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Biomechanical Testing of Additive Manufactured Proximal Humerus Fracture Fixation Plates

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Abstract

Achieving satisfactory fracture fixation in osteoporotic patients with unstable proximal humerus fractures remains a major clinical challenge. Varus collapse is one of the more prominent complications that may lead to screw cutout. This aim of this study was to compare the fixation provided by conventional locking plates with novel design concepts that are only feasible through additive manufacturing (AM) techniques. In addition to reversed engineered implants, two novel implant designs with integrated struts were included in the study to provide medial support to humeral head. The medial strut was either solid or included a porous lattice structure intended to promote bone ingrowth. Biomechanical tests were performed using low density synthetic bones with simulated 3-part comminuted fractures. Nondestructive torsion and compression were performed, followed by increasing cyclic loading. The relative displacements between the bone fragments were determined using a 3D motion capture system. The AM manufactured implants with medial strut showed significant reduction of varus displacement during the increasing cyclic loading when compared to conventional designs. AM reversed-engineered locking plates showed similar mechanical behavior to conventional plates with identical geometry. This study demonstrates the feasibility and potential of employing alternative design via AM for fixation of unstable comminuted proximal humerus fractures to reduce fragment displacement.

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Acknowledgments

We would like to acknowledge Elaine Schmidt for her assistance in conducting the physical testing.

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Authors and Affiliations

  1. Department of Mechanical Engineering, Pennsylvania State University, 232 Reber Bldg, University Park, PA, 16802, USA

    Maryam Tilton & Guha P. Manogharan

  2. Department of Orthopaedics and Rehabilitation, Pennsylvania State University College of Medicine, Hershey, PA, USA

    April Armstrong & Gregory S. Lewis

  3. Biedermann Lab for Orthopaedic Research, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA

    Jennifer Sanville, Matthew Chin & Michael W. Hast

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  1. Maryam Tilton
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Correspondence to Guha P. Manogharan.

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Tilton, M., Armstrong, A., Sanville, J. et al. Biomechanical Testing of Additive Manufactured Proximal Humerus Fracture Fixation Plates. Ann Biomed Eng 48, 463–476 (2020). https://doi.org/10.1007/s10439-019-02365-3

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