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Abstract

Background

Our study's purpose was to compare biomechanical performances of a proximal humerus locking plate (PHLP) with an antegrade intramedullary nail (IMN) in an osteoporotic two-part surgical neck proximal humerus fracture model.

Methods

Simulated fractures were made through the surgical neck of synthetic osteoporotic humeri. One group had identical transverse fractures instrumented with a PHLP with seven screws (PHLP-7; n = 4), a PHLP with nine screws (PHLP-9; n = 2), or an IMN (n = 4). Each underwent pre-fatigue testing, an identical fatigue protocol, and post-fatigue testing. A second high oblique fracture line was tested identically with PHLP-9 (n = 4) and IMN (n = 4) constructs.

Results

Statistical analyses of transverse specimen pre-fatigue stiffness revealed that the PHLP-7 and PHLP-9 were stiffer in anteroposterior bending and torsion compared to the IMN. There was no difference between the three constructs in varus-valgus bending or compression. Post-fatigue stiffness comparisons revealed no difference between the three constructs. For the oblique fracture, pre-fatigue differences were found with the IMN stiffer in varus-valgus bending and the PHLP-9 stiffer in torsion.

Discussion

The biomechanical performance of an angular-stable proximal humeral nail design was comparable, especially following fatigue, to locked plate/screw constructs in a synthetic osteoporotic two-part surgical neck proximal humerus fracture model.

Keywords

proximal humerus fracture intramedullary nail locked proximal humerus locking plate osteoporosis biomechanics

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References

Egol

Ong

Walsh

, et al. Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates. J Orthop Trauma 2008; 22: 159–164.

Südkamp

Bayer

Hepp

, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am 2009; 91: 1320–1328.

Schumaier

Grawe

. Proximal humerus fractures: evaluation and management in the elderly patient. Geriatr Orthop Surg Rehabil 2018; 9: 2151458517750516.

Hessmann

Hansen

WSM

Krummenauer

, et al. Locked plate fixation and intramedullary nailing for proximal humerus fractures: a biomechanical evaluation. J Trauma 2005; 58: 1194–1201.

Owsley

Gorczyca

. Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J Bone Joint Surg Am 2008; 90: 233–240.

Meier

Messmer

Regazzoni

, et al. Unexpected high complication rate following internal fixation of unstable proximal humerus fractures with an angled blade plate. J Orthop Trauma 2006; 20: 253–260.

Adedapo

Ikpeme

. The results of internal fixation of three- and four-part proximal humeral fractures with the Polarus nail. Injury 2001; 32: 115–121.

Ricchetti

Warrender

Abboud

. Use of locking plates in the treatment of proximal humerus fractures. J Shoulder Elbow Surg 2010; 19: 66–75.

Clavert

Adam

Bevort

, et al. Pitfalls and complications with locking plate for proximal humerus fracture. J Shoulder Elbow Surg 2010; 19: 489–494.

10.

Edwards

Wilson

Zhang

, et al. Two-part surgical neck fractures of the proximal part of the humerus. A biomechanical evaluation of two fixation techniques. J Bone Joint Surg Am 2006; 88: 2258–2264.

11.

Kralinger

Gschwentner

Wambacher

, et al. Proximal humeral fractures: what is semi-rigid? Biomechanical properties of semi-rigid implants, a biomechanical cadaver based evaluation. Arch Orthop Trauma Surg 2008; 128: 205–210.

12.

Agel

Jones

Sanzone

, et al. Treatment of proximal humeral fractures with Polarus nail fixation. J Shoulder Elbow Surg 2004; 13: 191–195.

13.

Charalambous

Siddique

Valluripalli

, et al. Proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg 2007; 127: 205–210.

14.

Cuny

Pfeffer

Irrazi

, et al. A new locking nail for proximal humerus fractures: the Telegraph nail, technique and preliminary results. Rev Chir Orthop Reparatrice Appar Mot 2002; 88: 62–67.

15.

Mittlmeier

TWF

Stedtfeld

Ewert

, et al. Stabilization of proximal humeral fractures with an angular and sliding stable antegrade locking nail (Targon PH). J Bone Joint Surg Am 2003; 85: 136–146.

16.

Mouradian

. Displaced proximal humeral fractures. Seven years’ experience with a modified Zickel supracondylar device. Clin Orthop Relat Res 1986; 212: 209–218.

17.

Wheeler

Colville

. Biomechanical comparison of intramedullary and percutaneous pin fixation for proximal humeral fracture fixation. J Orthop Trauma 1997; 11: 363–367.

18.

Horn

Gueorguiev

Brianza

, et al. Biomechanical evaluation of two-part surgical neck fractures of the humerus fixed by an angular stable locked intramedullary nail. J Orthop Trauma 2011; 25: 406–413.

19.

Tingart

Apreleva

von Stechow

, et al. The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus. J Bone Joint Surg Br 2003; 85: 611–617.

20.

Bayraktar

Morgan

Niebur

, et al. Comparison of the elastic and yield properties of human femoral trabecular and cortical bone tissue. J Biomech 2004; 37: 27–35.

21.

Sommers

Fitzpatrick

Madey

, et al. A surrogate long-bone model with osteoporotic material properties for biomechanical testing of fracture implants. J Biomech 2007; 40: 3297–3304.

22.

Patel

PSD

Shepherd

DET

Hukins

DWL

. Compressive properties of commercially available polyurethane foams as mechanical models for osteoporotic human cancellous bone. BMC Musculoskelet Disord 2008; 9: 37.

23.

Füchtmeier

May

Hente

, et al. Proximal humerus fractures: a comparative biomechanical analysis of intra and extramedullary implants. Arch Orthop Trauma Surg 2007; 127: 441–447.

24.

Sanders

Bullington

McGillivary

, et al. Biomechanical evaluation of locked plating in proximal humeral fractures. J Shoulder Elbow Surg 2007; 16: 229–234.

25.

Duc

Farron

Pichonnaz

, et al. Distribution of arm velocity and frequency of arm usage during daily activity: objective outcome evaluation after shoulder surgery. Gait Posture 2013; 38: 247–252.

26.

Lill

Hepp

Korner

, et al. Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimens. Arch Orthop Trauma Surg 2003; 123: 74–81.

27.

Hatzidakis

Shevlin

Fenton

, et al. Angular-stable locked intramedullary nailing of two-part surgical neck fractures of the proximal part of the humerus. A multicenter retrospective observational study. J Bone Joint Surg Am 2011; 93: 2172–2179.