Augmentation of plate osteosynthesis for proximal humeral fractures: a systematic review of current biomechanical and clinical studies

Biermann, Niklas; Prall, Wolf Christian; Böcker, Wolfgang; Mayr, Hermann O.; Haasters, Florian

doi:10.1007/s00402-019-03162-2

Cited by 38 publications

(36 citation statements)

References 63 publications

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“…Auto- and allo-grafting represent the most used strategies for PHF augmentation and patient treatment. However, even if good to excellent outcomes have been reported in the literature, these options still lack long-term follow up and comparative studies [ 76 ]. Nevertheless, the main problem of its extensive use is the concerns about possible side donor morbidity of autografts, their availability, and the high costs of allografts.…”

Section: Discussionmentioning

confidence: 99%

Synthetic Bone Substitutes and Mechanical Devices for the Augmentation of Osteoporotic Proximal Humeral Fractures: A Systematic Review of Clinical Studies

Marongiu

Verona

Cardoni

et al. 2020

JFB

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Background: Different augmentation techniques have been described in the literature in addition to the surgical treatment of proximal humeral fractures. The aim of this systematic review was to analyze the use of cements, bone substitutes, and other devices for the augmentation of proximal humeral fractures. Methods: A systematic review was conducted by using PubMed/MEDLINE, ISI Web of Knowledge, Cochrane Library, Scopus/EMBASE, and Google Scholar databases according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines over the years 1966 to 2019. The search term “humeral fracture proximal” was combined with “augmentation”; “polymethylmethacrylate, PMMA”; “cement”; “bone substitutes”; “hydroxyapatite”; “calcium phosphates”; “calcium sulfate”; “cell therapies”, and “tissue engineering” to find the literature relevant to the topic under review. Results: A total of 10 clinical studies considered eligible for the review, with a total of 308 patients, were included. Mean age at the time of injury was 68.8 years (range of 58–92). The most commonly described techniques were reinforcing the screw–bone interface with bone PMMA cement (three studies), filling the metaphyseal void with synthetic bone substitutes (five studies), and enhancing structural support with metallic devices (two studies). Conclusion: PMMA cementation could improve screw-tip fixation. Calcium phosphate and calcium sulfate injectable composites provided good biocompatibility, osteoconductivity, and lower mechanical failure rate when compared to non-augmented fractures. Mechanical devices currently have a limited role. However, the available evidence is provided mainly by level III to IV studies, and none of the proposed techniques have been sufficiently studied.

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Section: Discussionmentioning

confidence: 99%

Synthetic Bone Substitutes and Mechanical Devices for the Augmentation of Osteoporotic Proximal Humeral Fractures: A Systematic Review of Clinical Studies

Marongiu

Verona

Cardoni

et al. 2020

JFB

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“…Zur Verbesserung des Knochen-Implantate-Interface kann bei fortgeschrittener Osteoporose eine Augmentation der Kopfschrauben mit PMMA-Knochenzement durchgeführt werden. Damit lässt sich eine signifikant verbesserte Fixierung der Schrauben im osteoporotischen Knochen erreichen [22]. Metaphysäre Frakturen können auch mittels intramedullärer Nägel stabilisiert werden.…”

Section: Therapieunclassified

Der geriatrische Traumapatient

Schütze¹,

Gebhard²,

Richter³

2021

Geriatrie up2date

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“…Various approaches have been introduced to improve the biomechanical performance of locking plate fixation for osteoporotic proximal humerus fractures. 9 - 11 One of the available options is applying calcium phosphate or poly(methyl methacrylate) (PMMA) bone cement at the tip of cannulated locking screws. Numerous in vitro biomechanical studies have demonstrated enhanced primary stability of proximal humerus plating with cement-augmented screws.…”

Section: Introductionmentioning

confidence: 99%

“…Numerous in vitro biomechanical studies have demonstrated enhanced primary stability of proximal humerus plating with cement-augmented screws. 9 , 12 However, the clinical findings have been controversial regarding the benefit of bone cement augmentation with the proximal humerus internal locking system (PHILOS; DePuy Synthes, Zuchwil, Switzerland). 13 - 15 These variable results may be related to heterogenicity of augmentation techniques and the screw configurations used.…”

Section: Introductionmentioning

confidence: 99%

Cement augmentation of calcar screws may provide the greatest reduction in predicted screw cut-out risk for proximal humerus plating based on validated parametric computational modelling

Варга

Inzana

Fletcher

et al. 2020

Bone & Joint Research

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Aims Fixation of osteoporotic proximal humerus fractures remains challenging even with state-of-the-art locking plates. Despite the demonstrated biomechanical benefit of screw tip augmentation with bone cement, the clinical findings have remained unclear, potentially as the optimal augmentation combinations are unknown. The aim of this study was to systematically evaluate the biomechanical benefits of the augmentation options in a humeral locking plate using finite element analysis (FEA). Methods A total of 64 cement augmentation configurations were analyzed using six screws of a locking plate to virtually fix unstable three-part fractures in 24 low-density proximal humerus models under three physiological loading cases (4,608 simulations). The biomechanical benefit of augmentation was evaluated through an established FEA methodology using the average peri-screw bone strain as a validated predictor of cyclic cut-out failure. Results The biomechanical benefit was already significant with a single cemented screw and increased with the number of augmented screws, but the configuration was highly influential. The best two-screw (mean 23%, SD 3% reduction) and the worst four-screw (mean 22%, SD 5%) combinations performed similarly. The largest benefits were achieved with augmenting screws purchasing into the calcar and having posteriorly located tips. Local bone mineral density was not directly related to the improvement. Conclusion The number and configuration of cemented screws strongly determined how augmentation can alleviate the predicted risk of cut-out failure. Screws purchasing in the calcar and posterior humeral head regions may be prioritized. Although requiring clinical corroborations, these findings may explain the controversial results of previous clinical studies not controlling the choices of screw augmentation.

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Augmentation of plate osteosynthesis for proximal humeral fractures: a systematic review of current biomechanical and clinical studies

Cited by 38 publications

References 63 publications

Synthetic Bone Substitutes and Mechanical Devices for the Augmentation of Osteoporotic Proximal Humeral Fractures: A Systematic Review of Clinical Studies

Synthetic Bone Substitutes and Mechanical Devices for the Augmentation of Osteoporotic Proximal Humeral Fractures: A Systematic Review of Clinical Studies

Der geriatrische Traumapatient

Cement augmentation of calcar screws may provide the greatest reduction in predicted screw cut-out risk for proximal humerus plating based on validated parametric computational modelling

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