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Hong CK, Hsu KL, Kuan FC, Wang CH, Wang PH, Su WR. The effect of hole size on failure loads of the distal humerus fenestration in Outerbridge-Kashiwagi arthroplasty: A biomechanical study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:305-310. [PMID: 32544067 DOI: 10.5152/j.aott.2020.03.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to biomechanically assess the effect of humeral-fenestration size in the Outerbridge-Kashiwagi arthroplasty on the ultimate failure load of the distal humerus in a synthetic bone model. METHODS We biomechanically tested the influence of different humeral-fenestration sizes on the failure load of the distal humerus in Outerbridge-Kashiwagi arthroplasty. A total of 50 synthetic humerus models were divided into 5 groups based on the fenestration size: 10 mm, 12 mm, 15 mm, 18 mm, and 20 mm. All the samples were randomly assigned to receive either axial or anteroposterior (AP) loading and then loaded to failure at a rate of 2 mm/min on a material testing machine. The data regarding ultimate failure loads under the axial and AP loading were analyzed. RESULTS Under the AP loading, the mean ultimate failure loads of the 18 mm and 20 mm groups were lower than those of the other groups. Under the axial loading, the mean ultimate failure load of the 10 mm group was significantly greater than that of the 15 mm, 18 mm, and 20 mm groups. Additionally, the ultimate failure load of the 20 mm group was significantly lower than that of the 12 mm, 15 mm, and 18 mm groups. CONCLUSION The distal humeral fenestrations with a size greater than 18 mm may offer poor biomechanical properties in the Outerbridge-Kashiwagi ulnohumeral arthroplasty.
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Affiliation(s)
- Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, School of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, School of Medicine, National Cheng Kung University, Tainan, Taiwan;Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, School of Medicine, National Cheng Kung University, Tainan, Taiwan;Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Hsiu Wang
- Department of Nursing, National Cheng Kung University Hospital, School of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Hui Wang
- Department of Orthopedics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan;Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine,National Cheng Kung University, Tainan, Taiwan
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Hong CK, Yeh ML, Jou IM, Lin CL, Chang CH, Chang CH, Su WR. The effect of humeral-fenestration diameter in Outerbridge-Kashiwagi arthroplasty on failure load of the distal humerus: a cadaveric biomechanical study. Arch Orthop Trauma Surg 2018; 138:623-628. [PMID: 29356940 DOI: 10.1007/s00402-018-2876-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Outerbridge-Kashiwagi ulnohumeral arthroplasty is an effective method in treating elbow osteoarthritis; however, distal humerus fracture after surgery can become a critical issue. A previous biomechanical study has shown that the failure load of the distal humerus decreases after a fenestration, but the size of the fenestration hole has not yet been discussed. MATERIALS AND METHODS 32 fresh-frozen cadaveric distal humeri were obtained. Two drill sizes were chosen for fenestration: 12 and 15 mm in diameter. Two directions of force were applied with a materials testing machine for biomechanical testing: 5° flexion for axial loading and 75° flexion for anterior-posterior (AP) loading. Each specimen randomly received one of the two fenestration sizes, and force directions. All specimens were loaded to failure at a rate of 2 mm/min. RESULTS The failure loads of the 12 and 15 mm groups were not significantly different in either axial loading(3886 ± 1271 N vs 4286 ± 901 N) or AP loading(2303 ± 803 N vs 1897 ± 357 N). All specimens loaded with axial force failed via the fenestration holes; however, during AP loading, some specimens failed through the fenestration holes, while others at diaphysis (p = 0.28). CONCLUSIONS The failure load of distal humeri did not differ significantly after fenestration of 12 or 15 mm. The clinical relevance is that as the risk of distal humerus fracture is not exacerbated, a larger-size fenestration hole could be of help to improve the effectiveness of this surgical procedure.
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Affiliation(s)
- Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, Tainan, 70428, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.,Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - I-Ming Jou
- Department of Orthopedics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Li Lin
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, Tainan, 70428, Taiwan.,Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsun Chang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, Tainan, 70428, Taiwan
| | - Chih-Hung Chang
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, Tainan, 70428, Taiwan. .,Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan. .,Medical Device R&D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan.
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