Biomechanical evaluation of two intramedullary nailing techniques with different locking options in a three-part fracture proximal humerus model

Rothstock, Stephan; Plecko, Michael; Kloub, Martin; Schiuma, Damiano; Windolf, Markus; Gueorguiev, Boyko

doi:10.1016/j.clinbiomech.2012.03.003

Cited by 37 publications

(28 citation statements)

References 35 publications

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“…Our findings regarding the additional calcar screw partly stand in contrast to results reported in literature [15]. Mean axial construct stiffness was herein reported to range from 401 to 516 N/mm.…”

Section: Discussioncontrasting

confidence: 85%

“…These results are comparable to ours (Table 1). Nonetheless, axial stiffness was described to be significantly higher with than without locked calcar screw in combination with two supplementary "screw-in-screw" [15]. The authors report head migration and varus deformity to be smaller and the number of cycles to failure higher with these three additional screws.…”

Section: Discussionmentioning

confidence: 94%

“…Especially, the varus traction of the rotator cuff deemed responsible for loss of reduction was not simulated [15][16][17][18][19][20][21][22]. Specimens were not matched paired which also might have affected results.…”

Section: Discussionmentioning

confidence: 96%

“…First biomechanical investigations of this new intramedullary nail 1 with additional use of a locked calcar screw plus two posterior "screw-in-screw" (additional locking screw anchored in the proximal humeral head screws) demonstrated higher number of cycles to failure and less varus deformation compared to the same screw configuration without supplementary screws [15]. The isolated mechanical effect of the calcar screw without further mean of additional fixation in locked nailing remains unclear to author's knowledge.…”

Section: Introductionmentioning

confidence: 97%

See 3 more Smart Citations

Is there any advantage in placing an additional calcar screw in locked nailing of proximal humeral fractures?

Katthagen

Schwarze

Bauer

et al. 2015

Orthopaedics & Traumatology: Surgery & Research

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Section: Discussioncontrasting

confidence: 85%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 97%

See 2 more Smart Citations

Is there any advantage in placing an additional calcar screw in locked nailing of proximal humeral fractures?

Katthagen

Schwarze

Bauer

et al. 2015

Orthopaedics & Traumatology: Surgery & Research

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show abstract

“…However, there are only a few biomechanical studies available that evaluated this intramedullary implant. In 2012, Rothstock et al [18] presented increased stability and decreased varus displacement using a supplementary Bscrewin-screw^configuration and advocated an additional ascending calcar screw for SAN. Contrarily, Katthagen et al [19] showed that an additional unlocked calcar screw did not increase stability in a two-part fracture model fixed using a SAN construct.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Euler

Petri

Venderley

et al. 2017

International Orthopaedics (SICOT)

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Purpose Varus failure is one of the most common failure modes following surgical treatment of proximal humeral fractures. Straight antegrade nails (SAN) theoretically provide increased stability by anchoring to the densest zone of the proximal humerus (subchondral zone) with the end of the nail. The aim of this study was to biomechanically investigate the characteristics of this Bproximal anchoring point^(PAP). We hypothesized that the PAP would improve stability compared to the same construct without the PAP. Methods Straight antegrade humeral nailing was performed in 20 matched pairs of human cadaveric humeri for a simulated unstable two-part fracture. Results Biomechanical testing, with stepwise increasing cyclic axial loading (50-N increments each 100 cycles) at an angle of 20°abduction revealed significantly higher median loads to failure for SAN constructs with the PAP (median, 450 N; range, 200-1.000 N) compared to those without the PAP (median, 325 N; range, 100-500 N; p = 0.009). SAN constructs with press-fit proximal extensions (endcaps) showed similar median loads to failure (median, 400 N; range, 200-650 N), when compared to the undersized, commercially available SAN endcaps (median, 450 N; range, 200-600 N; p = 0.240). Conclusions The PAP provided significantly increased stability in SAN constructs compared to the same setup without this additional proximal anchoring point. Varus-displacing forces to the humeral head were superiorly reduced in this setting. This study provides biomechanical evidence for the Bproximal anchoring point's^rationale. Straight antegrade humeral nailing may be beneficial for patients undergoing surgical treatment for unstable proximal humeral fractures to decrease secondary varus displacement and thus potentially reduce revision rates.

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Screw‐in‐screw fixation of fragility sacrum fractures provides high stability without loosening—biomechanical evaluation of a new concept

Wagner

Schopper

Lodde

et al. 2020

Journal Orthopaedic Research

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Surgical treatment of fragility sacrum fractures with percutaneous sacroiliac (SI) screw fixation is associated with high failure rates. Turnout is detected in up to 20% of the patients. The aim of this study was to evaluate a new screw-in-screw implant prototype for fragility sacrum fracture fixation. Twenty-seven artificial hemipelvises were assigned to three groups (n = 9) for instrumentation of an SI screw, the new screw-in-screw implant prototype, ora transsacral screw. Before implantation, a vertical osteotomy was set in zone 1 after Denis. All specimens were biomechanically tested to failure in upright position. Validated setup and test protocol were used for complex axial and torsional loading applied through the S1 vertebral body to promote turnout of the implants. Interfragmentary movements were captured via optical motion tracking. Screw motions were evaluated by means of triggered anteroposterior X-rays. Interfragmentary movements and implant motions were significantly higher for SI screw fixation compared to both transsacral and screw-inscrew fixations. In addition, transsacral screw and screw-in-screw fixations revealed similar construct stability. Moreover, screw-in-screw fixation successfully prevented turnout of the implant that remained during testing at 0°rotation for all specimens. From biomechanical perspective, fragility sacrum fracture fixation with the new screw-in-screw implant prototype provides higher stability than an SI screw, being able to successfully prevent turnout. Moreover, it combines the higher stability of transsacral screw fixation with the less risky operational procedure of SI screw fixation and can be considered as their alternative treatment option.

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Biomechanical evaluation of two intramedullary nailing techniques with different locking options in a three-part fracture proximal humerus model

Cited by 37 publications

References 35 publications

Is there any advantage in placing an additional calcar screw in locked nailing of proximal humeral fractures?

Is there any advantage in placing an additional calcar screw in locked nailing of proximal humeral fractures?

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

Screw‐in‐screw fixation of fragility sacrum fractures provides high stability without loosening—biomechanical evaluation of a new concept

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