Locking Plate Fixation with and without Inferomedial Screws for Proximal Humeral Fractures: A Biomechanical Study

Burke, Naomi; Kennedy, Jim; Cousins, Gráinne; FitzPatrick, D.; Mullett, Hannan

doi:10.1177/230949901402200215

Cited by 34 publications

(28 citation statements)

References 24 publications

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“…Our biomechanical approach shown here specifically addressed the two-part model of such injury instead of the three- or four-part model, with the latter being biomechanically more complex and less feasible to standardize. The two-part model shown here has been established and widely used to answer biomechanical questions concerning the proximal humerus [ 16 , 21 , 22 , 27 ]. For this purpose, human cadaveric specimens with an average age of 66.8 ± 17.1 years and BMD values corresponding to the patients who typically suffer from proximal humerus fractures were used [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Biomechanical evaluation of hybrid double plate osteosynthesis using a locking plate and an inverted third tubular plate for the treatment of proximal humeral fractures

Theopold¹,

Schleifenbaum²,

Müller³

et al. 2018

PLoS ONE

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BackgroundTreating proximal humerus fractures can be challenging because of large metaphyseal defects that conceal anatomical landmarks. In such cases, medial cortical support with, for example, calcar screws, is mandatory. Nevertheless, varus dislocations and implant failures in patients with impaired bone quality persist. Thus, the need for effective treatment of these patients exists. Hybrid double plate osteosynthesis was introduced as an alternative, yielding similar results as calcar screws. However, a biomechanical comparison of the stability of these two techniques is pending.MethodsCadaveric humeral specimens were treated with plate osteosynthesis and calcar screws (group 1, n = 9) or hybrid double plate osteosynthesis (group 2, n = 9) using a proximal humerus fracture model with a two-part fracture. Displacement, stiffness, failure mode, and ultimate load were examined biomechanically in a cyclic compressive-loading scenario.ResultsAlthough the hybrid double plate osteosynthesis (group 2) tended to confer higher stiffnesses than the medial support screws at higher cycles (group 1), this trend was below the level of significance. The displacement revealed non-significantly lower values for group 1 as compared with group 2 for cycles 50 and 2000, but at 5000 cycles, group 2 offered non-significantly lower displacement values than group 1. The ultimate load tended to be non-significantly higher in the hybrid double plate osteosynthesis group (group 2: 1342±369 N, group 1: 855±408 N). Both groups yielded similar failure rates, with the majority of failures in group 2 being gap closures (n = 8), whereas those in group 1 being plate dislocations (n = 4).ConclusionsThe use of an additive plate osteosynthesis in the region of the bicipital groove may be a potential alternative to the previously-established method of using calcar screws. The biomechanical data obtained in this study suggests that hybrid double plate osteosynthesis is as rigid and robust as calcar screws.

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Section: Discussionmentioning

confidence: 99%

Biomechanical evaluation of hybrid double plate osteosynthesis using a locking plate and an inverted third tubular plate for the treatment of proximal humeral fractures

Theopold¹,

Schleifenbaum²,

Müller³

et al. 2018

PLoS ONE

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“…Each category also included studies testing two- and three-part fracture models as well as static and cyclic loading. Overall, synthetic humeri were assessed in ten studies [ 41 , 47 , 55 , 59 , 62 , 66 , 70 – 73 ] while others tested human cadaveric humeri. Only two studies involved four-part fractures [ 72 , 73 ], both of which belonged to humerus-tendon category.…”

Section: Biomechanical Testing Of Proximal Humerus Platesmentioning

confidence: 99%

“…Koval et al fixed the humeral shaft at 20° of abduction to simulate the primarily shear loading (approximately twice the amount of shear than compression) of the bone-plate construct. This set up acted as the basis for nine biomechanical studies [ 37 , 41 , 42 , 46 , 47 , 62 , 63 , 66 , 70 ]. As well as 20° abduction, Lever et al [ 63 ] mounted the shaft at 20° of forward flexion in a similar manner to Koval et al…”

Section: Biomechanical Testing Of Proximal Humerus Platesmentioning

confidence: 99%

Biomechanical analysis of plate systems for proximal humerus fractures: a systematic literature review

