How can medial support for proximal humeral fractures be achieved when positioning of regular calcar screws is challenging? Slotting and off-axis fixation strategies

2021 ◽  
Author(s):  
Jian Xu ◽  
Shi Zhan ◽  
Ming Ling ◽  
Dajun Jiang ◽  
Hai Hu ◽  
...  
Keyword(s):  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Medial Support ◽  
Axis Fixation ◽  
Calcar Screws

Biomechanical effects of calcar screws and bone block augmentation on medial support in locked plating of proximal humeral fractures

2014 ◽  
Vol 29 (7) ◽  
pp. 735-741 ◽  
Author(s):  
Jan Christoph Katthagen ◽  
Michael Schwarze ◽  
Josefin Meyer-Kobbe ◽  
Christine Voigt ◽  
Christof Hurschler ◽  
...  
Keyword(s):  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Bone Block ◽  
Locked Plating ◽  
Medial Support ◽  
Calcar Screws

BIOMECHANICAL COMPARISON OF THE ROLE OF INLAY GRAFT IN PROXIMAL HUMERUS FRACTURE FIXED WITH CONVENTIONAL PLATE AND LOCKING PLATE

2013 ◽  
Vol 13 (04) ◽  
pp. 1350055 ◽  
Author(s):  
CHENG-HUNG LEE ◽  
KUI-CHOU HUANG ◽  
CHIH-KUN HSIAO ◽  
SUNG CHENG ◽  
YAU-CHIA LIU ◽  
...  
Keyword(s):  
Locking Plate ◽  
Proximal Humerus ◽  
Varus Deformity ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Locking Plates ◽  
Medial Support ◽  
Maximal Load ◽  
Conventional Plate

With a varus deformity, repairs of proximal humeral fractures frequently fail after screws pull out due to lack of medial support. Indirect intramedullary grafts have been used to prevent such complications. A biomechanical study was performed to investigate the role of an intramedullary bone peg (strut) in fractures fixed with conventional and locking plates. Twenty artificial proximal humerus specimens were divided into four groups. Group 1 specimens were fixed with convention plates and group 2 specimens were fixed with the addition of a bone peg. Groups 3 and 4 specimens were fixed using locking plate and additional bone peg, respectively. All specimens were tested with a static loading test, and the axial stiffness and maximal load were recorded. Locking plates with inlay graft were the most rigid of the four groups. When an intramedullary graft was introduced, the maximal load increased by more than 200%, whether conventional or locking plates were used. The maximal load of a conventional plate with inlay graft was more than twice of that of the locking plate only. Indirect medial support acts as an anti-bending device, reducing the tension on the plate. It also decreases varus deformity and loosening of screws. Locking plate stabilize the plate-bone interface. Locking plate with indirect medial support is thus recommended for patients withsevere osteoporotic or medial comminuted proximal humeral fractures.

Medial support by fibula bone graft in angular stable plate fixation of proximal humeral fractures: an in vitro study with synthetic bone

2011 ◽  
Vol 20 (5) ◽  
pp. 740-746 ◽  
Author(s):  
Georg Osterhoff ◽  
Daniel Baumgartner ◽  
Philippe Favre ◽  
Guido A. Wanner ◽  
Hans Gerber ◽  
...  
Keyword(s):  
Bone Graft ◽  
Plate Fixation ◽  
In Vitro Study ◽  
Vitro Study ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Synthetic Bone ◽  
Medial Support

scholarly journals Application of a Lateral Intertubercular Sulcus Plate in the Treatment of Proximal Humeral Fractures: a Finite Element Analysis and Example in Clinical Practice

2021 ◽  
Author(s):  
Dong Li ◽  
WenXue Lv ◽  
WenMing Chen ◽  
Jing Meng ◽  
Song Liu ◽  
...  
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Locking Plate ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Element Analysis ◽  
Computed Tomography Images ◽  
Medial Support ◽  
Philos Plate ◽  
Intertubercular Sulcus

