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Descalzo Godoy I, Velasco Alcalde P, Del Olmo Galeano A, Del Río Hortelano J, Martínez Velez D, Fernández González J. Quality of life, functional and radiological outcomes of treatment of three-part and four-part proximal humerus fractures with locking plates and comparison in young versus older than 70 years: a retrospective cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:415-423. [PMID: 37566140 DOI: 10.1007/s00590-023-03675-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Verify if the use of locking plates in displaced three- and four-part proximal humerus fractures has meant an improvement even in patients over 70 years of age. MATERIAL AND METHODS We performed surgery with locking plate fixation in 56 consecutive patients with three- and four-part proximal humerus fractures according to Neer's classification between 1/1/15 and 12/31/20 at our Hospital. Patient satisfaction, quality of life, functionality and radiological variables, as well as the comparison between patients older and younger than 70 years were the main outcomes. Likewise, factors and complications that may have influenced these variables were analyzed as secondary outcomes. The analysis of all these variables was performed after a minimum follow-up time of 24 months after surgery. RESULTS 51 patients (92%) ended up satisfied or very satisfied according to the SF-36 test and with no disability or mild disability according to the DASH Score questionnaire. 46 patients (82%) obtained a satisfactory or excellent result according to the Neer scale modified by Cofield and 38 (68%) a good or excellent function according to the Constant Murley questionnaire. In 47 cases (84%) good radiological alignment was observed. Complications occurred in 20 patients (36%). The complications and the results of the SF-36, DASH Score, Neer scale modified by Cofield and Constant Murley tests depended on the radiological alignment (p = 0.009, p = 0.006, p = 0.025, p = 0.0008 and p = 0.0004). There were 37 patients younger than 70 years and 19 older than 70 years with no statistically significant differences when comparing the two groups. CONCLUSIONS This study demonstrates that satisfactory results can be obtained with osteosynthesis with locking plates in displaced proximal humerus fractures even in patients older than 70 years of age. LEVEL OF EVIDENCE III Retrospective Cohort, Treatment Study.
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Affiliation(s)
- Ignacio Descalzo Godoy
- Department of Orthopaedic Surgery and Traumatology, University Hospital La Princesa, Universidad Autónoma de Madrid, C/Diego de León 62, 28006, Madrid, Spain.
| | - Paula Velasco Alcalde
- Department of Orthopaedic Surgery and Traumatology, University Hospital La Princesa, Universidad Autónoma de Madrid, C/Diego de León 62, 28006, Madrid, Spain
| | - Alberto Del Olmo Galeano
- Department of Orthopaedic Surgery and Traumatology, University Hospital La Princesa, Universidad Autónoma de Madrid, C/Diego de León 62, 28006, Madrid, Spain
| | - Julián Del Río Hortelano
- Department of Orthopaedic Surgery and Traumatology, University Hospital La Princesa, Universidad Autónoma de Madrid, C/Diego de León 62, 28006, Madrid, Spain
| | - David Martínez Velez
- Department of Orthopaedic Surgery and Traumatology, University Hospital La Princesa, Universidad Autónoma de Madrid, C/Diego de León 62, 28006, Madrid, Spain
| | - Julián Fernández González
- Department of Orthopaedic Surgery and Traumatology, University Hospital La Princesa, Universidad Autónoma de Madrid, C/Diego de León 62, 28006, Madrid, Spain
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Technique and clinical results of a new intramedullary support nail and plate system for fixation of 3- or 4- part proximal humeral fractures in older adults. BMC Musculoskelet Disord 2022; 23:1033. [PMID: 36451141 PMCID: PMC9710141 DOI: 10.1186/s12891-022-05998-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Internal fixation of complex proximal humeral fractures (PHF) with osteoporosis is associated with a high incidence of complications. This study introduces the technique and clinical results of a novel intramedullary support nail and plate system (ISNPs) for the internal fixation of 3- or 4- part PHF in older adults. The ISNPs combines the concept of intramedullary support and dynamic fixation into a locking plate fixation system that can be applied using a minimally invasive surgical approach. METHODS A total of 46 consecutive patients diagnosed with 3- or 4-part PHF that met the criteria were included in this study, including 18 in the ISNPs group and 28 in the conventional locking plate (LP) group. Clinical results, including operative time, intraoperative bleeding, reduction quality, subjective outcome ratings, and complications, were compared between the two groups. Functional outcomes were evaluated using the Constant score and disability of the arm, shoulder, and hand (DASH) questionnaire at 1-year follow-up. RESULTS There were no significant differences in age, sex, local bone quality, Neer-fracture type, and follow-up time between the ISNPs and LP groups. For clinical analysis, there were no significant differences in intraoperative bleeding and operation time between the ISNPs and LP groups. Significant differences were observed in the percentage of the malreduced cases, Constant and DASH score analysis, and the patients' subjective evaluation ('excellent' and 'good' %) between the two groups. CONCLUSION The ISNPs technique proposed in this study provides a novel hybrid internal fixation model for complex PHF with osteoporosis. The clinical results at 1-year follow-up confirmed the advantage of applying it to 3- or 4- part PHF in older patients. Further studies are required to optimize its design and explore its optimal indications.
