Taming Computational Irreducibility in Fracture Healing: A Physics-Informed AI Framework for the Shear Shielding Nail-Plate Strategy - Abstract
Background: Hypertrophic nonunion after intramedullary (IM) nailing represents a failed self-organization of the fracture healing system. In the language
of Wolfram’s principle of computational irreducibility, the coupled biological and mechanical cascade is a complex program whose exact trajectory cannot
be shortcut. Experimental work in fracture mechanobiology, however, points to a shear-dominated interfragmentary environment as a major driver of this
unpredictability.
Objective: To formulate a unified framework that links mechanoregulatory physics, interfragmentary strain (IFS) mathematics, and a physics-informed AI
planner, and to illustrate its clinical application in femoral hypertrophic nonunion and shear-prone fractures treated with a shear-shielding nail-plate construct.
Methods: IFS was decomposed into axial (?x) and transverse (?y) components to quantify the “shear trap.” Building on stiffness superposition, we modeled
how adding a short non-locking 3.5-mm lateral plate in parallel to an IM nail alters the local strain field. A physics-informed surrogate model, trained on a
library of finite-element simulations, was conceptualized to predict ?x and ?y for candidate nail-plate constructs and to optimize plate length and position
under constraints of osteogenic strain, cost, and implant availability. Four femoral cases were treated with an IM nail plus a short lateral buttress plate without
nail exchange.
Results: Theoretical modeling shows that nail-plate augmentation can move the construct from a shear-dominant regime (high ?y) toward an axial-favourable
regime (preserved ?x with reduced ?y), consistent with mechanobiology favoring callus bridging. Clinically, three hypertrophic or shear-prone femoral cases
achieved progressive consolidation after addition of a short lateral plate without nail exchange, with pain relief and functional recovery. In a fourth case, the
same side-plating strategy was used to lock a corrected rotational alignment after symptomatic malrotation from IM nailing, with CT-confirmed restoration of
near-symmetric femoral torsion.
Conclusion: By using AI to operationalize vector mechanics and shear control, the shear-shielding nail-plate construct suppresses the stochastic noise of
transverse shear while preserving axial load sharing. This framework offers a mechanistically rational, cost-conscious, and potentially generalizable strategy
to tame computational irreducibility in hypertrophic nonunion and shear-prone fractures.