Biomechanical comparison of different pin configurations during percutaneous pinning for the treatment of proximal humeral fractures

Jiang, Chunyan; Zhu, Ye; Wang, Manyi; Rong, Guo-wei

doi:10.1016/j.jse.2006.05.011

Cited by 20 publications

(6 citation statements)

References 10 publications

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“…While our relatively low rate or loading is within the range employed in fracture studies of proximal humeri and femora, 22,24,31–35 varying rates may yield varying results. Differences in loading rate and/or loading mode may affect the validity of bone reuse, and hence they should be tested on a subset of the sample.…”

Section: Discussionmentioning

confidence: 99%

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Reusing Cadaveric Humeri for Fracture Testing After Testing Simulated Rotator Cuff Tendon Repairs

Skedros

Pitts

Knight

et al. 2014

BioResearch Open Access

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The financial cost of using human tissues in biomedical testing and surgical reconstruction is predicted to increase at a rate that is disproportionately greater than other materials used in biomechanical testing. Our first hypothesis is that cadaveric proximal humeri that had undergone monotonic failure testing of simulated rotator cuff repairs would not differ in ultimate fracture loads or in energy absorbed to fracture when compared to controls (i.e., bones without cuff repairs). Our second hypothesis is that there can be substantial cost savings if these cadaveric proximal humeri, with simulated cuff repairs, can be re-used for fracture testing. Results of fracture tests (conducted in a backwards fall configuration) and cost analysis support both hypotheses. Hence, the bones that had undergone monotonic failure tests of various rotator cuff repair techniques can be re-used in fracture tests because their load-carrying capacity is not significantly reduced.

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Section: Discussionmentioning

confidence: 99%

“…2). 22 The perimeter of contact area was 10–15 mm from the posterior drill holes of the repair. Force was applied in displacement control (Bionix 858; MTS Inc., Minneapolis, MN) at a rate of 2 mm/sec until fracture occurred.…”

Section: Methodsmentioning

confidence: 99%

Reusing Cadaveric Humeri for Fracture Testing After Testing Simulated Rotator Cuff Tendon Repairs

Skedros

Pitts

Knight

et al. 2014

BioResearch Open Access

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“…Several biomechanical studies had been done to compare different wire configurations in fixation of proximal humeral fractures. They found that a parallel configuration is better than a convergent configuration in both rotational and bending stresses and that a divergent configuration is better than a parallel configuration in rotational stresses [8,14,19]. The palm tree technique allows for insertion of the wires in a divergent manner that insures stable fixation.…”

Section: Discussionmentioning

confidence: 99%

Results of the percutaneous pinning of proximal humerus fractures with a modified palm tree technique

El-Alfy¹

2011

International Orthopaedics (SICOT)

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Purpose Many techniques are available for closed reduction and percutaneous fixation of proximal humeral fractures. The palm tree technique was described by Kapandji in 1989. In that technique three curved wires are inserted through one hole at the V-shaped insertion of the deltoid muscle. It is a good technique but it has some disadvantages. In this study we introduced some modifications for the technique, and we evaluated the clinical results of the modified technique in treatment of 18 cases. Methods Eighteen patients with displaced proximal humeral fractures were treated by closed reduction and percutaneous fixation with the palm tree technique after minor modifications. The age of the patients ranged from 38 to 75 years with an average of 56 years. Eleven were females and seven were males. The fractures were twopart in 13 cases and three-part fractures in five cases. Results The average time of healing was seven weeks. The follow-up period ranged from 14 months to 39 months with an average of 22 months. The Constant score ranged from 45 to 88 with a mean of 73. The results were satisfactory in 77% and unsatisfactory in 23% of the cases. The complications included pin tract infection in two cases, intraarticular wire migration in one case, skin necrosis around the wires in three cases and malunion with varus deformity in one case. No cases were complicated by neurovascular injury, loss of fixation or avascular necrosis of the humeral head. Conclusions The palm tree technique is a good method for fixation of proximal humeral fractures. It produces good grip in both of the proximal and distal fragments and allows for early joint movements. Our modifications allow for easy insertion of the wires, increase the stability of fixation and minimize the risk of complications.

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“…Humeri were loaded in order to stay within the linear elastic region (i.e., mean linearity, R^ = 0.97), thus preventing any damage prior to failure testing and likely replicating normal physiological activities that do not lead to injury. Shear tests simulated push off from a chair or crutch weight bearing, as previously done biomechanically [13,17,27,28]. The total number of humeri tested successfully for shear stiffness was as follows; fresh-frozen (n = 19), embalmed (n = 18), dried (n -15), artificial "normal" (n = 12), and artificial "osteoporotic" {n = 12).…”

Section: Shear Testsmentioning

confidence: 99%

Biomechanical Measurements of Stiffness and Strength for Five Types of Whole Human and Artificial Humeri

Aziz

Nicayenzi

Crookshank

et al. 2014

Journal of Biomechanical Engineering

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The human humerus is the third largest longbone and experiences 2-3% of all fractures. Yet, almost no data exist on its intact biomechanical properties, thus preventing researchers from obtaining a full understanding of humerus behavior during injury and after being repaired with fracture plates and nails. The aim of this experimental study was to compare the biomechanical stiffness and strength of "gold standard" fresh-frozen humeri to a variety of humerus models. A series of five types of intact whole humeri were obtained: human fresh-frozen (n = 19); human embalmed (n = 18); human dried (n = 15); artificial "normal" (n = 12); and artificial "osteoporotic" (n = 12). Humeri were tested under "real world" clinical loading modes for shear stiffness, torsional stiffness, cantilever bending stiffness, and cantilever bending strength. After removing geometric effects, fresh-frozen results were 585.8 ± 181.5 N/mm2 (normalized shear stiffness); 3.1 ± 1.1 N/(mm2 deg) (normalized torsional stiffness); 850.8 ± 347.9 N/mm2 (normalized cantilever stiffness); and 8.3 ± 2.7 N/mm2 (normalized cantilever strength). Compared to fresh-frozen values, statistical equivalence (p ≥ 0.05) was obtained for all four test modes (embalmed humeri), 1 of 4 test modes (dried humeri), 1 of 4 test modes (artificial "normal" humeri), and 1 of 4 test modes (artificial "osteoporotic" humeri). Age and bone mineral density versus experimental results had Pearson linear correlations ranging from R = -0.57 to 0.80. About 77% of human humeri failed via a transverse or oblique distal shaft fracture, whilst 88% of artificial humeri failed with a mixed transverse + oblique fracture. To date, this is the most comprehensive study on the biomechanics of intact human and artificial humeri and can assist researchers to choose an alternate humerus model that can substitute for fresh-frozen humeri.

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Biomechanical comparison of different pin configurations during percutaneous pinning for the treatment of proximal humeral fractures

Cited by 20 publications

References 10 publications

Reusing Cadaveric Humeri for Fracture Testing After Testing Simulated Rotator Cuff Tendon Repairs

Reusing Cadaveric Humeri for Fracture Testing After Testing Simulated Rotator Cuff Tendon Repairs

Results of the percutaneous pinning of proximal humerus fractures with a modified palm tree technique

Biomechanical Measurements of Stiffness and Strength for Five Types of Whole Human and Artificial Humeri

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