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GOMES GUSTAVOREMIGIO, MACIEL RAFAELALMEIDA, ALMEIDA NETO JOSÉINÁCIODE, TOLEDO DANIELCARVALHODE, MACHADO CARLAJORGE, BOMFIM LEONIDASDESOUZA. ANTEGRADE NAILING VERSUS LOCKING PLATE OF 2-AND 3-PART PROXIMAL HUMERUS FRACTURES. ACTA ORTOPÉDICA BRASILEIRA 2022; 30:e256113. [DOI: 10.1590/1413-785220223005e256113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022]
Abstract
ABSTRACT Objective: To evaluate and compare the proportions of complications and radiographic findings of osteosynthesis of 2- and 3-part proximal humerus fractures with two methods of treatment: third-generation antegrade nailing and locking plate. Methods: 46 patients with a mean age of 58.9 ± 16.6 years between January 2020 and January 2021 were evaluated. In sixteen cases (34.8%), antegrade nailing was used, and in thirty cases (65, 2%), a locking proximal humerus plate. The method used included the rate of complications with a minimum follow-up of 6 months after surgery and radiographic evaluation. Results: There was no difference between the groups regarding the proportion of complications (nail group 18.8%, plate group 13.3%; p = 0.681). The nail group had less residual varus loss (cervicodiaphyseal angle nail group with 132.1º ± 2.3º, plate group 123.8º ± 10.1º; p < 0.001). In the plate group, women had the lowest value (1.43 ± 0.22) of the deltoid tuberosity index (DTI) compared to men (1.58 ± 0.11) (p = 0.022). Conclusion: Osteosynthesis, with a locking plate and antegrade nailing, did not show differences in the proportion of complications. The nail group had less change in the postoperative cervicodiaphyseal angle, however, there were two serious complications with screw cut-out and varus deviation, requiring surgical reapproach. Level of Evidence II, Retrospective Observational Study.
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Mocini F, Rovere G, De Mauro D, De Sanctis EG, Smakaj A, Maccauro G, Liuzza F. Newer generation straight humeral nails allow faster bone healing and better functional outcome at mid-term. J Orthop Surg Res 2021; 16:631. [PMID: 34670577 PMCID: PMC8529842 DOI: 10.1186/s13018-021-02776-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/05/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose Although proximal and diaphyseal humerus fractures are frequent, the optimal management remains controversial. Antegrade nailing prevents further damage to the soft tissues and to the vascularization, but it has been associated with postoperative shoulder pain and dysfunction. During the latest years a straight nail design was developed to minimize these problems. Methods A total of 243 patients who had undergone surgery for antegrade intramedullary humeral nailing between January 2013 and July 2018 in A. Gemelli Trauma Center were divided into two groups according to the nail design used: straight nail group (S-group) and curvilinear nail group (C-group). Clinical data were collected using assessment forms (SF12-v2, Quick-DASH, ASES and Constant-Murley). Radiographic bone healing was assessed with RUST score at 30, 90 and 180 days after surgery. Results The S-group was made up of 128 patients with a mean age of 59 ± 19 (range 18–97) and a mean follow-up of 46 ± 9 months. The C-group was made up of 115 patients with a mean age of 53 ± 16 (range 18–88) and a mean follow-up of 51 ± 8 months. The S-group had a mental component summary (MCS) score of 54.3 ± 7.7 and a physical component summary (PCS) score of 46 ± 10.2, the C-group had a MCS score of 50.9 ± 8.4 and a PCS score of 44.1 ± 7.4. Quick-DASH and ASES were respectively 18.8 ± 4.3 and 78.6 ± 8.2 in the S-group, 28.3 ± 11.6 and 72.1 ± 13.5 in the C-group with statistical significance. Constant-Murley score was 73.9 ± 9.1 in the S-group (76% of the contralateral healthy side) and 69.4 ± 10.4 in the C-group (73% of the contralateral healthy side). The radiographic union score in the S-group was 4.1 ± 0.3 at 30 days after surgery, 7 ± 0.8 at 90 days and 10 ± 1.2 at 180 days, while in the C-group it was 4.2 ± 0.4 at 30 days, 6.4 ± 0.7 at 90 days and 9 ± 0.9 at 180 days. Conclusion Newer generation straight nails allow a faster bone healing and better functional outcome at mid-term follow up. Level of evidence III.
