Highlights
- •Parameters to improve elderly proximal humeral fracture fixation are studied.
- •Longer endosteal fibular augmentation enhanced lateral locking plate fixation.
- •Calcar screws improved the biomechanical stability irrespective of fibular length.
Abstract
Background
Endosteal augmentation enhances the stability of osteoporotic proximal humeral fracture
fixation, but the optimal configuration is unknown. The purpose of this study was
to compare the biomechanical properties of different lengths of fibula with or without
calcar screw in osteoporotic proximal humeral fracture.
Methods
Three-part proximal humeral fractures with osteopenia were created on 20 pairs of
fresh-frozen humeri specimens and allocated to four groups: (1) locking plate with
a 6-cm fibular strut allograft, (2) locking plate with a 6-cm fibular strut allograft
and additional calcar screws, (3) locking plate with a 12-cm fibular strut allograft，and
(4) locking plate with a 12-cm fibular strut allograft and additional calcar screws.
Specimens were loaded to simulate the force at 25° abduction. Thereafter, an axial
stiffness test and a compound cyclic load to failure test were applied. Structural
stiffness, number of cycles loaded to failure and relative displacement values for
5000 cycles at predetermined measurement points were recorded using a testing machine
and a synchronized 3D video tracking system.
Findings
In terms of initial stiffness, number of cycles loaded to failure, and relative displacement
values, the groups with 12-cm fibular strut showed obvious improvement compared to
the groups with 6-cm fibular strut irrespective of the influence of calcar screw implementation.
Further, the groups implemented with calcar screws also showed promising biomechanical
stability irrespective of fibular length.
Interpretation
Lateral locking plate with longer endosteal fibular augmentation and calcar screw
can significantly improve biomechanical stability for elderly proximal humeral fractures
with posteromedial comminution.
Keywords
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Article info
Publication history
Published online: December 01, 2022
Accepted:
November 29,
2022
Received:
July 12,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
