Advertisement

How to improve the biomechanical stability of endosteal augmentation for proximal humerus fracture with osteopenia? A cadaveric study

  • Author Footnotes
    1 These authors contributed equally to this work.
    Zhengguo Zhu
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    The Department of Orthopaedic Trauma, Chinese PLA General hospital (301 Hospital), 28 Fuxing Road, Wukesong, Beijing 100853, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
    Zuhao Chang
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    The Department of Orthopaedic Trauma, Chinese PLA General hospital (301 Hospital), 28 Fuxing Road, Wukesong, Beijing 100853, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
    Wei Zhang
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    AI Sports Engineering Lab, School of Sports Engineering, Beijing Sport University, Beijing, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
    Shaobo Nie
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    The Department of Orthopaedic Trauma, Chinese PLA General hospital (301 Hospital), 28 Fuxing Road, Wukesong, Beijing 100853, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
    Lin Qi
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    The Department of Orthopaedic Trauma, Chinese PLA General hospital (301 Hospital), 28 Fuxing Road, Wukesong, Beijing 100853, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
    Peifu Tang
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    The Department of Orthopaedic Trauma, Chinese PLA General hospital (301 Hospital), 28 Fuxing Road, Wukesong, Beijing 100853, China
    Search for articles by this author
  • Hua Chen
    Correspondence
    Corresponding authors.
    Affiliations
    The Department of Orthopaedic Trauma, Chinese PLA General hospital (301 Hospital), 28 Fuxing Road, Wukesong, Beijing 100853, China
    Search for articles by this author
  • Yujie Liu
    Correspondence
    Corresponding authors.
    Affiliations
    The Department of Orthopaedic Trauma, Chinese PLA General hospital (301 Hospital), 28 Fuxing Road, Wukesong, Beijing 100853, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bae J.H.
        • Oh J.K.
        • Chon C.S.
        • Oh C.W.
        • Yoon Y.C.
        The biomechanical performance of locking plate fixation with intramedullary fibular strut graft augmentation in the treatment of unstable fractures of the proximal humerus.
        J. Bone Joint Surg. (Br.). 2011; 93: 937
        • Bai L.
        • Fu Z.
        • An S.
        • Zhang P.
        • Zhang D.
        • Jiang B.
        Effect of calcar screw use in surgical neck fractures of the proximal Humerus with unstable medial support: A biomechanical study.
        J. Orthop. Trauma. 2014; 28: 452-457https://doi.org/10.1097/bot.0000000000000057
        • Bergmann G.
        • Graichen F.
        • Bender A.
        • Rohlmann A.
        • Westerhoff P.
        In vivo glenohumeral contact forces--measurements in the first patient 7 months postoperatively.
        J. Biomech. 2007; 40: 2139-2149
        • Brianza S.
        • Plecko M.
        • Gueorguiev B.
        • Windolf M.
        • Schwieger K.
        Biomechanical evaluation of a new fixation technique for internal fixation of three-part proximal humerus fractures in a novel cadaveric model.
        Clin. Biomech. (Bristol, Avon). 2010; 25: 886-892https://doi.org/10.1016/j.clinbiomech.2010.06.015
        • Burke N.G.
        • Kennedy J.
        • Cousins G.
        • Fitzpatrick D.
        • Mullett H.
        Locking plate fixation with and without inferomedial screws for proximal humeral fractures: a biomechanical study.
        J. Orthop. Surg. (Hong Kong). 2014; 22: 190-194https://doi.org/10.1177/230949901402200215
        • Chen H.
        • Zhu Z.G.
        • Li J.T.
        • Chang Z.H.
        • Tang P.F.
        Finite element analysis of an intramedulary anatomical strut for proximal humeral fractures with disrupted medial column instability: A cohort study - ScienceDirect.
        Int. J. Surg. 2020; 73: 50-56
        • Chow R.
        • Begum F.
        • Beaupre L.
        • Carey J.
        • Adeeb S.
        • Bouliane M.
        Proximal humeral fracture fixation: locking plate construct ± intramedullary fibular allograft.
        J. Shoulder Elb. Surg. 2012; 21: 894-901https://doi.org/10.1016/j.jse.2011.04.015
        • Erdoğan M.
        • Desteli E.E.
        • İmren Y.
        • Üztürk A.
        • Kılıç M.
        • Sezgin H.
        The effect of inferomedial screw on postoperative shoulder function and mechanical alignment in proximal humerus fractures.
        Eur. J. Orthop. Surg. Traumatol. 2014; 24: 1055-1059https://doi.org/10.1007/s00590-013-1391-y
        • Favre P.
        • Sheikh R.
        • Fucentese S.F.
        • Jacob H.
        An algorithm for estimation of shoulder muscle forces for clinical use.
        Clin. Biomech. 2005; 20: 822-833
        • Gardner M.J.
        • Weil Y.
        • Barker J.U.
        • Kelly B.T.
        • Helfet D.L.
        • Lorich D.G.
        The importance of medial support in locked plating of proximal humerus fractures.
        J. Orthop. Trauma. 2007; 21: 185-191https://doi.org/10.1097/BOT.0b013e3180333094
        • Gardner M.J.