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Affiliation(s)
- Fabrizio Mocini
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli n°8, Rome, Italy
| | - Giuseppe Rovere
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli n°8, Rome, Italy
| | - Domenico De Mauro
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli n°8, Rome, Italy
| | - Edoardo Giovannetti De Sanctis
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli n°8, Rome, Italy
| | - Amarildo Smakaj
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli n°8, Rome, Italy
| | - Giulio Maccauro
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli n°8, Rome, Italy
| | - Francesco Liuzza
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli n°8, Rome, Italy.
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Chi G, Ren H, Lin B, Huang K. Subtrochanteric femoral fracture with postoperative chronic osteomyelitis treated successfully by 1-stage operation: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:514. [PMID: 33850911 PMCID: PMC8039705 DOI: 10.21037/atm-21-413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Chronic osteomyelitis is a chronic infectious disease of bone tissue, which can cause necrosis of bone and surrounding soft tissue, and is a common complication of open fracture, internal fixation, diabetic foot and blood-borne bone infection. Traumatic osteomyelitis is caused by bone tissue infection after open fracture surgery or open reduction of fracture or other bone and joint surgery. The lesion is near the fracture end. Intramedullary infection is the most serious infection in acute stage, with high fever, chills and other toxemia symptoms, similar to acute hematogenous osteomyelitis. The other is the skin and muscle necrosis infection near the fracture, which makes Fractures that lose blood supply are exposed to air and become dry and necrotic, and the course of disease turns to chronic, often accompanied by infectious nonunion or bone damage. The course of disease is prolonged and the treatment is difficult. Subtrochanteric femoral fracture with postoperative chronic osteomyelitis is a rare condition requiring complex treatment. In the present study, we report on a 49-year-old male patient who received open reduction with intramedullary nail fixation due to subtrochanteric femoral fracture, but later suffered postoperative infection and developed chronic osteomyelitis. On the basis of the complete removal of the osteomyelitis lesion, we performed a 1-stage operation where free vascularized fibula was used to repair the bone defect, followed by effective internal fixation. The patient was followed up for 24 months and finally recovered from chronic osteomyelitis, with good functional recovery of the hip joint and a Harris score of 85.
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Affiliation(s)
- Genying Chi
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Haiyong Ren
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Bingyuan Lin
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Kai Huang
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
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Nail Versus Plate: A Biomechanical Comparison of a Locking Plate Versus an Intramedullary Nail With an Angular Stable Locking System in a Shoulder Simulator With Active Muscle Forces Using a Two-Part Fracture Model. J Orthop Trauma 2021; 35:e71-e76. [PMID: 33079835 DOI: 10.1097/bot.0000000000001909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare a locking compression plate versus an intramedullary nail with an angular stable locking system (ASLS) using a 2-part fracture model in a shoulder test bench. METHODS Twelve fresh frozen humeri were used for biomechanical testing in a shoulder simulator. A 2-part fracture model, with and without medial cortical support, was used to compare the locking plate and a nail with an ASLS. The varus impaction, varus per cycle motion, tilt, and tilt per cycle were analyzed. RESULTS No significant differences for the resulting forces in the glenoid fossa were evaluated. The stable fracture model showed no significant differences for the 2 groups. The median varus impaction was -0.96 degrees (range -0.55 to -4.26 degrees) in the plate group and 0.5 degrees (range -3.06 to 0.98 degrees) in the nail group, after 500 cycles of cyclic loading in the unstable fracture model. The plate group showed a significantly higher median varus impaction per cycle motion and median varus impaction at the 200th, 300th, and 400th cycle of physiological loading. CONCLUSIONS The intramedullary nail with the ASLS could be an alternative for patients suffering from osteoporosis and comorbidities.