Abstract Background: Inversion deformities caused by insufficient medial support are especially common when the PHILOS locking plate is used to treat proximal humeral fractures. Using finite element analysis, the present study aimed to compare the biomechanical properties of a PHILOS locking plate (PLP) and a PHILOS plate combined with a lateral intertubercular sulcus plate (PLP-LSP) in the fixation of proximal humeral fractures with loss of the medial column. We also present representative results for a 69-year-old female patient with a comminuted fracture of the proximal right humerus (Neer type four-part fracture) who underwent successful surgical treatment with a PHILOS plate combined with an auxiliary lateral intertubercular sulcus plate. Methods: After creating a three-dimensional finite element model of proximal humeral fracture with loss of the medial column, three implant models were established. A full-screw PHILOS plate (PLP) was used in Group A, while a PHILOS plate lacking medial screw support and an auxiliary plate were used in Group B (MPLP-LSP). A full-screw PHILOS plate and auxiliary plate were used in Group C (PLP-LSP). The three fixation models were applied to the proximal humerus fracture model, following which horizontal, compressive, and rotational loads were applied to the humerus model. We evaluated the structural stiffness and stress distribution of the implant and compared displacement and angle changes among the three models. Results: Displacement and angle changes were smallest in Group C (PLP-LSP). The implant model used in Group C also had the highest structural rigidity, endured less von Misses stress than the other two models , and had the strongest stability. In our clinical case, X-ray and computed tomography images obtained 3 months after the operation indicated that the fracture had healed, with good positioning of internal fixation and good functional recovery.Conclusion: A lateral intertubercular sulcus plate placed at the internodal grove not only aids in anatomical reduction but also provides effective lateral and medial support, thereby reducing stress on the PHILOS plate and providing better stability in patients with proximal humeral fractures.

scholarly journals Plate Fixation for Irreducible Proximal Humeral Fractures in Children and Adolescents—A Single-Center Case Series of Six Patients

Children ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 635
Author(s):  
Florian Freislederer ◽  
Susanne Bensler ◽  
Thomas Specht ◽  
Olaf Magerkurth ◽  
Karim Eid
Keyword(s):  
Closed Reduction ◽  
Biceps Tendon ◽  
Plate Fixation ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Constant Murley Score ◽  
Fractures In Children ◽  
Initial Surgery ◽  
Conjoint Tendon

Background: Recommended treatment for severely displaced proximal humeral fractures in children is the closed reduction and percutaneous fixation by K-wires or intramedullary nailing. Methods: From January 2016 to January 2017 6, 21 children/adolescents (range 8 to 16 years) with proximal humeral fractures were treated surgically for severe displacement. In these six patients, several attempts of closed reduction were unsuccessful, and an open reduction was performed. The humeral head was fixed with a 3.5 mm T-plate without affecting the growth plate. Plate removal was performed at a mean interval of 132 days after initial surgery. Two years after initial surgery, the clinical outcome was assessed by the Constant–Murley score and QuickDASH score (including sport/music and work) and the shoulder joint was evaluated with a standardized sonographic examination for the rotator cuff and the conjoint tendon. Results: In all six patients, dorsal displacement of the fracture was irreducible due to the interposition of tendinous or osseous structures. Intraoperatively, the interposed structures were the long biceps tendon in two, periosteal tissue in two, a bony fragment in one, and the long biceps tendon together with the conjoint tendon in one case. At mean follow-up of 26 months (range 22 months to 29 months), patients showed very good clinical results with an excellent mean Constant–Murley score of 97.5 (range 91 to 100) and mean QuickDASH score (including sport/music and work) of 5.5 (range 0–20.8). An X-ray follow-up 6 weeks after surgery demonstrated early consolidation and correct alignment in all patients. A sonographic evaluation at 2 years post injury showed that the biceps and the conjoined tendon were intact in all patients. Conclusions: If a proximal humeral fracture is not reducible by closed means, a tissue entrapment (most likely biceps tendon) should be considered. Treatment with an open reduction and plate fixation yields very good clinical and radiological results and preserves interposed structures as the biceps and conjoint tendon.

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