        • Boraiah S.
        • Helfet D.L.
        • Lorich D.G.
        Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant.
        J. Orthop. Trauma. 2008; 22: 195-200https://doi.org/10.1097/BOT.0b013e31815b3922
        • Hsiao C.K.
        • Tsai Y.J.
        • Yen C.Y.
        • Lee C.H.
        • Yang T.Y.
        • Tu Y.K.
        Intramedullary cortical bone strut improves the cyclic stability of osteoporotic proximal humeral fractures.
        BMC Musculoskelet. Disord. 2017; 18
        • Katthagen J.C.
        • Schwarze M.
        • Meyer-Kobbe J.
        • Voigt C.
        • Hurschler C.
        • Lill H.
        Biomechanical effects of calcar screws and bone block augmentation on medial support in locked plating of proximal humeral fractures.
        Clin. Biomech. 2014; 29: 735-741
        • Kim D.
        • Lee D.
        • Chun Y.
        • Shin S.
        Which additional augmented fixation procedure decreases surgical failure after proximal humeral fracture with medial comminution: fibular allograft or inferomedial screws?.
        J. Shoulder Elb. Surg. 2018; 27: 1852-1858https://doi.org/10.1016/j.jse.2018.03.020
        • Klug A.
        • Wincheringer D.
        • Harth J.
        • Schmidt-Horlohé K.
        • Hoffmann R.
        • Gramlich Y.
        Complications after surgical treatment of proximal humerus fractures in the elderly-an analysis of complication patterns and risk factors for reverse shoulder arthroplasty and angular-stable plating.
        J. Shoulder Elb. Surg. 2019; 28: 1674-1684https://doi.org/10.1016/j.jse.2019.02.017
        • Lee S.
        • Han S.
        • Yoo B.
        • Kim J.
        Outcomes of locking plate fixation with fibular allograft augmentation for proximal humeral fractures in osteoporotic patients: comparison with locking plate fixation alone.
        Bone Joint J. 2019; : 260-265https://doi.org/10.1302/0301-620x.101b3.bjj-2018-0802.r1
        • Little M.
        • Berkes M.
        • Schottel P.
        • Lazaro L.
        • LaMont L.
        • Pardee N.
        • et al.
        The impact of preoperative coronal plane deformity on proximal humerus fixation with endosteal augmentation.
        J. Orthop. Trauma. 2014; 28: 338-347https://doi.org/10.1097/bot.0000000000000012
        • Mao F.
        • Zhang D.H.
        • Peng X.C.
        • Liao Y.
        Comparison of surgical versus non-surgical treatment of displaced 3- and 4-part fractures of the proximal Humerus: A Meta-analysis.
        J. Investig. Surg. 2015; 28: 215-224
        • Matassi F.
        • Angeloni R.
        • Carulli C.
        • Civinini R.
        • Di Bella L.
        • Redl B.
        • et al.
        Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus.
        Injury. 2012; 43: 1939-1942https://doi.org/10.1016/j.injury.2012.08.004
        • Mease S.
        • Kraeutler M.
        • Gonzales-Luna D.
        • Gregory J.
        • Gardner M.
        • Choo A.
        Current controversies in the treatment of geriatric proximal humeral fractures.
        J. Bone Joint Surg. Am. 2021; 103: 829-836https://doi.org/10.2106/jbjs.20.00665
        • Neviaser A.
        • Hettrich C.
        • Beamer B.
        • Dines J.
        • Lorich D.
        Endosteal strut augment reduces complications associated with proximal humeral locking plates.
        Clin. Orthop. Relat. Res. 2011; 469: 3300-3306https://doi.org/10.1007/s11999-011-1949-0
        • Palvanen M.
        • Kannus P.
        • Niemi S.
        • Parkkari J.
        Update in the epidemiology of proximal humeral fractures.
        Clin. Orthop. Relat. Res. 2006; 442: 87-92https://doi.org/10.1097/01.blo.0000194672.79634.78
        • Ponce B.
        • Thompson K.
        • Raghava P.
        • Eberhardt A.
        • Tate J.
        • Volgas D.
        • et al.
        The role of medial comminution and calcar restoration in varus collapse of proximal humeral fractures treated with locking plates.
        J. Bone Joint Surg. Am. 2013; 95 (e113(111-117))https://doi.org/10.2106/jbjs.K.00202
        • Yahuaca B.
        • Simon P.
        • Christmas K.
        • Patel S.
        • Gorman R.
        • Mighell M.
        • et al.
        Acute surgical management of proximal humerus fractures: ORIF vs. hemiarthroplasty vs. reverse shoulder arthroplasty.
        J. Shoulder Elb. Surg. 2020; 29: S32-S40https://doi.org/10.1016/j.jse.2019.10.012
        • Zhang W.
        • Zeng L.
        • Liu Y.
        • Pan Y.
        • Zhang W.
        • Zhang C.
        • et al.
        The mechanical benefit of medial support screws in locking plating of proximal humerus fractures.
        PLoS One. 2014; 9e103297https://doi.org/10.1371/journal.pone.0103297