Locking plate fixation provides superior fixation of humerus split type greater tuberosity fractures than tension bands and double row suture bridges

Gaudelli, C.; Ménard, Jérémie; Mutch, Jennifer; Laflamme, G. Yves; Petit, Yvan; Rouleau, Dominique M.

doi:10.1016/j.clinbiomech.2014.08.013

Cited by 28 publications

(17 citation statements)

References 12 publications

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“…Depending on the size and comminution of the tuberosity fragment, fixation can be achieved through heavy non-absorbable sutures, suture anchors, tension bands, screws with a washer or plates [ 7 , 8 ]. In accordance with the recent literature, locking plate fixation provides the strongest biomechanical fixation for split type greater tuberosity fractures [ 9 ].…”

Section: Introductionsupporting

confidence: 80%

Biomechanical Analysis of the Fixation Strength of a Novel Plate for Greater Tuberosity Fractures

Kaisidis

Pantos

Bochlos

et al. 2018

TOORTHJ

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Background:The incidence of isolated greater tuberosity fractures has been estimated to be 20% of all proximal humeral fractures. It is generally accepted that displaced (>5 mm) fractures should be treated surgically but the optimal surgical fixation of greater tuberosity fractures remains unclear.Objective:The goal of this study was to simulate the environment of application of a new plate system (Kaisidis plate, Fa Königsee) for fractures of greater tuberosity, and to demonstrate the stability of the plate.Methods:A Finite Element Method (FEM) simulation analysis was performed on a Kaisidis plate fixed with nine screws, in a greater tuberosity fracture model. Solid Works 2015 simulation software was used for the analysis. The Kaisidis plate is a bone plate intended for greater tuberosity fractures. It is a low profile plate with nine holes for 2,4 mm diameter locking screws, eight suture holes and additional K-wire holes for temporary fixation of the fragment.The supraspinatus tendon has the greatest effect on the fracture zone, and as such, was the primary focus for this study. For this study, we performed only linear calculations.Results:The calculations were performed in a way so that the total applied force resulted in a maximum stress of 816 N/mm2. The findings indicated that the most critical points of the Kaisidis system are the screws that are connected to the bone. The maximal force generated by the supraspinatus tendon was 784 N, which is higher than the minimal acceptable force.The results of the FEM analysis showed that the maximal supraspinatus force was 11.6% higher than the minimal acceptable force. As such, the load would exceed twice the amount of maximal force required to tear the supraspinatus tendon, before the screw or the plate would show first signs of plastic deformation.Conclusion:Based on the results of this analysis and the fulfilment of our acceptance criterion, the FEM model indicated that the strength of the Kaisidis plate exceeded that of the proposed maximum loads under non-cycli loading conditions.

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Section: Introductionsupporting

confidence: 80%

Biomechanical Analysis of the Fixation Strength of a Novel Plate for Greater Tuberosity Fractures

Kaisidis

Pantos

Bochlos

et al. 2018

TOORTHJ

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“…Additionally, arthroscopic double-row suture anchor fixation may damage the rotator cuff, as the medial anchors are inserted through the intact cuff attached to the greater tuberosity fragment [17,19]. As for ORIF, several alternative surgical techniques are available for use such as a tension band which may have fewer differences compared with the arthroscopic technique, however, it was reported in a biomechanical study that a locking plate provides superior fixation of a greater tuberosity fracture compared with tension bands [10]. We used the locking plate because we thought it would improve fracture healing by distributing its pressure over a larger area [5,6,26,32].…”

