Anatomical analysis of different helical plate designs for proximal humeral shaft fracture fixation

Pastor, Torsten; Kastner, Philipp; Souleiman, Firas; Gehweiler, Dominic; Migliorini, Filippo; Link, Björn‐Christian; Beeres, Frank J. P.; Babst, Reto; Nebelung, Sven; Ganse, Bergita; Schoeneberg, Carsten; Gueorguiev, Boyko; Knobe, Matthias

doi:10.1007/s00068-022-02082-y

Cited by 4 publications

(4 citation statements)

References 28 publications

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“…Despite the promising clinical reports, the optimal implant design has yet to be evaluated, as not only biomechanical aspects but also anatomical characteristics should be considered. A recent study demonstrated the safe feasibility of a 45 • -helical plate inserted with MIPO technique [35]. Furthermore, neither the ALPS nor the 90 • -helical plate was able to spare the deltoid insertion during MIPO.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it was concluded that, from an anatomical perspective, a 45 • -helical implant offers the optimal shape as it can be pushed through the weaker central part of the deltoid insertion still avoiding the radial nerve distally. Furthermore, a recent biomechanical study demonstrated the inferior performance of a 90 • -helical implant, as compared with straight plates during cyclic testing [35]. Additional human cadaveric biomechanical studies are needed to evaluate the competence of different plate designs, especially of the 45 • -helical plate, via cyclic testing.…”

Section: Discussionmentioning

confidence: 99%

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Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study

Pastor,

Zderic,

Pastor

et al. 2023

Medicina

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Background and Objectives: The surgical treatment of proximal humeral shaft fractures usually considers application of either long straight plates or intramedullary nails. By being able to spare the rotator cuff and avoid the radial nerve distally, the implementation of helical plates might overcome the downsides of common fixation methods. The aims of the current study were (1) to explore the biomechanical competence of different plate designs and (2) to compare their performance versus the alternative treatment option of using intramedullary nails. Materials and Methods: Twenty-four artificial humeri were assigned to the following four groups for simulation of an unstable proximal humeral shaft fracture and instrumentation: Group 1 (Straight-PHILOS), Group 2 (MULTILOC-Nail), Group 3 (45°-Helical-PHILOS), and Group 4 (90°-Helical-PHILOS). All specimens underwent non-destructive, quasi-static biomechanical testing under loading in axial compression, torsion in internal/external rotation, and pure bending in four directions, accompanied by motion tracking. Results: Axial stiffness/displacement in Group 2 was significantly higher/smaller than in all other groups (p ≤ 0.010). Torsional displacement in Group 2 was significantly bigger than in all other groups (p ≤ 0.017). Significantly smaller coronal plane displacement was identified in Group 2 versus all other groups (p < 0.001) and in Group 4 versus Group 1 (p = 0.022). Significantly bigger sagittal plane displacement was detected in Group 4 versus all other groups (p ≤ 0.024) and in Group 1 versus Group 2 (p < 0.001). Conclusions: Intramedullary nails demonstrated higher axial stiffness and smaller axial interfragmentary movements compared with all investigated plate designs. However, they were associated with bigger torsional movements at the fracture site. Although 90°-helical plates revealed bigger interfragmentary movements in the sagittal plane, they demonstrated improved resistance against displacements in the coronal plane when compared with straight lateral plates. In addition, 45°-helical plates manifested similar biomechanical competence to straight plates and may be considered a valid alternative to the latter from a biomechanical standpoint.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study

Pastor,

Zderic,

Pastor

et al. 2023

Medicina

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“…However, during the application of a medial plate, such vital structures of the thigh as the femoral vessels and nerves, the descending genicular artery, and the saphenous nerve may be impaired by the surgical approach. Helical plates have already proved useful for the treatment of proximal humeral shaft fractures 14,15 . Hence, a helically shaped medial plate may be used to avoid damaging the vital structures of the thigh as already reported in several anatomic studies 16–20 .…”

Section: Introductionmentioning

confidence: 95%

“…Helical plates have already proved useful for the treatment of proximal humeral shaft fractures. 14,15 Hence, a helically shaped medial plate may be used to avoid damaging the vital structures of the thigh as already reported in several anatomic studies. [16][17][18][19][20] However, this concept has not been subjected to a direct biomechanical comparison against straight double plating so far.…”

Section: Introductionmentioning

confidence: 97%

Is augmented femoral lateral plating with helically shaped medial plates biomechanically advantageous over straight medial plates?

Pastor,

Zderic,

Drenchev

et al. 2023

Journal Orthopaedic Research

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BackgroundDual plating of comminuted distal femoral fractures allows for early patient mobilization. An additional helically shaped medial plate avoids the medial vital structures of the thigh. Aim: to investigate the biomechanical competence of augmented lateral locking compression plate distal femur (LCP‐DF) using an additional straight versus a helically shaped medial LCP of the same length.MethodsTen pairs of human cadaveric femora were instrumented with a lateral anatomical 15‐hole LCP‐DF. Following, they were pairwise instrumented with either an additional medial straight 14‐hole LCP (group1) or a 90°‐helical shape LCP (group2). All specimens were biomechanically tested under quasi‐static and progressively increasing combined cyclic axial and torsional loading until failure.ResultsInitial interfragmentary axial displacement and flexion under static compression were significantly smaller in group1 (0.11±0.12mm and 0.21±0.10°) versus group2 (0.31±0.14mm and 0.68±0.16°), p≤0.007. Initial varus deformation under static compression remained not significantly different between group1 (0.57±0.23°) and group2 (0.75±0.34°), p=0.085. Flexion movements during dynamic loading were significantly higher for group2 (2.51±0.54°) versus group1 (1.63±1.28°), p=0.015, however, no significant differences were observed in terms of varus, internal rotation, axial and shear displacements between the groups, p≥0.204. Cycles to failure and load at failure were higher in group2 (25172±6376 and 3017N±638N) compared to group1 (22277±4576 and 2728N±458N) with no significant differences between them, p=0.195.ConclusionFrom a biomechanical perspective, helical double plating may be considered as useful alternative to straight double plating, demonstrating ameliorated damping capacities during flexion deformation and safer application as the medial neurovascular structures of the thigh are avoided.This article is protected by copyright. All rights reserved.

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Biomechanical analysis of helical versus straight plating of proximal third humeral shaft fractures

Pastor

Knegsel

Beeres

et al. 2023

Arch Orthop Trauma Surg

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Anatomical analysis of different helical plate designs for proximal humeral shaft fracture fixation

Cited by 4 publications

References 28 publications

Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study

Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study

Is augmented femoral lateral plating with helically shaped medial plates biomechanically advantageous over straight medial plates?

Biomechanical analysis of helical versus straight plating of proximal third humeral shaft fractures

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