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 ◽  
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.

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.

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

2017 ◽  
Vol 58 ◽  
pp. 128-136 ◽  
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

scholarly journals Reduction and Fixation of Proximal Humeral Fracture With Severe Medial Instability Using a Small Locking Plate

2021 ◽  
Author(s):  
Yuelei Zhang ◽  
Lifu Wan ◽  
Lecheng Zhang ◽  
Chao Yan ◽  
Gang Wang
Keyword(s):  
Locking Plate ◽  
Constant Score ◽  
Operation Time ◽  
Humeral Fracture ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Final Visit ◽  
Medial Cortex ◽  
Screw Penetration ◽  
The Mean

Abstract Background Currently, the reduction and support of comminuted medial cortex of humeral fracture remains a challenge, Therefore, a novel reduction and fixation technique that employs an anteromedial small locking plate was explored in this study, and its viability and the associated complications were assessed. Methods Fifteen cases of proximal humeral fractures with medial instability (five cases were classified as three-part and ten as four-part by Neer classification) were treated by the proposed reduction technique using an anteromedial small locking plate. Subsequently, the radiological and clinical outcomes were evaluated over an average follow-up period of 18.53 months. Results The average operation time was 108 minutes (range, 70–130 minutes), and the mean fracture union time in all patients was 12.13 weeks (range, 8–16 weeks). Complications such as infection and neurovascular injury were not observed. Postoperative X-ray showed avascular necrosis and screw penetration in one patient, while screw penetration, varus malunion, or significant reduction loss was not found in the other cases. The mean Constant score was 79.8 (range, 68–92) during the final visit. Conclusions The use of an anteromedial small locking plate improved the reduction efficiency, reconstructed the medial support, and alleviated the occurrence of complications in proximal humeral fractures with medial instability.

scholarly journals Comparison of stresses in monoblock tilted implants and conventional angled multiunit abutment-implant connection systems in the all-on-four procedure

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Özge Özdal Zincir ◽  
Ateş Parlar
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Surgical Procedures ◽  
Principal Stresses ◽  
Element Analysis ◽  
Edentulous Mandible ◽  
Group A ◽  
Group B ◽  
Von Mises ◽  
Von Mises Stresses

Abstract Background The All-on-four dental implant method is an implantology method designed to provide a comfortable prosthetic treatment option by avoiding advanced surgical procedures. This research aims to compare and evaluate the stress and tension values in conventional angled multiunit abutment-implant connection systems and monoblock dental implants used in the all-on-four procedure with finite element analysis. Methods Two master models were created by placing four implants connected to multiunit abutments (group A) in the interforaminal region of a completely edentulous mandible and four monoblock implants (group B) in the same region of another completely edentulous mandible. Group A implants were classified according to their diameter as follows: 3.5 mm (M1A), 4.0 mm (M2A), and 4.5 mm (M3A). Similarly, group B implants were classified as M1B, M2B, and M3B. In the six models rehabilitated with acrylic fixed prostheses, a 100 N force was applied to the anterior implant region, and a 250 N force was applied to the posterior cantilever in both axial and 30° oblique directions. Von Mises stresses were analyzed in the bone and implant regions of all models. Results M1A and M1B, M2A and M2B, and M3A and M3B were compared with each other under axial and oblique forces. The maximum Von Mises stresses in the bone around implants and the prosthesis screws, and the maximum and minimum principal stresses in the cortical and trabecular bone in group A models were significantly higher than those in group B models. Conclusions In monoblock implant systems under axial and oblique forces, higher stress is accumulated in the bone, prosthesis screw and implant compared to multiunit abutment-implant connection systems.

scholarly journals Reduction and fixation of proximal humeral fracture with severe medial instability using a small locking plate

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuelei Zhang ◽  
Lifu Wan ◽  
Lecheng Zhang ◽  
Chao Yan ◽  
Gang Wang
Keyword(s):  
Locking Plate ◽  
Constant Score ◽  
Operation Time ◽  
Humeral Fracture ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Final Visit ◽  
Medial Cortex ◽  
Screw Penetration ◽  
The Mean

Abstract Background Currently, the reduction and support of comminuted medial cortex of humeral fracture remains a challenge, Therefore, a novel reduction and fixation technique that employs an anteromedial small locking plate was explored in this study, and its viability and the associated complications were assessed. Methods Fifteen cases of proximal humeral fractures with medial instability (five cases were classified as three-part and ten as four-part by Neer classification) were treated by the proposed reduction technique using an anteromedial small locking plate. Subsequently, the radiological and clinical outcomes were evaluated over an average follow-up period of 18.53 months. Results The average operation time was 108 min (range, 70–130 min), and the mean fracture union time in all patients was 12.13 weeks (range, 8–16 weeks). Complications such as infection and neurovascular injury were not observed. Postoperative X-ray showed avascular necrosis and screw penetration in one patient, while screw penetration, varus malunion, or significant reduction loss was not found in the other cases. The mean Constant score was 79.8 (range, 68–92) during the final visit. Conclusions The use of an anteromedial small locking plate improved the reduction efficiency, reconstructed the medial support, and alleviated the occurrence of complications in proximal humeral fractures with medial instability.

scholarly journals Comparison between minimally invasive plate osteosynthesis and the deltopectoral approach with allogenous fibular bone graft in proximal humeral fractures

2020 ◽  
Vol 23 (3) ◽  
pp. 136-143
Author(s):  
Joon Yub Kim ◽  
Jinho Lee ◽  
Seong-Hun Kim
Keyword(s):  
Minimally Invasive ◽  
Bone Graft ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Group A ◽  
Group B ◽  
Deltopectoral Approach

Background: Both allogenous fibular bone graft and minimally invasive plate osteosynthesis have been developed to reduce issues such as fixation failure, displacement, angulation, and nonunion after plate fixation of proximal humeral fractures. However, there have been no studies investigating the differences in clinical results between these methods. The purpose of this study was to investigate the clinical differences between open reduction and plate fixation via a deltopectoral approach with allogenous fibular bone graft and a minimally invasive approach, in Neer's classification two-, three-part proximal humeral fractures.Methods: In this retrospective study, 77 patients with Neer classification two-, three-part proximal humeral fractures were treated at two different institutions. Clinical and radiological evaluations were performed in 39 patients who underwent minimally invasive plate osteosynthesis at one institution (group A) and 38 patients who underwent the deltopectoral approach with allogenous fibular bone graft at another institution (group B). The results between the groups were compared.Results: The minimally invasive plate osteosynthesis procedure (group A) was significantly less time- consuming and caused less bleeding than allogenous fibular bone graft through a deltopectoral approach (group B) (P<0.05). The duration of the fracture union was significantly reduced in group A (14.5±3.4 weeks; range, 10–22 weeks) compared to group B (16.4±4.3 weeks; range, 12–28 weeks) (P<0.05). There were no statistically significant differences between the two groups when evaluating the visual analog scale and Constant scores 1 year postoperatively. Radiological evaluation including neck-shaft angle and plate height were measured on the final follow-up X-ray image. There was no difference in radiological outcomes between the two groups. There were no statistically significant differences in malunion between the two groups; there were three malunion cases (7.7%) in group A and four (10.5%) in group B.Conclusions: The minimally invasive plate osteosynthesis procedure and deltopectoral approach with allogenous fibula bone graft for Neer's classification two-, three-part proximal humeral fractures demonstrated similar clinical and radiological results. However, allogenous fibula grafts require longer surgery, cause more bleeding, and result in longer fracture healing time than the minimally invasive plate osteosynthesis procedure.

scholarly journals The Applications of Finite Element Analysis in Proximal Humeral Fractures

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
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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