A mechanical comparison between conventional and modified angular plates for proximal humeral fractures

Carrera, Eduardo F; Nicolao, Fábio Anauate; Netto, Nicola Archetti; Carvalho, Renato L.; Reis, Fernando Baldy dos; Giordani, E.J.

doi:10.1016/j.jse.2008.02.003

Cited by 8 publications

(10 citation statements)

References 10 publications

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“…8,21 Thus artificial bone models were used for the mechanical evaluation of proximal humeral fractures previously. 5,24 Both our experimental setup and previously published cadaveric studies were unable to generate the typical cutthrough that can be found clinically. 10,11,21,27,36 The reason for this might be that neither approach can simulate the bone remodeling occurring in vivo.…”

Section: Discussionmentioning

confidence: 99%

“…Generally, the humerus was tested in nonphysiologic bending, axial compression, or torsion and with large variations in applied external loads or a large number of cycles. 5,10,11,15,21,27 In vivo, the varus collapse of the humeral head is likely a result of SSP and DELT active contraction. 27 Walsh et al 36 developed a testing device simulating the rotator cuff by clamping together SSP, infraspinatus, and subscapularis but not teres minor.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Medial support by fibula bone graft in angular stable plate fixation of proximal humeral fractures: an in vitro study with synthetic bone

Osterhoff

Baumgartner

Favre

et al. 2011

Journal of Shoulder and Elbow Surgery

106

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Medial support by fibula bone graft in angular stable plate fixation of proximal humeral fractures: an in vitro study with synthetic bone

Osterhoff

Baumgartner

Favre

et al. 2011

Journal of Shoulder and Elbow Surgery

106

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“…All the fracture models found in the literature are based on full osteotomies of the proximal humerus. [8][9][10][11][12][13] A limitation of our study was that we tested only with medial and lateral displacement, not allowing ante-or retroversion during creation of the fracture and displacement of the head. Therefore, the effect of combined displacements could not be investigated.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12][13] We devised a new model with a complete bony rupture but intact medial soft tissues using 18 specimens in a pilot series. It was found that a valgus fracture model gave a reproducible calcar fracture with preservation of the periosteum.…”

Section: Methodsmentioning

confidence: 99%

The medial periosteal hinge, a key structure in fractures of the proximal humerus

Kralinger

Unger

Wambacher

et al. 2009

The Journal of Bone and Joint Surgery. British volume

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The medial periosteal hinge plays a key role in fractures of the head of the humerus, offering mechanical support during and after reduction and maintaining perfusion of the head by the vessels in the posteromedial periosteum. We have investigated the biomechanical properties of the medial periosteum in fractures of the proximal humerus using a standard model in 20 fresh-frozen cadaver specimens comparable in age, gender and bone mineral density. After creating the fracture, we displaced the humeral head medial or lateral to the shaft with controlled force until complete disruption of the posteromedial periosteum was recorded. As the quality of periosteum might be affected by age and bone quality, the results were correlated with the age and the local bone mineral density of the specimens measured with quantitative CT. Periosteal rupture started at a mean displacement of 2.96 mm (SD 2.92) with a mean load of 100.9 N (SD 47.1). The mean maximum load of 111.4 N (SD 42.5) was reached at a mean displacement of 4.9 mm (SD 4.2). The periosteum was completely ruptured at a mean displacement of 34.4 mm (SD 11.1). There was no significant difference in the mean distance to complete rupture for medial (mean 35.8 mm (SD 13.8)) or lateral (mean 33.0 mm (SD 8.2)) displacement (p = 0.589). The mean bone mineral density was 0.111 g/cm(3) (SD 0.035). A statistically significant but low correlation between bone mineral density and the maximum load uptake (r = 0.475, p = 0.034) was observed. This study showed that the posteromedial hinge is a mechanical structure capable of providing support for percutaneous reduction and stabilisation of a fracture by ligamentotaxis. Periosteal rupture started at a mean of about 3 mm and was completed by a mean displacement of just under 35 mm. The microvascular situation of the rupturing periosteum cannot be investigated with the current model.

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“…Each category also included studies testing two- and three-part fracture models as well as static and cyclic loading. Overall, synthetic humeri were assessed in ten studies [ 41 , 47 , 55 , 59 , 62 , 66 , 70 – 73 ] while others tested human cadaveric humeri. Only two studies involved four-part fractures [ 72 , 73 ], both of which belonged to humerus-tendon category.…”

Section: Biomechanical Testing Of Proximal Humerus Platesmentioning

confidence: 99%

Biomechanical analysis of plate systems for proximal humerus fractures: a systematic literature review

2018

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BackgroundProximal humerus fractures are the third most common in the human body but their management remains controversial. Open reduction and internal fixation with plates is one of the leading modes of operative treatment for these fractures. The development of technologies and techniques for these plates, during the recent decades, promise a bright future for their clinical use. A comprehensive review of in vitro biomechanical studies is needed for the comparison of plates’ mechanical performance and the testing methodologies. This will not only guide clinicians with plate selection but also with the design of future in vitro biomechanical studies. This review was aimed to systematically categorise and review the in vitro biomechanical studies of these plates based on their protocols and discuss their results. The technologies and techniques investigated in these studies were categorised and compared to reach a census where possible.Methods and resultsWeb of Science and Scopus database search yielded 62 studies. Out of these, 51 performed axial loading, torsion, bending and/or combined bending and axial loading while 11 simulated complex glenohumeral movements by using tendons. Loading conditions and set-up, failure criteria and performance parameters, as well as results for each study, were reviewed. Only two studies tested four-part fracture model while the rest investigated two- and three-part fractures. In ten studies, synthetic humeri were tested instead of cadaveric ones. In addition to load–displacement data, three-dimensional motion analysis systems, digital image correlation and acoustic emission testing have been used for measurement.ConclusionsOverall, PHILOS was the most tested plate and locking plates demonstrated better mechanical performance than non-locking ones. Conflicting results have been published for their comparison with non-locking blade plates and polyaxial locking screws. Augmentation with cement [calcium phosphate or poly(methyl methacrylate)] or allografts (fibular and femoral head) was found to improve bone-plate constructs’ mechanical performance. Controversy still lies over the use of rigid and semi-rigid implants and the insertion of inferomedial screws for calcar region support. This review will guide the design of in vitro and in silico biomechanical tests and also supplement the study of clinical literature.Electronic supplementary materialThe online version of this article (10.1186/s12938-018-0479-3) contains supplementary material, which is available to authorized users.

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A mechanical comparison between conventional and modified angular plates for proximal humeral fractures

Cited by 8 publications

References 10 publications

Medial support by fibula bone graft in angular stable plate fixation of proximal humeral fractures: an in vitro study with synthetic bone

Medial support by fibula bone graft in angular stable plate fixation of proximal humeral fractures: an in vitro study with synthetic bone

The medial periosteal hinge, a key structure in fractures of the proximal humerus

Biomechanical analysis of plate systems for proximal humerus fractures: a systematic literature review

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