No Contribution of Tension-Reducing Rotator Cuff Sutures on Locking Plate Fixation in a 2-Part Proximal Humerus Fracture Model

Sinatra, Philip M.; Jernick, Michael L.; Bledsoe, Gary; Kaar, Scott G.

doi:10.1097/bot.0000000000000051

Cited by 11 publications

(18 citation statements)

References 29 publications

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“…The lack of consistency regarding the optimal fixation of 2-part PHFs with medial calcar disruption in elderly individuals in the literature, 15,16 accompanied by the debilitating nature of shoulder function, warrants further exploration into this challenging issue. We performed this retrospective study to assess outcomes of older patients sustaining 2-part PHFs with medial column disruption stabilized using this PHILOS plate plus oblique insertion of autologous fibula as a primary procedure.…”

Section: Introductionmentioning

confidence: 99%

PHILOS Plate Plus Oblique Insertion of Autologous Fibula for 2-Part Proximal Humerus Fractures With Medial Column Disruption: A Retrospective Study

Shu

Chen

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction: The aim of this retrospective study was to evaluate the outcomes of older patients with 2-part proximal humerus fractures (PHFs) with medial column disruption stabilized using a proximal humeral internal locking system (PHILOS) plate plus oblique insertion of autologous fibula as a primary procedure. Materials and Methods: Data involving 112 patients (112 shoulders) sustaining 2-part PHFs with medial column disruption treated with PHILOS plate plus oblique insertion of autologous fibula as a primary procedure during 2012-2019 were identified. The median follow-up was 36 months (range: 11.2-43.5 months). The primary endpoint was the Constant scores and American Shoulder and Elbow Surgeons (ASES) scores. The secondary endpoint was the main orthopedic complication rate. Results: The median Constant and ASES scores were 78 (range, 52-95) and 77 (range, 62-96) at the final follow-up, respectively. The main orthopedic complication rate was 10.7% (12/112). Twelve orthopedic complications in 8 patients were detected, and they involved loss of reduction, varus collapse, aseptic loosening, mal-union, revision, and intolerable shoulder pain. Of these complications, 3 (2.6%) involved loss of reduction, 2 (1.7%) involved varus collapse, 3 (2.6%) involved aseptic loosening, 1 (0.8%) involved mal-union, 2 (1.7%) required revision surgery, and 1 (0.8%) presented intolerable shoulder pain. Conclusion: PHILOS plate plus oblique insertion of autologous fibula as a primary procedure may yield good functional outcomes and a low rate of the main orthopedic complications.

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Section: Introductionmentioning

confidence: 99%

PHILOS Plate Plus Oblique Insertion of Autologous Fibula for 2-Part Proximal Humerus Fractures With Medial Column Disruption: A Retrospective Study

Shu

Chen

et al. 2021

Geriatr Orthop Surg Rehabil

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“…As noted, previous investigations evaluating the use of suture fixation into the rotator cuff in 2-part and 3-part proximal humerus fractures have concluded that there is no benefit to this practice. 8,9 In these studies, tuberosities remained attached to the head fragment or were part of a large cortical piece that was well secured by the plate and screw device, a situation that is uncommonly encountered in more complex fracture patterns where the tuberosity fragments are uncommonly so large. This discordance between recommended clinical practice and biomechanical data was an additional reason we sought to investigate the contribution of muscular forces on fracture alignment.…”

Section: Discussionmentioning

confidence: 99%

Muscular Forces Responsible for Proximal Humeral Deformity After Fracture

Chalmers

Wright

Patel

et al. 2022

Journal of Orthopaedic Trauma

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Objectives: To evaluate the contribution of each of the rotator cuff muscles and deltoid to fracture deformity in a 2-part proximal humerus fracture model. Our hypothesis was that superior cuff muscles would have the greatest contribution to coronal plane deformity, whereas muscles with anterior and posterior attachments would have the greatest contribution to axial and sagittal plane deformity.Methods: A medial wedge osteotomy was created in 8 cadaveric shoulder specimens. A custom shoulder testing system was used to load each rotator cuff muscle and deltoid under increasing loading conditions. Fracture displacement was measured using a Microscribe digitizing system. The primary outcome was the contribution of each muscle to varus collapse. Secondary outcomes included contributions of each muscle to apex anterior/posterior deformity and humeral head anteversion/retroversion.Results: Unbalanced loading of the supraspinatus resulted in the greatest varus deformity (34.5 6 2.3 degrees), followed by the infraspinatus (22.3 6 3.6 degrees) and subscapularis (21.7 6 3.1 degree) (P , 0.05). Unbalanced loading of the subscapularis induced the greatest apex posterior (27.5 6 4.8 degrees, P , 0.05) and retroversion (39.0 6 5.6 degrees, P , 0.05) deformity, whereas the infraspinatus induced the greatest apex anterior (8.7 6 3.4 degrees, P . 0.05) and anteversion (17.7 6 5.7 degrees, P . 0.05) deformity. Conclusions:In this proximal humerus fracture model, the supraspinatus was the primary driver of varus deformity, whereas the subscapularis and infraspinatus contributed to apex posterior/ retroversion and apex anterior/anteversion, respectively. The subscapularis and infraspinatus are also important secondary drivers of varus deformity. This study establishes a physiologically relevant fracture model that mimics in vivo conditions for future biomechanical testing.

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“…The interfragmentary displacements and rotations recorded from these systems can help locate regions of local instability within construct, especially in complex three-part fractures [ 57 , 61 , 82 , 84 ]. Also, fracture gap distance and the relative displacements and rotations between bone and implant can been calculated from these systems [ 64 , 69 , 85 – 87 ]. These two parameters have the advantage that they are both already measured in clinic to assess post-operative stability of bone-plate constructs [ 112 – 114 ].…”

Section: Discussionmentioning

confidence: 99%

“…The same three muscles were loaded by Walsh et al [ 81 ] to represent glenohumeral abduction of 30°. Two studies [ 85 , 86 ] testing cadaveric tendons were based on the biomechanical study by Osterhoff et al [ 71 ]. Sinatra et al [ 85 ] used custom-made shoulder testing setup connected to a material testing machine to recreate 50–100° single plane shoulder abduction.…”

Section: Biomechanical Testing Of Proximal Humerus Platesmentioning

confidence: 99%

“…Two studies [ 85 , 86 ] testing cadaveric tendons were based on the biomechanical study by Osterhoff et al [ 71 ]. Sinatra et al [ 85 ] used custom-made shoulder testing setup connected to a material testing machine to recreate 50–100° single plane shoulder abduction. This was achieved with the application of cyclic tensile forces to supraspinatus, infraspinatus, subscapularis, and teres minor tendons while lifting 5 lbs to simulate arm weight.…”

Section: Biomechanical Testing Of Proximal Humerus Platesmentioning

confidence: 99%

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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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No Contribution of Tension-Reducing Rotator Cuff Sutures on Locking Plate Fixation in a 2-Part Proximal Humerus Fracture Model

Abstract: Tension-relieving rotator cuff sutures added to locking plate fixation did not lead to a change in fracture gap with cyclic loading or an increase in ultimate failure load in a 2-part surgical neck proximal humerus fracture model without medial support.

Cited by 11 publications

References 29 publications

PHILOS Plate Plus Oblique Insertion of Autologous Fibula for 2-Part Proximal Humerus Fractures With Medial Column Disruption: A Retrospective Study

PHILOS Plate Plus Oblique Insertion of Autologous Fibula for 2-Part Proximal Humerus Fractures With Medial Column Disruption: A Retrospective Study

Muscular Forces Responsible for Proximal Humeral Deformity After Fracture

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

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