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

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.

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Application of a lateral intertubercular sulcus plate in the treatment of proximal humeral fractures: A finite element analysis and example in clinical practice

10.21203/rs.3.rs-391928/v2 ◽

2021 ◽

Author(s):

Dong Li ◽

WenXue Lv ◽

WenMing Chen ◽

Jing Meng ◽

Song Liu ◽

...

Keyword(s):

Finite Element ◽

Locking Plate ◽

Humeral Fracture ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Element Analysis ◽

Group A ◽

Philos Plate ◽

Group B ◽

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 PLP 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 the results of 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 a proximal humeral fracture with loss of the medial column, three implant models were established. A full-screw PLP was used in Group A, a PHILOS plate lacking medial screw support and an auxiliary plate (MPLP-LSP) was used in Group B, and a full-screw PLP-LSP was used in Group C. The three fixation models were applied to the proximal humeral fracture model, following which horizontal, compressive, and rotational loads were applied to the humerus model. We evaluated 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) compared to those in Group A and Group B. The implant model used in Group C also showed the highest structural rigidity, endured less von Misses stress, and had the strongest stability than that used in Group A and Group B. Conclusion: An LSP placed at the internodal grove not only aids in anatomical reduction but also provides effective lateral and medial support, thereby reducing stress on the PLP and providing better stability in patients with proximal humeral fractures.

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Biomechanical effect of medial cortical support and medial screw support on the locking plate fixation of the proximal humeral fractures with a medial gap: a finite element analysis

Acta Orthopaedica et Traumatologica Turcica ◽

10.3944/aott.2015.14.0204 ◽

2015 ◽

Cited By ~ 3

Author(s):

Pan Yang

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Locking Plate ◽

Plate Fixation ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Locking Plate Fixation ◽

Element Analysis ◽

Biomechanical Effect

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Biomechanical Principles Used in Finite Element Analysis for Proximal Humeral Fractures with Locking Plates

Medical Science and Technology ◽

10.12659/mst.907350 ◽

2017 ◽

Vol 58 ◽

pp. 128-136 ◽

Cited By ~ 1

Author(s):

Ismael Mendoza-Muñoz ◽

Álvaro González-Ángeles ◽

Miriam Siqueiros-Hernández ◽

Mildrend Montoya-Reyes

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Locking Plates ◽

Element Analysis

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Finite element analysis of an intramedulary anatomical strut for proximal humeral fractures with disrupted medial column instability: A cohort study

International Journal of Surgery ◽

10.1016/j.ijsu.2019.11.026 ◽

2020 ◽

Vol 73 ◽

pp. 50-56 ◽

Cited By ~ 1

Author(s):

Hua Chen ◽

Zheng-guo Zhu ◽

Jian-tao Li ◽

Zu-hao Chang ◽

Pei-fu Tang

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Cohort Study ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Element Analysis

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Invited commentary on Finite element analysis of an intramedulary anatomical strut for proximal humeral fractures with disrupted medial column instability: A Cohort Study (Int J Surg 2019; Epub ahead of print)

International Journal of Surgery ◽

10.1016/j.ijsu.2019.12.026 ◽

2020 ◽

Vol 74 ◽

pp. 79-80

Author(s):

Baohui Su ◽

Xiaoyan Xia

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Cohort Study ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Element Analysis

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The Applications of Finite Element Analysis in Proximal Humeral Fractures

Computational and Mathematical Methods in Medicine ◽

10.1155/2017/4879836 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Yongyu Ye ◽

Wei You ◽

Weimin Zhu ◽

Jiaming Cui ◽

Kang Chen ◽

...

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Glenohumeral Joint ◽

State Of The Art ◽

Review Article ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Noninvasive Method ◽

Element Analysis ◽

Geriatric Population

Proximal humeral fractures are common and most challenging, due to the complexity of the glenohumeral joint, especially in the geriatric population with impacted fractures, that the development of implants continues because currently the problems with their fixation are not solved. Pre-, intra-, and postoperative assessments are crucial in management of those patients. Finite element analysis, as one of the valuable tools, has been implemented as an effective and noninvasive method to analyze proximal humeral fractures, providing solid evidence for management of troublesome patients. However, no review article about the applications and effects of finite element analysis in assessing proximal humeral fractures has been reported yet. This review article summarized the applications, contribution, and clinical significance of finite element analysis in assessing proximal humeral fractures. Furthermore, the limitations of finite element analysis, the difficulties of more realistic simulation, and the validation and also the creation of validated FE models were discussed. We concluded that although some advancements in proximal humeral fractures researches have been made by using finite element analysis, utility of this powerful tool for routine clinical management and adequate simulation requires more state-of-the-art studies to provide evidence and bases.

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Real-time finite element analysis allows homogenization of tissue scale strains and reduces variance in a mouse defect healing model

Scientific Reports ◽

10.1038/s41598-021-92961-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Graeme R. Paul ◽

Esther Wehrle ◽

Duncan C. Tourolle ◽

Gisela A. Kuhn ◽

Ralph Müller

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Fracture Healing ◽

Real Time ◽

Mechanical Stimulus ◽

Stimulus Level ◽

Micro Computed Tomography ◽

Reference Distribution ◽

Element Analysis ◽

Computed Tomography Images

AbstractMechanical loading allows both investigation into the mechano-regulation of fracture healing as well as interventions to improve fracture-healing outcomes such as delayed healing or non-unions. However, loading is seldom individualised or even targeted to an effective mechanical stimulus level within the bone tissue. In this study, we use micro-finite element analysis to demonstrate the result of using a constant loading assumption for all mouse femurs in a given group. We then contrast this with the application of an adaptive loading approach, denoted real time Finite Element adaptation, in which micro-computed tomography images provide the basis for micro-FE based simulations and the resulting strains are manipulated and targeted to a reference distribution. Using this approach, we demonstrate that individualised femoral loading leads to a better-specified strain distribution and lower variance in tissue mechanical stimulus across all mice, both longitudinally and cross-sectionally, while making sure that no overloading is occurring leading to refracture of the femur bones.

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