Mechanical Comparison in Cadaver Specimens of Three Different 90-Degree Double-Plate Osteosyntheses for Simulated C2-Type Distal Humerus Fractures With Varying Bone Densities

Abstract

Bone-implant anchorage was different between locking and nonlocking plate constructs and depended on BMD. While in good bone quality implant choice was not critical, both locking plates provided superior resistance against screw loosening as compared to the CRP at low BMD values (<420 mg/cm). Based on our laboratory results, we conclude that locking plates such as the LCP and DHP are constructs designed to keep anatomical reduction in the presence of comminution and poor bone quality in a low intra-articular fracture of the distal humerus.

Comparative study of three models of extra-articular distal humerus fracture osteosynthesis using the finite element method on an osteoporotic computational model

“…Under physiological conditions, most pronounced are the flexion 15 and lateral 12,18 load, while the axial load is considerably smaller. Significantly smaller displacements under axial load obtained in this study as well suggest a substantially lesser importance of that load in the overall evaluation of the construction's biomechanical stability, which is in line with previous studies 17 , although they were not conducted on the same level of the distal humerus.…”

“…11,[13][14][15][16][17][18] No study to date has addressed the issue of biomechanical stability on the transition of the distal humeral diaphysis into the distal segment of the humerus.…”

“…[15][16][17] Loads applied in the study are within the physiological limits of loads in everyday activity of the postoperative rehabilitation period, and we avoided applying loads that would cause permanent plastic deformations on the implants. Furthermore, choosing the 10 mm gap length for this study was aimed at achieving extreme instability on the biomechanical model.…”

“…Those studies are very uneven: with regard to the number and types of models, methods and load directions, methods and precision of displacements measurements, and thus the conclusions derived from them are hardly mutually comparable. 11,[13][14][15][16][17][18] Using the finite element method, attempts were made to find the optimal plate configuration which would improve its biomechanical properties, taking into account the specific anatomy of the distal humerus.…”

“…9 No prospective randomized studies have been published on their outcomes, and the majority of the studies carried out were retrospective and involved a small number of patients. [10][11][12][13][14][15][16][17][18][19][20][21][22][23] Hence it is not possible to draw conclusions from them on the ideal configuration of the implant for stabilization of distal humerus fractures. …”