle instrumentation for the treatment of thoracolumbar fractures","volume":"33","author":"Liang","year":"2020","journal-title":"J. Invest. Surg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"e12190","DOI":"10.1097\/MD.0000000000012190","article-title":"National incidence of traumatic spinal fractures in China","volume":"97","author":"Liu","year":"2018","journal-title":"Medicine"},{"key":"B20","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/1749-799X-4-28","article-title":"Two levels above and one level below pedicle screw fixation for the treatment of unstable thoracolumbar fracture with partial or intact neurology","volume":"4","author":"Modi","year":"2009","journal-title":"J. Orthop. Surg. Res."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2022\/6497754","article-title":"Mechanical analysis of posterior pedicle screw system placement and internal fixation in the treatment of lumbar fractures","volume":"2022","author":"Mu","year":"2022","journal-title":"Comput. Math. Methods Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"43","DOI":"10.3390\/jfb12030043","article-title":"Finite element method for the evaluation of the human spine: A literature overview","volume":"12","author":"Naoum","year":"2021","journal-title":"J. Funct. Biomater."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1234","DOI":"10.1016\/j.compbiomed.2013.06.011","article-title":"Effects of degenerated intervertebral discs on intersegmental rotations, intradiscal pressures, and facet joint forces of the whole lumbar spine","volume":"43","author":"Park","year":"2013","journal-title":"Comput. Biol. Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/s0887-2171(96)90010-4","article-title":"Thoracolumbar burst fracture: Evaluating stability","volume":"17","author":"Petersilge","year":"1996","journal-title":"Semin. Ultrasound CT MR"},{"key":"B25","doi-asserted-by":"publisher","first-page":"884","DOI":"10.1016\/j.jbiomech.2009.01.017","article-title":"Realistic loading conditions for upper body bending","volume":"42","author":"Rohlmann","year":"2009","journal-title":"J. Biomech."},{"key":"B26","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1097\/BSD.0000000000000634","article-title":"Thoracolumbar burst fractures","volume":"31","author":"Rosenthal","year":"2018","journal-title":"Clin. Spine Surg."},{"key":"B27","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.clinbiomech.2009.09.010","article-title":"Extent of corpectomy determines primary stability following isolated anterior reconstruction in a thoracolumbar fracture model","volume":"25","author":"Schmoelz","year":"2010","journal-title":"Clin. Biomech."},{"key":"B28","doi-asserted-by":"publisher","first-page":"2028","DOI":"10.1097\/BRS.0b013e3182a8a381","article-title":"AOSpine thoracolumbar spine injury classification system: Fracture description, neurological status, and key modifiers","volume":"38","author":"Vaccaro","year":"2013","journal-title":"Spine (Phila Pa 1976)"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e11244","DOI":"10.1097\/MD.0000000000011244","article-title":"Extent and location of fixation affects the biomechanical stability of short- or long-segment pedicle screw technique with screwing of fractured vertebra for the treatment of thoracolumbar burst fractures: An observational study using finite element analysis","volume":"97","author":"Wang","year":"2018","journal-title":"Med. Baltim."},{"key":"B30","doi-asserted-by":"publisher","first-page":"753","DOI":"10.21037\/atm-20-4091","article-title":"Biomechanical finite element analysis of superior endplate collapse after thoracolumbar fracture surgery","volume":"8","author":"Wang","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.1080\/10255842.2012.668537","article-title":"A combined numerical and experimental technique for estimation of the forces and moments in the lumbar intervertebral disc","volume":"16","author":"Wang","year":"2013","journal-title":"Comput. Method. Biomec."},{"key":"B32","doi-asserted-by":"publisher","first-page":"071007","DOI":"10.1115\/1.4050537","article-title":"Comparison of posterior fixation strategies for thoracolumbar burst fracture: A finite element study","volume":"143","author":"Wong","year":"2021","journal-title":"J. Biomech. Eng."},{"key":"B33","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1109\/TMI.2003.814783","article-title":"Nonlinear finite-element analysis and biomechanical evaluation of the lumbar spine","volume":"22","author":"Wong","year":"2003","journal-title":"IEEE Trans. Med. Imaging"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e0211676","DOI":"10.1371\/journal.pone.0211676","article-title":"The stability of long-segment and short-segment fixation for treating severe burst fractures at the thoracolumbar junction in osteoporotic bone: A finite element analysis","volume":"14","author":"Wu","year":"2019","journal-title":"PLoS One"},{"key":"B35","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.medengphy.2018.10.003","article-title":"Stress distribution in vertebral bone and pedicle screw and screw-bone load transfers among various fixation methods for lumbar spine surgical alignment: A finite element study","volume":"63","author":"Xu","year":"2019","journal-title":"Med. Eng. Phys."},{"key":"B36","doi-asserted-by":"publisher","first-page":"e0250009","DOI":"10.1371\/journal.pone.0250009","article-title":"Different fixation pattern for thoracolumbar fracture of ankylosing spondylitis: A finite element analysis","volume":"16","author":"Zhang","year":"2021","journal-title":"PLoS One"}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2023.1229218\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T16:15:37Z","timestamp":1691424937000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2023.1229218\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,7]]},"references-count":36,"alternative-id":["10.3389\/fbioe.2023.1229218"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2023.1229218","relation":{},"ISSN":["2296-4185"],"issn-type":[{"type":"electronic","value":"2296-4185"}],"subject":[],"published":{"date-parts":[[2023,8,7]]},"article-number":"1229218"}}