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

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Screw cut out and varus collapse are the most common complication of locked plate fixation of proximal humerus fractures. The purpose of this study was to compare dual plating and endosteal fibular allograft struts as augmentation strategies to prevent varus collapse.

Materials and methods

A trapezoidal osteotomy was created at the metaphysis to create a 2-part proximal humerus model in 18 paired shoulder specimens. Each specimen was assigned to group A, B, or C and was fixed with either a lateral locking plate, a lateral locking plate and anterior one-third tubular plate in an orthogonal 90/90 configuration, or a lateral locking plate with intramedullary fibular strut, respectively. The specimens were stressed in axial compression to failure. Displacement, elastic limit, ultimate load, and stiffness were recorded and calculated.

Results

There was no difference in mean cyclic displacement between the three groups (0.71 mm vs 0.89 mm vs 0.61 mm for Group A, B, C, respectively). Lateral plating demonstrated the greatest absolute and relative displacement at the elastic limit (5.3 mm ± 1.5 and 4.4 mm ± 1.3) without significance. The elastic limit or yield point was greatest for fibular allograft, Group C (1223 N ± 501 vs 1048 N ± 367 for Group B and 951 N ± 249 for Group A) without significance.

Conclusions

Dual plating of proximal humerus fractures in a 90–90 configuration demonstrates similar biomechanical properties as endosteal fibular strut allograft. Both strategies demonstrate superior stiffness to isolated lateral locked plating.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

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Funding

Materials from DePuy Synthes. No biases related to this study.

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Authors and Affiliations

  1. Steadman Philippon Research Institute, 181 W. Meadow Dr. Ste 1000, Vail, CO, 81657, USA

    Ravi Patel, Justin R. Brown, Jon W. Miles, Grant J. Dornan, Christopher Bartolomei, Rony-Orijit Dey Hazra, Leslie B. Vidal & Peter J. Millett

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  1. Ravi Patel
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Contributions

RP, JWM, CB, LV, and PM contributed to conceptualization; JRB, JWM, CB, LV, and PM contributed to methodology; JWM and GJD contributed to formal analysis and investigation; RP, JRB, JWM, GJD, R-ODH, and PM contributed to writing—original draft preparation; RP, JRB, JWM, GJD, R-ODH, and PM contributed to writing—review and editing; RP, JRB, JWM, CB, and PM contributed to funding acquisition; RP, JRB, CB, LV, and PM contributed to Resources; GJD, LV, and PM contributed to supervision.

Corresponding author

Correspondence to Peter J. Millett.

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Conflict of interest

Leslie Vidal MD—Outside the submitted work, she reports receiving royalties and consultant payments from Smith and Nephew. She has affiliation with and receives research support from the Steadman Philippon Research Institute a 501(c)(3) non-profit institution supported financially by private donations and corporate support from the following entities: Arthrex, Ossur, Siemens, Smith & Nephew, DOD, and DJO. Peter Millett MD—Outside the submitted work, he reports receiving royalties and consultant payments from Arthrex and owns stock in Vumedi. He receives IP royalties from MedBridge and Springer Publishing; he is a part owner of ProofPoint Biologics. He has affiliation with and receives research support from the Steadman Philippon Research Institute a 501(c)(3) non-profit institution supported financially by private donations and corporate support from the following entities: Arthrex, Ossur, Siemens, Smith & Nephew, DOD, and DJO. The remaining authors have no relevant financial or non-financial interests to disclose.

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Patel, R., Brown, J.R., Miles, J.W. et al. Preventing varus collapse in proximal humerus fracture fixation: 90–90 dual plating versus endosteal fibular allograft strut. Arch Orthop Trauma Surg 143, 4653–4661 (2023). https://doi.org/10.1007/s00402-022-04738-1

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