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

Overview

Journal BMC Surg

Publisher Biomed Central

Specialty General Surgery

Date 2022 Mar 18

PMID 35300664

Authors

Dong Li

WenXue Lv

Wenming Chen

Jing Meng

Song Liu

ZongKang Duan

Bo Yu

Affiliations

Soon will be listed here.

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, we 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.

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 additional steel plate (MPLP-LSP) were 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 in 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 exhibited greater structural rigidity, endured less von Mises stress, and was more stable than the models used in Group A and Group B.

Conclusion: An LSP placed at the intertubercular sulcus provides effective lateral and medial support, thereby reducing stress on the PLP and providing better stability with proximal humeral fractures.

Citing Articles

Enhancing fixation stability in proximal humerus fractures: screw orientation optimization in PHILOS plates through finite element analysis and biomechanical testing.

Liu J, Zhang Z, Li P, Piao C Sci Rep. 2024; 14(1):27064.

PMID: 39511321 PMC: 11543819. DOI: 10.1038/s41598-024-78702-x.

Increasing the angle between caudal screw and the transverse plane may aggravate the risk of femoral head necrosis by deteriorating the fixation stability in patients with femoral neck fracture.

Zhang J, Wan S, Luo X, Zhang C, Wu C, He L Eur J Med Res. 2024; 29(1):170.

PMID: 38475888 PMC: 10929213. DOI: 10.1186/s40001-024-01737-3.

Preventing varus collapse in proximal humerus fracture fixation: 90-90 dual plating versus endosteal fibular allograft strut.

Patel R, Brown J, Miles J, Dornan G, Bartolomei C, Dey Hazra R Arch Orthop Trauma Surg. 2023; 143(8):4653-4661.

PMID: 36598604 DOI: 10.1007/s00402-022-04738-1.

References

Laflamme G, Moisan P, Chapleau J, Goulet J, Leduc S, Benoit B . Novel Technical Factors Affecting Proximal Humerus Fixation Stability. J Orthop Trauma. 2020; 35(5):259-264. DOI: 10.1097/BOT.0000000000001984. View

Klug A, Gramlich Y, Wincheringer D, Schmidt-Horlohe K, Hoffmann R . Trends in surgical management of proximal humeral fractures in adults: a nationwide study of records in Germany from 2007 to 2016. Arch Orthop Trauma Surg. 2019; 139(12):1713-1721. DOI: 10.1007/s00402-019-03252-1. View

Choi S, Kang H, Bang H . Technical tips: dualplate fixation technique for comminuted proximal humerus fractures. Injury. 2014; 45(8):1280-2. DOI: 10.1016/j.injury.2014.04.029. View

Brekelmans W, Poort H, Slooff T . A new method to analyse the mechanical behaviour of skeletal parts. Acta Orthop Scand. 1972; 43(5):301-17. DOI: 10.3109/17453677208998949. View

Yang P, Zhang Y, Liu J, Xiao J, Ma L, Zhu C . Biomechanical effect of medial cortical support and medial screw support on locking plate fixation in proximal humeral fractures with a medial gap: a finite element analysis. Acta Orthop Traumatol Turc. 2015; 49(2):203-9. DOI: 10.3944/AOTT.2015.14.0204. View

Gardner M, Boraiah S, Helfet D, Lorich D . Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma. 2008; 22(3):195-200. DOI: 10.1097/BOT.0b013e31815b3922. View

Buchler P, Farron A . Benefits of an anatomical reconstruction of the humeral head during shoulder arthroplasty: a finite element analysis. Clin Biomech (Bristol). 2003; 19(1):16-23. DOI: 10.1016/j.clinbiomech.2003.09.009. View

Barlow J, Logli A, Steinmann S, Sems S, Cross W, Yuan B . Locking plate fixation of proximal humerus fractures in patients older than 60 years continues to be associated with a high complication rate. J Shoulder Elbow Surg. 2020; 29(8):1689-1694. DOI: 10.1016/j.jse.2019.11.026. View

Della Rotonda G, Guastafierro A, Viglione S, Russo F, Coscione A, Ciccarelli M . Analysis of early and late clinical and radiologic complications of proximal humeral fractures using open reduction, internal fixation, and intramedullary titanium cage augmentation. J Shoulder Elbow Surg. 2020; 29(9):1843-1851. DOI: 10.1016/j.jse.2020.01.077. View

10.

He Y, He J, Wang F, Zhou D, Wang Y, Wang B . Application of Additional Medial Plate in Treatment of Proximal Humeral Fractures With Unstable Medial Column: A Finite Element Study and Clinical Practice. Medicine (Baltimore). 2015; 94(41):e1775. PMC: 4616805. DOI: 10.1097/MD.0000000000001775. View

11.

Gardner M, Weil Y, Barker J, Kelly B, Helfet D, Lorich D . The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma. 2007; 21(3):185-91. DOI: 10.1097/BOT.0b013e3180333094. View

12.

Bell J, Leung B, Spratt K, Koval K, Weinstein J, Goodman D . Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J Bone Joint Surg Am. 2011; 93(2):121-31. PMC: 3016042. DOI: 10.2106/JBJS.I.01505. View

13.

Mease S, Kraeutler M, Gonzales-Luna D, Gregory J, Gardner M, Choo A . Current Controversies in the Treatment of Geriatric Proximal Humeral Fractures. J Bone Joint Surg Am. 2021; 103(9):829-836. DOI: 10.2106/JBJS.20.00665. View

14.

Oppeboen S, Wikeroy A, Fuglesang H, Dolatowski F, Randsborg P . Calcar screws and adequate reduction reduced the risk of fixation failure in proximal humeral fractures treated with a locking plate: 190 patients followed for a mean of 3 years. J Orthop Surg Res. 2018; 13(1):197. PMC: 6085712. DOI: 10.1186/s13018-018-0906-y. View

15.

Kim D, Kim T, Hwang J . PHILOS plate fixation with polymethyl methacrylate cement augmentation of an osteoporotic proximal humerus fracture. Clin Shoulder Elb. 2020; 23(3):156-158. PMC: 7714289. DOI: 10.5397/cise.2020.00206. View

16.

He Y, Zhang Y, Wang Y, Zhou D, Wang F . Biomechanical evaluation of a novel dualplate fixation method for proximal humeral fractures without medial support. J Orthop Surg Res. 2017; 12(1):72. PMC: 5429529. DOI: 10.1186/s13018-017-0573-4. View

17.

Ye Y, You W, Zhu W, Cui J, Chen K, Wang D . The Applications of Finite Element Analysis in Proximal Humeral Fractures. Comput Math Methods Med. 2017; 2017:4879836. PMC: 5610852. DOI: 10.1155/2017/4879836. View

18.

Zeng L, Zeng L, Jiang Y, Wei H, Zhang W, Chen Y . Influence of Medial Support Screws on the Maintenance of Fracture Reduction after Locked Plating of Proximal Humerus Fractures. Chin Med J (Engl). 2018; 131(15):1827-1833. PMC: 6071468. DOI: 10.4103/0366-6999.237396. View

19.

Kim Y, Kang S, Jung K, Oh Y . The potential of locking plate with intramedullary fibular allograft to manage proximal humeral fracture with an unstable medial column. Arch Orthop Trauma Surg. 2020; 142(1):91-97. DOI: 10.1007/s00402-020-03604-2. View

20.

Shen P, Zhu Y, Zhu L, Li X, Xu Y . Effects of medial support screws on locking plating of proximal humerus fractures in elderly patients: a retrospective study. Ann Transl Med. 2019; 7(20):560. PMC: 6861759. DOI: 10.21037/atm.2019.09.61. View