How to enhance the stability of locking plate fixation of proximal humerus fractures? An overview of current biomechanical and clinical data

Schliemann, Benedikt; Wähnert, Dirk; Theisen, Christina; Herbort, Mirco; Kösters, Clemens; Raschke, Michael J.; Weimann, André

doi:10.1016/j.injury.2015.04.020

Cited by 72 publications

(44 citation statements)

References 49 publications

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“…The human population, especially in developed countries, is aging, which makes age-related health issues more important. Diseases of the locomotive system, such as fractures, osteoporosis, rheumatoid arthritis, and others, are the second most frequent diseases after the cardiovascular diseases (Schliemann et al, 2015). Many growth factors and hormones are known for their supportive effect on bone growth (e.g., bone morphogenetic protein 2, BMP-2); nevertheless, their isolation and production can be complicated and expensive (Bhattacharya et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Application of whey protein isolate in bone regeneration: Effects on growth and osteogenic differentiation of bone-forming cells

Douglas

Vandrovcová

Kročilová

et al. 2018

Journal of Dairy Science

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Recently, milk-derived proteins have attracted attention for applications in the biomedical field such as tissue regeneration. Whey protein isolate (WPI), especially its main component β-lactoglobulin, can modulate immunity and acts as an antioxidant, antitumor, antiviral, and antibacterial agent. There are very few reports of the application of WPI in tissue engineering, especially in bone tissue engineering. In this study, we tested the influence of different concentrations of WPI on behavior of human osteoblast-like Saos-2 cells, human adipose tissue-derived stem cells (ASC), and human neonatal dermal fibroblasts (FIB). The positive effect on growth was apparent for Saos-2 cells and FIB but not for ASC. However, the expression of markers characteristic for early osteogenic cell differentiation [type-I collagen (COL1) and alkaline phosphatase (ALP)] as well as ALP activity, increased dose-dependently in ASC. Importantly, Saos-2 cells were able to deposit calcium in the presence of WPI, even in a proliferation medium without other supplements that support osteogenic cell differentiation. The results indicate that, depending on the cell type, WPI can act as an enhancer of cell proliferation and osteogenic differentiation. Therefore, enrichment of biomaterials for bone regeneration with WPI seems a promising approach, especially due to the low cost of WPI.

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Section: Introductionmentioning

confidence: 99%

Application of whey protein isolate in bone regeneration: Effects on growth and osteogenic differentiation of bone-forming cells

Douglas

Vandrovcová

Kročilová

et al. 2018

Journal of Dairy Science

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“…These findings stand in contrast to past investigations which compared surgical and non-surgical treatments of Neer class 3 or 4 partial fractures and found no significant differences in treatment outcomes between the two methods. Other studies showed that there were no differences between locking plate and semijoint osteoplasties [22,23].…”

Section: Discussionmentioning

confidence: 93%

The biomechanics of combined lateral and posterior plates for treating proximal humerus fractures with medial column defects

Zhang

Yuechao

Wang

et al. 2020

Preprint

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KEYWORDSproximal humeral fracture, locking plate, internal fixation, biomechanics, finite element analysis 2 Abstract Background. We investigated the therapeutic effects associated with the combined use of lateral and posterior plates for treating complex proximal humerus fractures. Methods. We used in vitro biomechanical experiments and computer three-dimensional finite element analyses to investigate the biomechanical properties of combined lateral and posterior plates when treating proximal humerus fractures. Eighteen left SAWBONE (Pacific Research Labs) humerus bones were randomly divided among three groups. We established a medial column defect model for surgical neck fractures in each bone specimen and achieved fixation using a proximal humerus locking plate. Each of the three groups used a different fixation method. Group A used a Proximal Humerus Internal Locking System (PHILOS) plate support only. Group B used the PHILOS plate with a posterior locking plate (but without medial column support screws). Group C used the PHILOS plate with both the posterior locking plate and medial column support screws. We subjected three sets of specimens to axial compression, torsion, shear compression, model failure, fatigue testing, and micro-strain analyses.Results and conclusions. In vitro biomechanical analysis and three-dimensional finite element analyses showed that the PHILOS plate, in combination with the posterior locking plate and medial column support screws (Group C), had significantly enhanced biomechanical properties when compared with traditional single plate supports.

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“…To resolve the issues associated with medial reduction loss and varus deformity, two points were presented [22] (1)…”

Section: Discussionmentioning

confidence: 99%

A novel surgical approach and technique and short-term clinical efficacy for the treatment of proximal humerus fractures with the combined use of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation

Wang

Wang²,

Dong

et al. 2020

Preprint

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Background and hypothesis: The typical anterolateral approach is widely used to treat proximal humerus fractures with lateral locking fixation. However, lateral fixation cannot completely avoid medial reduction loss and varus deformity especially in the cases of an unstable medial column. We present a novel medial surgical approach and technique together with a minimally invasive lateral locking plate to fix proximal humerus fractures with an unstable medial column.Materials and Methods: An anatomical study was performed and an anatomical medial locking proximal humerus plate was designed based on the measurement results. Between November 2014 and April 2017, eight cases of proximal humerus fractures with unstable medial columns underwent medial fixation. All surgeries were performed by a single surgeon. Patients were followed clinically and radiographically at 1, 3, 6 and 12 months postoperatively.Results: There was a safe region located at the medial part of the proximal humerus just beneath the articular surface. An anatomical medial locking proximal humerus plate could be placed in the medial column and did not affect the axillary nerve, blood supply of the humeral head or stability of the shoulder joint. Successful fracture healing was achieved in all 8 cases. The function and range of motion of the shoulder joint were satisfactory 24 months postoperatively, with an average Constant score (CS) of 82.8. No reduction loss (≥ 10 degrees in any direction), screw cutout, nonunion, or deep infection occurred.Conclusions: The combined application of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation is effective in maintaining operative reduction and preventing varus collapse and implant failure in proximal humerus fractures with an unstable medial column.Level of evidence: Retrospective Study

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How to enhance the stability of locking plate fixation of proximal humerus fractures? An overview of current biomechanical and clinical data

Cited by 72 publications

References 49 publications

Application of whey protein isolate in bone regeneration: Effects on growth and osteogenic differentiation of bone-forming cells

Application of whey protein isolate in bone regeneration: Effects on growth and osteogenic differentiation of bone-forming cells

The biomechanics of combined lateral and posterior plates for treating proximal humerus fractures with medial column defects

A novel surgical approach and technique and short-term clinical efficacy for the treatment of proximal humerus fractures with the combined use of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation

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