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Mocini F, Cazzato G, Masci G, Malerba G, Liuzza F, Maccauro G. Clinical and radiographic outcomes after antegrade intramedullary nail fixation of humeral fractures. Injury 2020; 51 Suppl 3:S34-S38. [PMID: 32430196 DOI: 10.1016/j.injury.2020.04.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 04/17/2020] [Accepted: 04/25/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Humerus fractures are frequent, accounting for about 3-4% of all fractures in adults. Treatment for fractures of the diaphyseal and proximal meta-epiphyseal regions remains controversial: there is no unanimity in the scientific community about the superiority of surgical treatment over non-surgical treatment and which is the best between possible surgical treatments. Among the choices for surgical treatment the most commonly used implants are the locking-compression plate and the intramedullary nailing. The purpose of this study was to perform a clinical and radiographic follow-up in patients who underwent surgical procedures for reduction and osteosynthesis of proximal or diaphyseal humeral fractures by means of anterograde intramedullary nailing with a straight-shaped nail. PATIENTS AND METHODS A clinical and radiographic follow-up was performed in 56 patients who underwent surgical procedures for reduction and osteosynthesis of proximal or diaphyseal humeral fractures by means of antegrade intramedullary nailing using Synthes MultiLoc® system. Clinical data were collected using subjective quality of life assessment forms (SF12-v2), quality of life related to specific disabilities assessment forms (Quick-DASH, ASES score, WORC) and objective functional assessment forms (Constant-Murley score). The radiographic Follow-Up was performed at 30, 90 and 180 days from the date of the surgery. RESULTS Almost all patients were able to return to a satisfactory quality of life, comparable with the one before the traumatic episode. The functional results were assessed as excellent or good with almost complete recovery of the range of motion and moderate recovery of strength. The residual pain encountered was moderate or zero. The average QuickDASH score was 17.7 ± 4.3 (range 9.1 - 27.3). The average ASES score was 73.8 ± 8.1 (range 58.3 - 88.3). The average WORC score was 543.3 ± 100 [74% ± 4.8%] (range 310 - 740). The mean Constant-Murley score was 69.6 ± 4.6 (range 61 - 84). All patients had a fair or good consolidation of the fracture on radiographic examinations. The calculated RUST score was 4.2 ± 0.4 (range 4-5) 30 days after surgery, 6.1 ± 0.9 (range 4- 8) 90 days after surgery and 9.8 ± 1.5 (range 7-12) to 180 days after surgery. No major complications were found. CONCLUSIONS Treatment of the diaphyseal and proximal meta-epiphyseal humeral fractures with antegrade intramedullary nail provides excellent subjective and objective clinical results and good radiographic results. However, clinical studies with larger number of patients and longer follow-up are necessary.
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Affiliation(s)
- F Mocini
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy, Università cattolica del Sacro Cuore, Roma, Italia
| | - G Cazzato
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy, Università cattolica del Sacro Cuore, Roma, Italia
| | - G Masci
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy, Università cattolica del Sacro Cuore, Roma, Italia.
| | - G Malerba
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy, Università cattolica del Sacro Cuore, Roma, Italia
| | - F Liuzza
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy, Università cattolica del Sacro Cuore, Roma, Italia
| | - G Maccauro
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy, Università cattolica del Sacro Cuore, Roma, Italia
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Abstract
Proximal humeral fractures are a commonly encountered injury; however, no consensus has been reached for the ideal treatment. Current surgical fixation options include plate, plate with fibular strut allograft, intramedullary fixation, pinning, suture constructs, and external fixation. Each of these options possesses distinct advantages and disadvantages. With the evolution of implant design, a greater understanding of the mechanisms of failure of fixation, and the ability to preserve fracture biology, the management of proximal humeral fractures with intramedullary fixation has become an accepted treatment option. From a biomechanical perspective, intramedullary fixation may have advantages over laterally based fixation, in particular with fractures associated with significant calcar comminution. The ability to insert the implant from a superior starting point may help preserve vascular supply to the humeral head and tuberosities. With reported outcomes comparable with the aforementioned techniques and an evolving understanding of fracture characteristics and failures of fixation, intramedullary fixation represents an alternative treatment option for proximal humeral fractures with specific fixation and biologic advantages.
