Biomechanical evaluation of a novel dualplate fixation method for proximal humeral fractures without medial support

Objective This study was performed to evaluate the clinical effect of MultiLoc® nails (DePuy Synthes, Raynham, MA, USA) on the treatment of four-part proximal humeral fractures (PHFs). Methods From January 2014 to January 2018, 32 patients with four-part PHFs were treated with intramedullary MultiLoc® nails in our hospital. The operation time, bleeding volume, postoperative X-ray findings, and fracture healing status were recorded and analyzed. At the end of follow-up, the clinical outcome was evaluated based on the visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) shoulder score, Constant–Murley score (CMS), and occurrence of any complications. Results Among all patients, the average operation time was 124.5 minutes (range, 91–152 minutes), the average amount of bleeding was 90 mL (range, 55–150 mL), and the fracture healing rate was 100%. At the end of follow-up, the mean VAS score was 1.6 ± 0.4, mean ASES score was 84.4 ± 6.3, and mean CMS was 70.3 ± 6.1; no serious complications had occurred; and the patients exhibited good recovery of shoulder function. Conclusions MultiLoc nails® can be applied to the treatment of four-part PHFs. This surgical fixation method has no obvious complications and helps to restore shoulder function.

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

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2014.06.008 ◽

2014 ◽

Vol 29 (7) ◽

pp. 735-741 ◽

Cited By ~ 28

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

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Biomechanical evaluation of a new gliding screw concept for the fixation of proximal humeral fractures

Bone and Joint Research ◽

10.1302/2046-3758.76.bjr-2017-0356.r1 ◽

2018 ◽

Vol 7 (6) ◽

pp. 422-429 ◽

Cited By ~ 5

Author(s):

Y. P. Acklin ◽

I. Zderic ◽

J. A. Inzana ◽

S. Grechenig ◽

R. Schwyn ◽

...

Keyword(s):

Motion Tracking ◽

Plate Fixation ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

High Rate ◽

Initial Stiffness ◽

Screw Perforation ◽

Optical Motion ◽

Biomechanical Evaluation ◽

Philos Plate

Aims Plating displaced proximal humeral fractures is associated with a high rate of screw perforation. Dynamization of the proximal screws might prevent these complications. The aim of this study was to develop and evaluate a new gliding screw concept for plating proximal humeral fractures biomechanically. Methods Eight pairs of three-part humeral fractures were randomly assigned for pairwise instrumentation using either a prototype gliding plate or a standard PHILOS plate, and four pairs were fixed using the gliding plate with bone cement augmentation of its proximal screws. The specimens were cyclically tested under progressively increasing loading until perforation of a screw. Telescoping of a screw, varus tilting and screw migration were recorded using optical motion tracking. Results Mean initial stiffness (N/mm) was 581.3 (sd 239.7) for the gliding plate, 631.5 (sd 160.0) for the PHILOS and 440.2 (sd 97.6) for the gliding augmented plate without significant differences between the groups (p = 0.11). Mean varus tilting (°) after 7500 cycles was comparable between the gliding plate (2.6; sd 1.9), PHILOS (1.2; sd 0.6) and gliding augmented plate (1.7; sd 0.9) (p = 0.10). Similarly, mean screw migration(mm) after 7500 cycles was similar between the gliding plate (3.02; sd 2.85), PHILOS (1.30; sd 0.44) and gliding augmented plate (2.83; sd 1.18) (p = 0.13). Mean number of cycles until failure with 5° varus tilting were 12702 (sd 3687) for the gliding plate, 13948 (sd 1295) for PHILOS and 13189 (sd 2647) for the gliding augmented plate without significant differences between the groups (p = 0.66). Conclusion Biomechanically, plate fixation using a new gliding screw technology did not show considerable advantages in comparison with fixation using a standard PHILOS plate. Based on the finding of telescoping of screws, however, it may represent a valid approach for further investigations into how to avoid the cut-out of screws. Cite this article: Y. P. Acklin, I. Zderic, J. A. Inzana, S. Grechenig, R. Schwyn, R. G. Richards, B. Gueorguiev. Biomechanical evaluation of a new gliding screw concept for the fixation of proximal humeral fractures. Bone Joint Res 2018;7:422–429. DOI: 10.1302/2046-3758.76.BJR-2017-0356.R1.

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Mid-term results of a less-invasive locking plate fixation method for proximal humeral fractures: a prospective observational study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-015-0618-y ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 4

Author(s):

Benjamin Bockmann ◽

Benjamin Buecking ◽

Daniel Franz ◽

Ralph Zettl ◽

Steffen Ruchholtz ◽

...

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Locking Plate ◽

Plate Fixation ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Fixation Method ◽

Locking Plate Fixation ◽

Less Invasive ◽

Mid Term Results

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Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the “proximal anchoring point”

International Orthopaedics ◽

10.1007/s00264-017-3498-y ◽

2017 ◽

Vol 41 (9) ◽

pp. 1715-1721 ◽

Cited By ~ 6

Author(s):

Simon A. Euler ◽

Maximilian Petri ◽

Melanie B. Venderley ◽

Grant J. Dornan ◽

Werner Schmoelz ◽

...

Keyword(s):

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Antegrade Nailing ◽

Biomechanical Evaluation

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

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519413500553 ◽

2013 ◽

Vol 13 (04) ◽

pp. 1350055 ◽

Cited By ~ 1

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.

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