Peter Schwarzenberg ^1* Thomas Colding-Rasmussen ^2,3 Daniel J. Hutchinson ⁴ Jorge San Jacinto Garcia ⁴ Viktor Granskog ⁵ Michael Mørk Petersen ^3,6 Tatjana Pastor ^1,7 Tine Weis ^3,6 Michael Malkoch ⁴ Christian Nai En Tierp-Wong ^2,3,6 Peter Varga ¹

• ¹ AO Research Institute Davos, Davos, Switzerland
• ² Department of Orthopedic Surgery, Hvidovre University Hospital, Copenhagen, Denmark
• ³ Ortopædkirurgisk Afdeling, Sjællands Universitetshospital, Københavns Universitet, Køge, Denmark
• ⁴ Department of Fiber and Polymer Technology, School of Chemistry, Biotechnology and Health, Royal Institute of Technology, Stockholm, Sweden
• ⁵ Other, Stockholm, Sweden
• ⁶ Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
• ⁷ Department for Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland

Phalangeal fractures are common, particularly in younger patients, leading to a large economic burden, due to higher incident rates among patients of working age. In traumatic cases where the fracture may be unstable, plate fixation has grown in popularity due to its greater construct rigidity. However, these metal plates have increased reoperation rates due to inflammation of the surrounding soft tissue. To overcome these challenges, a novel osteosynthesis platform, AdhFix, has been developed. This method uses a light-curable polymer that can be shaped in situ around traditional metal screws to create a plate like structure that has been shown to not induce soft tissue adhesions. However, to effectively evaluate any novel osteosynthesis device, the biomechanical environment must first be understood. In this study, the internal loads in a phalangeal plate osteosynthesis were measured under simulated rehabilitation exercises. In a human hand cadaver study, a plastic plate with known biomechanical properties was used to fix a 3 mm osteotomy and each finger was fully flexed to mimic traditional rehabilitation exercise. The displacements of the bone fragments were tracked with a stereographic camera system and coupled with specimen specific finite element (FE) models to calculate the internal loads in the osteosynthesis. Following this, AdhFix patches were created and monotonically tested under similar conditions to determine survival of the novel technique. The internal bending moment in the osteosynthesis was 6.78 ± 1.62 Nmm and none of the AdhFix patches failed under the monotonic rehabilitation exercises. This study demonstrates a method to calculate the internal loads on an osteosynthesis device during non-load bearing exercises and that the novel AdhFix solution did not fail under traditional rehabilitation protocols in this controlled setting. Further studies are required prior to clinical application.