scholarly journals The proximal humeral locking plate positioning to the pectoralis major tendon in achieving the proper calcar screw location: a cadaveric study

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Nattha Kulkamthorn ◽  
Naruebade Rungrattanawilai ◽  
Thanakorn Tarunotai ◽  
Nantaphon Chuvetsereporn ◽  
Piyachat Chansela ◽  
...  
Keyword(s):  
Locking Plate ◽  
Humeral Fracture ◽  
Pectoralis Major ◽  
Clinical Anatomy ◽  
Osteoarthritic Change ◽  
Screw Insertion ◽  
Anatomic Landmark ◽  
Screw Position ◽  
Inferior Border ◽  
Locking Plate System

Abstract Background Proximal humeral fracture is the third most common of osteoporotic fracture. Most surgical cases were treated by fixation with anatomical locking plate system. The calcar screw plays a role in medial support and improving varus stability. Proximal humerus fracture in elderly patients are commonly seen with greater tuberosity (GT) fracture. The GT fragment is sometimes difficult to use as an anatomic landmark for proper plate and screw position. Therefore, the insertion of pectoralis major tendon (PMT) may be used as an alternative landmark for appropriate plate and calcar screw position. The purpose of study is going to identify the vertical distance from PMT to a definite point on the position of locking plate. Methods 30 cadaveric shoulders at the department of clinical anatomy were performed. Shoulders with osteoarthritic change (n = 5) were excluded. Finally, 25 soft cadaveric shoulders were recruited in this study. The PHILOS™ plate was placed 2 mm posterior to the bicipital groove. A humeral head (HH) was cut in the coronal plane at the level of the anterior border of the PHILOS plate with a saw. A calcar screw was inserted close to the inferior cortex of HH. Distance from the upper border of elongated combi-hole (UB-ECH) to the upper border of pectoralis major tendon (UB-PMT) was measured. The plate was then moved superiorly until the calcar screw was 12 mm superior to the inferior border of HH and the distance was repeatedly measured. Results The range of distance from UB-PMT to the UB-ECH was from − 4.50 ± 7.95 mm to 6.62 ± 7.53 mm, when calcar screw was close to inferior border of HH and when the calcar screw was 12 mm superior to the inferior border of HH, respectively. The highest probability of calcar screw in proper location was 72% when UB-ECH was 3 mm above UB-PMT. Discussion and conclusion The GT fragment is sometimes difficult to use as an anatomic landmark for proper plate and screw position. PMT can be used as an alternative anatomic reference. UB-PMT can serve as a guide for proper calcar screw insertion. UB-ECH should be 3 mm above UB-PMT and three-fourths of cases achieved proper calcar screw location.

scholarly journals Augmentation of a Locking Plate System Using Bioactive Bone Cement—Experiment in a Proximal Humeral Fracture Model

2018 ◽  
Vol 9 ◽  
pp. 215145931879531 ◽  
Author(s):  
Guan-Ming Kuang ◽  
Tak Man Wong ◽  
Jun Wu ◽  
Jun Ouyang ◽  
Haihua Guo ◽  
...  
Keyword(s):  
Bone Cement ◽  
Proximal Humeral Fracture ◽  
Locking Plate ◽  
Humeral Fracture ◽  
Fracture Model ◽  
Bending Test ◽  
Control Group ◽  
X Ray ◽  
Locking Plate System ◽  
Plate System