Section: Discussionmentioning

confidence: 99%

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

Liao¹,

Zhang²,

Li³

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Arthroscopic double-row suture-anchor fixation and open reduction and internal fixation (ORIF) are used to treat displaced greater tuberosity fractures, but there are few data that can help guide the surgeon in choosing between these approaches. Questions/Purposes We therefore asked: (1) Is there a difference in surgical time between arthroscopic doublerow suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures? (2) Are there differences in the postoperative ROM and functional scores between arthroscopic double-row suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures? (3) Are there differences in complications resulting in additional operations between the two approaches?Methods Between 2006 and 2012, we treated 79 patients surgically for displaced greater tuberosity fractures. Of those, 32 (41%) were considered eligible for our study based on inclusion criteria for isolated displaced greater tuberosity fractures with a displacement of at least 5 mm but less than 2 cm. During that time, we generally treated patients with displaced greater tuberosity fractures with a displacement greater than 1 cm or with a fragment size greater than 393 cm with open treatment, and patients with displaced greater tuberosity fractures with a displacement less than 1 cm or with a fragment size less than 393 cm with arthroscopic treatment. Fifty-three underwent open treatment based on those indications, and 26 underwent arthroscopic treatment, of whom 17 (32%) and 15 (58%) were available for followup at a mean of 34 months (range, 24-28 months). All patients with such fractures identified from our institutional database were treated by these two approaches and no other methods were used. Surgical time was defined as the time from initiation of the incision to the time when suture of the incision was finished, and was determined by an observer with a stopwatch. Patients were followed up in the outpatient department at 6, 12, and 24 weeks, and every 6 month thereafter. Radiographs showed optimal reduction immediately after surgery and at every followup. Radiographs were obtained to assess fracture healing. Patients were followed up for a mean of 34 months (range, 24-48 months). At the last followup, ROM, VAS score, and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate clinical outcomes. All these data were retrieved from our institutional database through chart review. Complications were assessed through chart review by one observer other than the operating surgeon.

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“…The mini-locking plate can sufficiently cover fracture fragments, and the locking screws can be fixed at angles even in osteoporotic fracture fragments, yielding good tensile strength and anchor force to ensure the fixation strength of the fractured fragments, such that displacement cannot easily occur. Gaudelli et al 22 reported that locking plate fixation provided stronger and stiffer biomechanical fixation than tension bands and doublerow suture bridges for split-type greater tuberosity fractures. Compared with nonsurgical management, patients can perform shoulder function exercises earlier.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study in the Treatment of a 2-Part Greater Tuberosity Fracture Using the F3 Biomet Plate

Zhao

Liu

et al. 2016

International Surgery

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The purpose of this study was to evaluate the clinical efficacy of the F3 Biomet plate in the treatment of 2-part displaced humeral greater tuberosity fractures. We compared the clinical outcomes of patients with displaced greater tuberosity fractures who underwent surgical treatment using an F3 plate with those of patients who were treated nonsurgically. Eleven patients with 2-part displaced humeral greater tuberosity fractures were surgically treated with use of an F3 Biomet plate, whereas 12 patients with equal injuries were treated nonsurgically. Each patient underwent follow-up for at least 1 year. We retrospectively collected data and analyzed the clinical outcomes. The Constant score and DASH score were used to assess the shoulder function, and X-rays were taken to evaluate the fracture healing. X-rays of the patients in both groups showed that the fractures achieved union after the 1-year follow-up. Patients treated surgically with an F3 plate and open reduction internal fixation had better Constant score and DASH score results for shoulder function than those treated nonsurgically. In the present study, surgical treatment of displaced humeral greater tuberosity fractures with the use of an F3 plate led to a 100% union rate and good clinical outcomes. The F3 Biomet plate can be considered an effective implant for the treatment of displaced humeral greater tuberosity fractures. The level of evidence is therapeutic III.

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Locking plate fixation provides superior fixation of humerus split type greater tuberosity fractures than tension bands and double row suture bridges

Cited by 28 publications

References 12 publications

Biomechanical Analysis of the Fixation Strength of a Novel Plate for Greater Tuberosity Fractures

Biomechanical Analysis of the Fixation Strength of a Novel Plate for Greater Tuberosity Fractures

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

A Retrospective Study in the Treatment of a 2-Part Greater Tuberosity Fracture Using the F3 Biomet Plate

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