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Jo YH, Lee KH, Lee BG. Surgical trends in elderly patients with proximal humeral fractures in South Korea: a population-based study. BMC Musculoskelet Disord 2019; 20:136. [PMID: 30927910 PMCID: PMC6441205 DOI: 10.1186/s12891-019-2515-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/17/2019] [Indexed: 12/17/2022] Open
Abstract
Background It is known that there are large regional variations in treatment methods for the management of proximal humeral fractures. The objective of this study was to investigate the national surgical trends in elderly patients with proximal humeral fractures in South Korea. Methods We analyzed the Korean Health Insurance Review and Assessment Service database from 2008 to 2016. International Classification of Diseases, 10th revision codes and procedure codes were used to identify patients aged ≥65 years with proximal humeral fractures. Results A total of 69,120 proximal humeral fractures were identified from 2008 to 2016. The overall operative rate for proximal humeral fractures increased steadily from 24.6% in 2008 to 36.8% in 2016 (p < 0.001). The rate of cases treated with open reduction and internal fixation tended to increase each year, from 71.5% of the overall surgeries in 2008 to 85.6% in 2016; conversely, the rate of cases treated with closed reduction and internal fixation tended to decrease from 19.9% in 2008 to 4.5% in 2016. In terms of type of arthroplasty procedure, the rate of cases treated with reverse shoulder arthroplasty tended to increase significantly each year, from 8.2% of the overall arthroplasty procedures in 2008 to 52.0% in 2016 (p < 0.001). The proportion of reverse shoulder arthroplasty was shown to increase especially in patients aged 80 years or older. Conclusion Overall, our findings indicated that surgical treatment of proximal humeral fractures, particularly by open reduction and internal fixation, continues to increase; in terms of type of arthroplasty procedure, the rate of cases treated with reverse shoulder arthroplasty tended to increase.
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Affiliation(s)
- Young-Hoon Jo
- Department of Orthopaedic Surgery, Sungmin Hospital, 70 Sinseok-ro, Seo-gu, Incheon, 22789, Republic of Korea
| | - Kwang-Hyun Lee
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Bong-Gun Lee
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
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Inferior displacement of greater tuberosity fracture suggests an occult humeral neck fracture: a retrospective single-centre study. INTERNATIONAL ORTHOPAEDICS 2019; 43:1429-1434. [DOI: 10.1007/s00264-019-04294-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
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Zhang X, Huang J, Zhao L, Luo Y, Mao H, Huang Y, Chen W, Chen Q, Cheng B. Inferomedial cortical bone contact and fixation with calcar screws on the dynamic and static mechanical stability of proximal humerus fractures. J Orthop Surg Res 2019; 14:1. [PMID: 30606215 PMCID: PMC6318990 DOI: 10.1186/s13018-018-1031-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to explore the effect of retaining inferomedial cortical bone contact and fixation with calcar screws on the dynamic and static mechanical stability of proximal humerus fractures treated with a locking plate. METHODS Twelve Synbone prosthetic humeri (SYNBONE-AG, Switzerland) were used for a wedge osteotomy model at the proximal humerus, in four groups. In the cortex contact + screw fixation group and cortex contact group, the inferomedial cortical bone contact was retained. In the screw fixation group and control group, the inferomedial cortical bone contact was not retained. Calcar screw fixation was implemented only in the screw fixation groups. The dynamic and static mechanical stability of the models were tested with dynamic fatigue mechanics testing, quasi-static axial compression, three-point bending, and torsion testing. RESULTS The cortex contact + screw fixation group showed the longest fatigue life and the best stability. There was 35% difference in fatigue life between the cortex contact + screw fixation group and the cortex contact group, 43%between the cortex contact + screw fixation group and screw fixation group, and 63% between the cortex contact + screw fixation group and screw fixation group (P < 0.01). The cortex contact + screw fixation group showed the best axial compressive stiffness, bending stiffness, and torsion stiffness; these were successively decreased in the other three groups (P < 0.01). CONCLUSION Retaining inferomedial cortical bone contact and fixation with two calcar screws maintained fracture stability with the highest strength and minimum deformation. Of the two methods, restoration of the inferomedial cortical bone support showed better dynamic and static biomechanical properties than placement of calcar screws alone.
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Affiliation(s)
- Xiaofeng Zhang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Jinshan Branch, Shanghai, China
| | - Junwu Huang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Jinshan Branch, Shanghai, China.
| | - Lin Zhao
- Department of Orthopedics, Shanghai Sixth People's Hospital, Jinshan Branch, Shanghai, China
| | - Yi Luo
- Department of Orthopedics, Shanghai Sixth People's Hospital, Jinshan Branch, Shanghai, China
| | - Hanxin Mao
- Department of Orthopedics, Shanghai Sixth People's Hospital, Jinshan Branch, Shanghai, China
| | - Yanfeng Huang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Jinshan Branch, Shanghai, China
| | - Weibing Chen
- Department of Orthopedics, Shanghai Sixth People's Hospital, Jinshan Branch, Shanghai, China
| | - Qi Chen
- Department of Orthopedics, Shanghai Sixth People's Hospital, Jinshan Branch, Shanghai, China
| | - Bangjun Cheng
- Department of Orthopedics, Shanghai Sixth People's Hospital, Jinshan Branch, Shanghai, China
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