Introduction: The purpose of this study was to test whether local filling of a novel strontium-containing hydroxyapatite (Sr-HA) bone cement can augment the fixation of a locking plate system in a cadaveric proximal humeral facture model. Materials and Methods: Twelve pairs of formalin-treated cadaveric humeri were used. One side in each pair was for cemented group, while the other side was for the control group. The bone mineral density (BMD) of the samples was tested. A 3-part facture model was created and then reduced and fixed by a locking plate system. In the cemented group, the most proximal 4 screw holes were filled with 0.5 mL bone cement. In the control group, the screw holes were not filled by cement. Locking screws were inserted in a standard manner before the cement hardened. X-ray was taken before all the specimens being subjected to mechanical study, in which 6 pairs were used for axial loading (varus bending) test, while other 6 pairs were used for axial rotational test. Results: There is no difference in BMD between the cemented side and the control side. The X-ray shows that the implant is in position. Cement filling was noted in the most proximal 4 screws in the cemented group. Better mechanical outcome was seen in the cemented groups, in terms of less maximal displacement per cycle and higher failure point and stiffness in varus bending test. However, no difference was found between the cemented group and the control group in the axial rotation test. Discussion: In similarity with the previous studies, our results showed better mechanical results in the cemented group. However, due to the limitations (e.g. sample size, fracture model, testing protocol, etc), we still cannot directly extrapolate current mechanical results to clinical practice at the present moment. Furthermore, it is still unknown whether better primary outcome may lead to better long-term results, even though the local release of strontium may enhance the local bone formation. Conclusion: The local filling of Sr-HA bone cement augments the fixation of the locking plate system in current proximal humeral fracture model.

Mechanical performance in axial compression of a titanium polyaxial locking plate system in a fracture gap model

2015 ◽  
Vol 28 (02) ◽  
pp. 88-94 ◽  
Author(s):  
E. J. Comerford ◽  
R. S. Birch ◽  
J. F. Innes ◽  
M. B. Walton ◽  
A. W. Tomlinson
Keyword(s):  
Axial Compression ◽  
Locking Plate ◽  
Mechanical Performance ◽  
Ct Images ◽  
Screw Head ◽  
Fixed Angle ◽  
Screw Insertion ◽  
Working Length ◽  
Locking Plate System ◽  
Plate System

SummaryObjective: To evaluate the bending strength of the VetLOX® polyaxial locking plate system.Materials and methods: Thirty-five 3.5 mm 12-hole titanium VetLOX® plates were used to stabilize seven different construct designs in a 1 cm fracture gap simulation model. Each construct was subjected to axial compression. Mean bending stiffness (BS) and yield load (YL) of each construct design were analysed using a one-way ANOVA and Tukey post-hoc analysis. Screw angulation was measured on reconstructed computed tomography (CT) images.Results: Reducing plate working length for fixed-angle constructs significantly increased BS (p <0.01) and YL (p <0.01). For a constant plate working length, increasing screw number did not significantly affect BS (p = 1.0) or YL (p = 0.86). Screw angulation measurement technique was validated by intra-class correlation coefficients (ICC) (ICC >0.9 for inter- and intra-observer measurements). An average screw angle of 13.2° did not significantly affect mechanical performance although incomplete screw head-plate engagement was noted on some reconstructed CT images when angulation exceeded 10°. Prefabricated screw-head inserts did not significantly increase mechanical performance. A 4 mm bone-plate stand-off distance significantly reduced BS and YL by 63% and 69% respectively.Clinical relevance: The VetLOX® system allows the benefits of polyaxial screw insertion whilst maintaining comparable bending properties to fixed angle insertion. The authors recommend accurate plate contouring to reduce the risk of plate bending.

scholarly journals Two-Dimensional Visualization of the Three-Dimensional Planned Sacroiliac Screw Corridor with the Slice Fusion Method

2021 ◽  
Vol 10 (2) ◽  
pp. 184
Author(s):  
Maximilian Kerschbaum ◽  
Siegmund Lang ◽  
Florian Baumann ◽  
Volker Alt ◽  
Michael Worlicek
Keyword(s):  
Pelvic Ring ◽  
Three Dimensional ◽  
Fusion Method ◽  
Two Dimensional ◽  
Posterior Pelvic Ring ◽  
Simple Method ◽  
Sacroiliac Screw ◽  
Screw Insertion ◽  
Multiplanar Reconstructions ◽  
Screw Position

Insertion of sacro-iliac (SI) screws for stabilization of the posterior pelvic ring without intraoperative navigation or three-dimensional imaging can be challenging. The aim of this study was to develop a simple method to visualize the ideal SI screw corridor, on lateral two-dimensional images, corresponding to the lateral fluoroscopic view, used intraoperatively while screw insertion, to prevent neurovascular injury. We used multiplanar reconstructions of pre- and postoperative computed tomography scans (CT) to determine the position of the SI corridor. Then, we processed the dataset into a lateral two-dimensional slice fusion image (SFI) matching head and tip of the screw. Comparison of the preoperative SFI planning and the screw position in the postoperative SFI showed reproducible results. In conclusion, the slice fusion method is a simple technique for translation of three-dimensional planned SI screw positioning into a two-dimensional strict lateral fluoroscopic-like view.