2018

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BackgroundProximal humerus fractures are the third most common in the human body but their management remains controversial. Open reduction and internal fixation with plates is one of the leading modes of operative treatment for these fractures. The development of technologies and techniques for these plates, during the recent decades, promise a bright future for their clinical use. A comprehensive review of in vitro biomechanical studies is needed for the comparison of plates’ mechanical performance and the testing methodologies. This will not only guide clinicians with plate selection but also with the design of future in vitro biomechanical studies. This review was aimed to systematically categorise and review the in vitro biomechanical studies of these plates based on their protocols and discuss their results. The technologies and techniques investigated in these studies were categorised and compared to reach a census where possible.Methods and resultsWeb of Science and Scopus database search yielded 62 studies. Out of these, 51 performed axial loading, torsion, bending and/or combined bending and axial loading while 11 simulated complex glenohumeral movements by using tendons. Loading conditions and set-up, failure criteria and performance parameters, as well as results for each study, were reviewed. Only two studies tested four-part fracture model while the rest investigated two- and three-part fractures. In ten studies, synthetic humeri were tested instead of cadaveric ones. In addition to load–displacement data, three-dimensional motion analysis systems, digital image correlation and acoustic emission testing have been used for measurement.ConclusionsOverall, PHILOS was the most tested plate and locking plates demonstrated better mechanical performance than non-locking ones. Conflicting results have been published for their comparison with non-locking blade plates and polyaxial locking screws. Augmentation with cement [calcium phosphate or poly(methyl methacrylate)] or allografts (fibular and femoral head) was found to improve bone-plate constructs’ mechanical performance. Controversy still lies over the use of rigid and semi-rigid implants and the insertion of inferomedial screws for calcar region support. This review will guide the design of in vitro and in silico biomechanical tests and also supplement the study of clinical literature.Electronic supplementary materialThe online version of this article (10.1186/s12938-018-0479-3) contains supplementary material, which is available to authorized users.

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“…Both Burke et al and Lescheid et al used synthetic humerus models to compare the efficacies of locking plate fixation with or without medial column support in maintaining the reduction of proximal humeral fractures. They both presented promising results that medial column support provided more stable reconstruction and reduced complications [ 67 , 68 ]. More importantly, the significance of medial column support was verified by finite element analysis.…”

Section: Applicationsmentioning

confidence: 99%

The Applications of Finite Element Analysis in Proximal Humeral Fractures

You

Zhu

et al. 2017

Computational and Mathematical Methods in Medicine

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Proximal humeral fractures are common and most challenging, due to the complexity of the glenohumeral joint, especially in the geriatric population with impacted fractures, that the development of implants continues because currently the problems with their fixation are not solved. Pre-, intra-, and postoperative assessments are crucial in management of those patients. Finite element analysis, as one of the valuable tools, has been implemented as an effective and noninvasive method to analyze proximal humeral fractures, providing solid evidence for management of troublesome patients. However, no review article about the applications and effects of finite element analysis in assessing proximal humeral fractures has been reported yet. This review article summarized the applications, contribution, and clinical significance of finite element analysis in assessing proximal humeral fractures. Furthermore, the limitations of finite element analysis, the difficulties of more realistic simulation, and the validation and also the creation of validated FE models were discussed. We concluded that although some advancements in proximal humeral fractures researches have been made by using finite element analysis, utility of this powerful tool for routine clinical management and adequate simulation requires more state-of-the-art studies to provide evidence and bases.

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Locking Plate Fixation with and without Inferomedial Screws for Proximal Humeral Fractures: A Biomechanical Study

Cited by 34 publications

References 24 publications

Biomechanical evaluation of hybrid double plate osteosynthesis using a locking plate and an inverted third tubular plate for the treatment of proximal humeral fractures

Biomechanical evaluation of hybrid double plate osteosynthesis using a locking plate and an inverted third tubular plate for the treatment of proximal humeral fractures

Biomechanical analysis of plate systems for proximal humerus fractures: a systematic literature review

The Applications of Finite Element Analysis in Proximal Humeral Fractures

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