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

Pastor, Torsten; Knegsel, Kenneth P van; Beeres, Frank J. P.; Migliorini, Filippo; Babst, Reto; Nebelung, Sven; Ganse, Bergita; Schoeneberg, Carsten; Gueorguiev, Boyko; Knobe, Matthias

doi:10.1007/s00402-023-04814-0

Cited by 7 publications

(5 citation statements)

References 41 publications

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“…A common concern regarding the use of helical plates is the torsion generated during their axial loading, as demonstrated in a study focusing on a single 180°-helical plate design. 34 However, in the double plate constructs of the current work, the rotational forces were absorbed by the lateral straight plate so that both groups revealed no significant differences in terms of torsion and shear when the constructs were loaded in internal rotation.…”

Section: Discussionmentioning

confidence: 61%

“…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%

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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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Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

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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“…The maximum main stress and maximum shear stress in the stature blade were 656.26 MPa and 327.60 MPa, respectively. The reliability value was 1.05 and it was found that this value is very low apparently this value decreases under unwanted crop loading conditions and therefore, the blade does not meet the safe conditions [23].…”

Section: Related Workmentioning

confidence: 99%

Using Different Angles of Rotating Blades Using the Finite Element Method

Ali Hassan,

Soheili Mehdizadeh

2024

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One of the most important operations in agriculture is tillage, which has a great contribution to increasing crop yield and aeration of the soil and, ultimately, root development. Among the important tools for tillage are rotary rotators that are exposed to high and variable dynamic loads, so they are designed to have both the greatest contribution to soil agitation and high strength; It is necessary. Therefore, in this research, an L-shaped blade sample was designed for a rotator using a Biomimetic method. Due to the extensive research that has been done in the world in the field of manufacturing different types of rotators with a rotating agitator mechanism, therefore, it is necessary to study and optimize the rotator blades according to Iranian conditions. In this study, the studied variables include dependent and independent variables. Dependent variables include von Mises stress and arm displacement, and independent variables include the dimensions and geometric parameters of the Shape of the Rotator Blades. The idea for the blade design was inspired by the paw of a mole rat. Six blades were designed by simple method and biomimetic method and then by finite element method. Effects of blade angle change and design method on stress distribution, maximum displacement, maximum energy absorbed in the blade, reliability and under 400 N checked out. The results showed that in all designed models, the values of stress, displacement and energy absorbed were lower in the biomimetic design mode. As the blade angle increased, the values of the above parameters also decreased. Finally, the best model for having the least von Mises stress and the highest reliability was the blade with a Biomimetic design and a 20-degree angle.

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“…Symmetry in the fracture patterns was ensured by using a cutting jig. Optical markers were attached to the humeral head and shaft at a distance of 5 mm from the osteotomy gap for motion tracking, as described in previous work [18][19][20].…”

Section: Specimen Preparation/surgical Techniquementioning

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

Cited by 7 publications

References 41 publications

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

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

Using Different Angles of Rotating Blades Using the Finite Element Method

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

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