The Sacral Laminar Slope Is an Anatomic Landmark for Freehand S2AI Screw Insertion

2017 ◽  
Vol 17 (10) ◽  
pp. S262 ◽  
Author(s):  
James D. Lin ◽  
Lee A. Tan ◽  
Jamal Shillingford ◽  
Joseph L. Laratta ◽  
Yongjung Kim ◽  
...  
Keyword(s):  
Screw Insertion ◽  
Anatomic Landmark

scholarly journals Locking nail versus locking plate for proximal humeral fracture fixation in an elderly population: a prospective randomised controlled trial

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Johannes E. Plath ◽  
Christian Kerschbaum ◽  
Tobias Seebauer ◽  
Rainer Holz ◽  
Daniel J. H. Henderson ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Fracture Fixation ◽  
Proximal Humeral Fracture ◽  
Elderly Population ◽  
Locking Plate ◽  
Controlled Trial ◽  
Humeral Fracture ◽  
Locking Nail ◽  
Randomised Controlled

scholarly journals Evaluation of open reduction and internal fixation of proximal humerus fractures using a locking plate with smooth pegs – A retrospective study

2018 ◽  
Vol 11 (6) ◽  
pp. 411-418
Author(s):  
Frida Hansson ◽  
Magdalena Riddar ◽  
Anders Ekelund
Keyword(s):  
Quality Of Life ◽  
Retrospective Study ◽  
Internal Fixation ◽  
Avascular Necrosis ◽  
Open Reduction ◽  
Locking Plate ◽  
Constant Score ◽  
Humeral Fracture ◽  
The Mean

Background Optimal treatment of displaced proximal humeral fractures is controversial. This retrospective study aims to identify complications and clinical outcomes using a locking plate with smooth pegs instead of screws (S3 plate). Method Eighty-two patients with displaced proximal humeral fracture classified with 2–4 fragments (Neer’s classification) treated with open reduction and internal fixation (ORIF) with S3 plate were studied retrospectively. Clinical outcome according to constant score; Single Shoulder Value; Disabilities of Arm, Shoulder and Hand; and European Quality of life-5 dimensions and complication rate defined radiologically including peg penetration, avascular necrosis, and loss of reduction was assessed minimum 2.5 years after surgery. Results A total of 11 peg penetrations were identified (13.6%). Avascular necrosis was seen in 8.5% (n = 7). Mean constant score at follow-up was 64.4 with a relative constant score of 87% (standard deviation 18%) compared to the contralateral uninjured side. The mean Disabilities of Arm, Shoulder and Hand score was 12.7 and mean European Quality of life-5 dimensions score 0.83. The mean Single Shoulder Value was 78.3. No cases of deep infection were seen. Conclusions Fixation with S3 plate shows a proper osteosynthesis and the functional outcome is good. Symptomatic peg penetrations are rare and the incidence is lower compared to what has been reported with locked screws.

scholarly journals Locking Plate for Proximal Humeral Fracture in the Elderly Population: Serial Change of Neck Shaft Angle

2012 ◽  
Vol 4 (3) ◽  
pp. 209 ◽  
Author(s):  
Aditya C Pawaskar ◽  
Kee-Won Lee ◽  
Jong-Min Kim ◽  
Jin-Woong Park ◽  
Iman W Aminata ◽  
...  
Keyword(s):  
Proximal Humeral Fracture ◽  
Elderly Population ◽  
Locking Plate ◽  
Humeral Fracture ◽  
The Elderly ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
Serial Change
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